Congress and health care: In like a lion, out like a lamb?

Congress passed bipartisan legislation to fund the Department of Health and Human Services (HHS) for a full fiscal year, the first time in over 20 years that a full year of funding became law.


The 115th Congress recessed in early October, having wrapped up most of its work on health care for the year. While it will return in December for a brief postelection (lame-duck) session to address a few remaining issues, big changes in health care policy are not expected to be among them. (There has been some talk among conservatives about Congress again taking up ACA repeal in the lame-duck session, especially if Democrats win control of one or both chambers in the November election, but the political obstacles and limited number of working days left make this unlikely—yet can't be ruled out entirely.)

This anticipated no-drama finish for health care policy is largely because before recessing, Congress passed bipartisan legislation, signed into law by President Trump on Sept. 29, to fund the Department of Health and Human Services (HHS) for a full fiscal year, from Oct. 1, 2018, through Sept. 30, 2019. This was the first time in over 20 years that a full year of funding for the Labor-HHS-Education appropriations bill became law before the Oct. 1 start of the federal fiscal year. The president also signed into law a separate bill to ensure a full year of funding for the Veterans Health Administration. These were a welcome departure from the usual practice of Congress waiting until the last minute to pass a short-term extension to keep the government agencies funded past Sept. 30; in some years, Congress even allowed a temporary shutdown to take place before appropriating the needed money.

To be clear, the spending agreement doesn't ensure year-long funding for all federal agencies, many of which are operating under a short-term funding extension until Dec. 7, requiring that this Congress and the President act in the lame-duck session to agree on a plan to keep them open. There could be plenty of end-of-the-year drama yet on federal spending, but health care programs that fall under the HHS are thankfully excluded.

As recommended by ACP, the HHS spending agreement sustains, and in some cases increases, funding for essential federal health care workforce programs and medical research. The National Health Service Corps, which provides scholarships and loan repayment to health care professionals to help expand the country's primary care workforce, will continue to be funded at current levels, with dedicated dollars for substance use disorder treatment that will not come at the expense of reducing funding for scholarships and loan repayment.

The Title VII Health Professions program, which supports the training and education of clinicians to enhance the supply, diversity, and distribution of the health care workforce, will be funded on par with current levels. Title VII is the only source of federal training dollars specifically targeted to general internal medicine, general pediatrics, and family medicine. The budget agreement also provides increased funding for Community Health Centers, the National Institutes of Health, and the Agency for Healthcare Research and Quality.

Prior to the recess, Congress also enacted and President Trump signed into law comprehensive legislation to address the opioid epidemic. This legislation includes provisions to expand alternatives to opioid treatment, lift barriers to medication-assisted treatment using buprenorphine and naloxone, improve the interoperability of state-run prescription drug monitoring programs, and authorize grants to provide additional education and training for the health care workforce to improve treatment for opioid and substance use disorders—policies also recommended by ACP.

That this Congress is likely to end its two-year session with a no-drama agreement on health care spending and opioids is especially surprising, given that it generated more than enough drama last year over in its (mostly) unsuccessful efforts to roll back coverage and patient protections. Remember that this is the same Congress that tried repeatedly to repeal and replace the Affordable Care Act, gut the ACA's preexisting condition protections and coverage requirements, cap the federal contribution to Medicaid, and defund Planned Parenthood clinics—and, in each case, fell short of the votes needed. ACP helped lead the advocacy efforts to stop these bad policies from becoming law.

The 115th Congress came in like a lion on health care, promising yet failing to repeal or defund programs that benefit patients, and now appears ready to go out more like a lamb, enacting bipartisan agreements to fund essential health programs and a response to the opioid epidemic. This would be very good news indeed for patients and their physicians, and for ACP advocacy on their behalf. Unless, that is, Congress makes another ill-advised run at repealing the ACA in the lame-duck session, adding unnecessary drama–and danger–to the millions of patients who benefit from the ACA.