In a rare show of bipartisanship for the mostly polarized 115th Congress, Republican and Democratic Senate leaders announced a two-year budget deal that would increase federal spending for defense as well as key domestic priorities, including many health programs.
Not in the deal, for which the path to the president's desk remains unclear, is any bipartisan legislation aimed at shoring up the Affordable Care Act's individual health insurance marketplaces. Senate Majority Leader Mitch McConnell (R-Ky.) promised Sen. Susan Collins (R-Maine) a vote on health legislation in exchange for her vote for the GOP tax bill in December. So far, that vote has not materialized.
The deal, which also faces an uncertain fate in the House, does appear to include almost every other health priority Democrats have been pushing the past several months, including two years of renewed funding for community health centers and a series of other health programsCongress failed to provide for before they technically expired last year.
"We have reached a budget deal that neither side loves but both sides can be proud of," said Senate Minority Leader Chuck Schumer (D-N.Y.) on the Senate floor. "That's governing."
Said McConnell, "This bill represents a significant bipartisan step forward."
Senate leaders are still negotiating last details of the accord, including the size of a cut to the ACA's Prevention and Public Health Fund, which would help offset the costs of this legislation.
In the Medicare program, the deal would accelerate the closing of the "doughnut hole" in Medicare drug coverage that requires seniors to pay thousands of dollars out-of-pocket before catastrophic coverage kicks in. It would also repeal the controversial Medicare Independent Payment Advisory Board (IPAB), which is charged with holding down Medicare spending for the federal government if it exceeds a certain level. Members have never been appointed to the board, however, and its use has not so far been triggered by Medicare spending. Both the closure of the doughnut hole and creation of the IPAB were part of the ACA.
The agreement would also fund a host of more limited health programs — some of which are known as "extenders" because they often ride along with other, larger health or spending bills.
And in a victory for the physical therapy industry and patient advocates, the accord would permanently repeal a limit on Medicare's coverage of physical therapy, speech-language pathology and outpatient treatment. Previously, the program capped coverage after $2,010 worth of occupational therapy and another $2,010 for speech-language therapy and physical therapy combined. But Congress had long taken action to delay those caps or provide exemptions — meaning they had never actually taken effect.
According to an analysis by the nonpartisan Congressional Budget Office, permanently repealing the caps would cost about $6.47 billion over the next decade.
Lawmakers would also forestall cuts mandated by the ACA to reduce the payments made to so-called Disproportionate Share Hospitals, which serve high rates of low-income patients. Those cuts have been delayed continuously since the law's 2010 passage.
Limited programs are also affected. The deal would fund for five years the Maternal, Infant and Early Childhood Home Visiting Program, a program that helps guide low-income, at-risk mothers in parenting. It served about 160,000 families in fiscal year 2016.