By NPR
STAFF • December
18, 2019 Originally published on December 18, 2019
5:01 pm
Congress is set to pass a $1.4 trillion spending package
this week, which President Trump has said he'll sign. The legislation includes
policy changes and funding increases that public health advocates are
celebrating, as well as the permanent repeal of three key taxes that were
designed to pay for Obamacare — a win for industry groups.
Notably absent from the spending package: legislation to
address surprise billing or prescription drug prices. The House passed a prescription drug price bill last week,
but a bill that can get through the Senate may be a long way off. Surprise
billing proposals had support from both parties in both chambers of Congress as
well as in the White House. Still, such legislation have proven difficult to nail down. Lawmakers
involved say it is a priority for next year.
Our health reporting team took a look at what is in
the package and picked out notable highlights, including some surprising policy
reverses for Congress.
Repeal of health taxes designed to pay for ACA
When President Barack Obama signed
the Affordable Care Act into law in 2010, he said: "It is
paid for. It is fiscally responsible." But many of the taxes designed to
cover the cost of expanding health coverage to 20 million people have been derailed. Now, the so-called
"Cadillac tax" on generous employer health plans is getting
permanently nixed, as are taxes on health insurance companies and
medical-device makers.
Insurance industry groups applaud the move. But the
repeal of these taxes alarmed many health policy and budget watchers. It will
contribute $373 billion to the deficit, according to an estimate from Congress'
Joint Committee on Taxation.
"So we're cutting the funding out from under
Obamacare, but still doing all the spending," says Marc Goldwein, of the nonpartisan Committee
for a Responsible Federal Budget. "This whole bill is about reversing the
few hard choices that we made to pay for Obamacare."
"Everybody seems to want lower deficit in the
abstract, but when it comes time to actually cut spending or raise taxes, there
doesn't seem to be the political will in either party at the moment," he
adds. —Selena Simmons-Duffin, health policy reporter
Raising the age to buy tobacco products to 21
The measure raises the federal age limit from 18 to 21
and would apply to both cigarettes and e-cigarettes.
At least 16 states and Washington, D.C., have raised the
minimum age to buy tobacco products to 21, according to the American Lung Association. The organization,
which has long campaigned to raise the federal age limit, said the move
"will significantly reduce youth tobacco use and save thousands of
lives."
The national conversation around tobacco age limits
gained new momentum thanks to the surging numbers of teenagers who are
vaping. The Trump administration had signaled that it planned to introduce an
age limit. Some major tobacco companies have backed the idea, such as Altria,
which owns Philip Morris USA and partially owns JUUL.
Advocates against vaping are also pushing for a federal
ban on flavors for e-cigarettes, to make them less appealing to kids. Earlier
this year, Trump had pledged to impose a flavor ban but has
appeared to walk that idea back since then. It's not
clear whether further sweeping regulations of the industry are still in store.
—Merrit Kennedy, news desk reporter
A foundation for President Trump's plan to end HIV
In his state of the union address in February, President
Trump announced a plan to end the HIV epidemic
in America by 2030. This year, not a whole lot has happened toward this goal
because there hasn't been funding from Congress — until now. The president's
budget had called for $291 million, and Congress will overshoot that slightly.
This past fall, the Department of Health and Human
Services gave grants to 32 state and local health
departments where there are HIV
"hotspots" so that they could develop or update
programs to reach the goal of ending the epidemic. With this federal funding
coming through, the hope is that those places will be able to hit the ground
running.
"This is just the foundation — it's the first year
of funding," says Carl Schmid of the AIDS Institute and the
President's Advisory Council on HIV/AIDS. "It's an excellent start, but to
achieve the goal of ending the epidemic, we'll need a lot more money to scale
it up for next year and the years to come." —Selena Simmons-Duffin,
health policy reporter
Paving the way to develop more generic drugs
A bill intended to promote generic drug competition is
also expected to get a ride in the budget. The Creating and Restoring Equal
Access To Equivalent Samples Act — called the the CREATES Act, for short — aims
to make sure branded manufacturers sell samples of their products to companies
that want to use them to develop generic versions.
