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$1.1 trillion spending bill and what it means for healthcare in 2014

By Katie Ni
Education & Outreach Coordinator, AMSA Health Policy Team

Last Thursday, the Senate voted to pass the $1.1 trillion spending bill that will fund the government through this September. The bill passed easily in both the Senate and the House-- perhaps with the memory of government shutdown still fresh in representatives’ minds. Here is the short and sweet version of what this year’s budget has in store for health policy:

1. Funding for the Affordable Care Act will be cut. The ACA will see cut funding in two places: $1 billion will be cut from Prevention and Public Health Fund, and $10 million will be cut from the Independent Payment Advisory Board (IPAB), the panel given the task of making changes to Medicare payment and program rules. IPAB was made to achieve savings for Medicare, but has been denounced by its critics as a “death panel” that will reduce access to care. A cut of $10 million from the IPAB’s former budget of $15 million may limit the board’s capabilities significantly.

2. The NIH will recover funding lost from sequestration, BUT overall will see a decrease in funding. The NIH will receive $29.9 billion for 2014, which is $1 billion more than its post-sequestration value, but $714 million less than its original 2013 budget. While the research giant will at least be able to recover funds lost from sequestration, it is discouraging to see the government’s deemphasizing of biomedical research, which works on new vaccines and treatments, curing diseases like cancer and diabetes, and other projects that could profoundly improve human health.

3. Funding for the FDA and CDC have increased. The FDA will receive $2.6 billion in 2014, a near-$100 million increase from its 2013 budget. The CDC will receive $6.9 billion, $369 million more than its 2013 budget. The FDA regulates food, medication, and other consumer products, while the CDC has an important role in monitoring and preventing diseases. Both will impact the health of a huge number of people based on their ability to carry out these tasks, and hopefully the extra funding will be used efficiently to help these important agencies function in the coming year.

4. Federal funding is banned from being used for most abortions. The bill also bans foreign aid from being used toward abortions, and funds abstinence-only education in schools. Always a controversial topic, it would appear that the pro-lifers have made several gains through this spending bill. Some health plans available under the ACA could continue to cover elective abortion, but in general, this measure will make it more difficult for women to choose an abortion (for reasons other than rape, incest, or medical emergency), especially for women on subsidized health plans.

For current and future physicians, the cut ACA funding will be the aspect of the spending bill that has the greatest impact. On paper, the spending decrease on the ACA represents a compromise made between the Republican and Democratic parties; however, in practice, the cut programs—reworking Medicare costs and implementing preventative health programs— are projects that have potential to decrease health expenditures in the future. Choosing to cut them now may translate to a net loss down the road. While it is encouraging to hear that Congress has finally successfully compromised on a budget and avoided a second government shutdown-level crisis, the spending bill represents a mixed bag in terms of health policy.

Additional information/sources:

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