Brand-name companies have, at times, refused to sell samples to would-be
generic competitors, citing a Food and Drug Administration program designed to
keep potentially harmful drugs from being misused. The FDA says some brands
have exploited this program to stall development of generics, maintain their
monopolies and keep prices and profits high. With the passage of the CREATES
Act, generic companies can sue if they think they've been wrongfully denied
samples.
"It's not a panacea, but it's definitely an
important step forward in providing relief for Americans struggling with high
prescription drug costs," says Harvard Medical School instructor Ameet Sarpatwari. The bill has been
introduced five times but never managed to pass despite bipartisan sponsorship.
The Congressional Budget Office expects CREATES to save taxpayers $3.7 billion
over 10 years. —Sydney Lupkin, pharmaceuticals correspondent
First funding for gun violence research since 1996
The budget provides $25 million for research on
preventing deaths and injuries from guns, split equally between the National
Institutes of Health and the Centers for Disease Control and Prevention.
"This is a very meaningful, small step in the right
direction," says Christian Heyne, vice president of
policy at Brady, an organization focused on ending gun violence. He notes that
these are the nation's two preeminent public health agencies. The CDC has shied
away from gun violence research since 1996, when legislation known as the Dickey Amendment first prohibited
the agency from using federal funds to advocate or promote gun control. In
2018, language added to instructions
accompanying a spending bill made it clear that the CDC was allowed to conduct
research on the causes of gun violence. At that time, Congress provided no
funding.
Now, lawmakers have not only allocated money,
"they're actually naming that this money needs to be spent to research gun
violence," says Heyne. —Nell Greenfieldboyce, correspondent
Shoring up suicide prevention efforts
The budget provides SAMHSA with $19 million for the Suicide
Prevention Lifeline — this includes an increase of $7 million
over last year. The additional funding is a "significant
improvement," notes Lauren McGrath, the vice president of public policy at
Centerstone, a behavioral health care provider working in several states.
Calls to the Lifeline are answered by a patchwork of about 165 local call centers that
receive only about $1,500 to 2,000 per year of federal money. Most of the
federal funds support the Lifeline's national infrastructure. The additional
funding "will provide much needed resources to improve consumer access to
the National Suicide Lifeline," McGrath wrote in an email. The funds will
likely be used to identify areas where there are gaps in coverage and to find
ways to fill in those gaps, she adds.
Still, she notes that the service is far from fully
funded and centers struggle to keep pace with the rise in call volumes. As call
volumes have increased, so have wait times and dropped calls. "We have a
lot more work to do here," she adds.
The spending package also includes an increase of $7
million for the Zero Suicide Program, which provides a tools,
training and outreach to help health care systems adopt effective suicide
prevention approaches.
This budget doesn't address funding needs for
transitioning to the new 988 number that's in the works. That
might come in the next fiscal year, notes McGrath. —Rhitu Chatterjee, health
correspondent
Medicaid in the territories, community health clinics,
and other "extenders"
The U.S. territories had been facing a dramatic funding cliff this fall. The ACA gave
the territories 10 years of additional money for Medicaid, but that ran out in
September — causing a potential $1 billion shortfall in 2020. Guam and
the Virgin Islands warned they would need to start cutting their Medicaid
rolls, and Puerto Rico would have had to cut benefits to account for the
funding cliff.
Now, they won't have to — the spending package restores
funding to the territories' Medicaid for two years. In fact, as Politico first reported, the White House
agreed to four years of funding, but Trump objected, a source familiar with the
negotiations confirmed to NPR.
Also attached to the budget are several other health
"extenders," including funding for community health centers and
safety net hospitals. However, those only get funding until May, notes Edwin
Park, a research professor and the Georgetown Center for Children
and Families.
Park thinks the new May deadline might be designed to
help push forward legislation on other health priorities like prescription drug
prices or surprise billing.
"I hope that Congress will come back in the spring
of 2020 and will provide a longer-term extension, as opposed to again kicking
the can down the road and placing these provisions in limbo," Park says. —Selena
Simmons-Duffin, health policy reporter
Copyright 2019 NPR. To see more, visit https://www.npr.org.
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