Last Friday, President Trump signed a massive $1.3 trillion federal spending bill—the Omnibus Consolidated Appropriations Act of 2018. It is loaded with new spending for health care programs that were supported by the California Medical Association (CMA). Unfortunately, it did not include two bills that CMA was strongly promoting – the Affordable Care Act (ACA) market stabilization bill and a permanent solution for the nearly 700,000 Deferred Action for Childhood Arrivals program recipients.

A brief summary of the federal spending bill is below.

Bipartisan ACA Market Stabilization: CMA, the American Medical Association (AMA) and other physician groups strongly advocated to include the bipartisan ACA market stabilization bill in the omnibus spending package. Unfortunately, lawmakers could not reach a compromise. It would have funded for two-years the cost-sharing assistance that helps low-income families afford copayments and deductibles that President Trump eliminated in 2017. It would have also provided state waiver flexibility and reinsurance funding to cover high-cost, catastrophic cases. The Congressional Budget Office estimated that the bill would have reduced premiums by 20 percent in 2020. A compromise could not be reached because the Freedom Caucus insisted on placing abortion restrictions on the ACA plans in exchange for the two-year ACA stabilization bill.

Opioids: The bill includes nearly $4 billion in new funding for prevention, treatment and law enforcement to address the opioid crisis. With the $6 billion in the Budget Act enacted by Congress in February, new 2018-2019 opioid funding totals $10 billion. The breakdown is as follows:

• $500 million for National Institutes of Health research on opioid addiction, development of opioid alternatives, pain management and addiction treatment.


• $27 million for Mental and Behavioral Health Education Training to recruit and train professionals in psychiatry, psychology, social work, marriage and family therapy, substance abuse prevention and treatment, and other areas.


• $105 million for the National Health Service Corps to expand access to opioid and substance use disorder treatment in rural and underserved areas.


• $100 million for a new Rural Communities Opioids Response Program to support prevention and treatment of substance use disorder in 220 counties and other rural communities identified by the Centers for Disease Control and Prevention (CDC) as being at high risk.


• $350 million (for a total of $475 million) to support CDC’s Opioid Prescription Drug Overdose Prevention activities. $10 million must be used to conduct a nationwide opioid education campaign to increase understanding of the epidemic and to increase prevention activities. Also requires CDC to promote the use of prescription drug monitoring programs (PDMP) and expand efforts to enhance the utility of state PDMPs to make them more interconnected, in real-time, and usable for public health surveillance and clinical decision making. CMA aggressively advocated for this provision to ensure that the federal government work with electronic health record (EHR) vendors to link EHRs to state PDMPs.


• $1 billion in new funding for State Opioid Response Grants


• $94 million for law enforcement and grants to combat opioid, heroin and other drug trafficking.


• $94 million to strengthen Food and Drug Administration (FDA) presence at international mail facilities and to fund equipment and technology to increase FDA capacity to inspect more incoming packages to detect illicit fentanyl.

Gun Violence: The bill included $2.3 billion in funding associated with the STOP School Violence Act of 2018 to cover mental health services, security training and school safety programs to prevent gun violence. It also fully funds the FBI National Instant Criminal Background Check System. While CDC research promoting gun control is still prohibited, the Omnibus spending bill included a general clarification that there are no restrictions on general research related to gun violence. However, there was no funding appropriated for such research. Finally, it increased funding for the National Violent Death Reporting System to all 50 states to assist researchers and lawmakers.

CMA continues to support California Senator Dianne Feinstein’s legislation that would ban assault weapons and high-capacity magazines, as well as efforts to require more extensive background checks and waiting periods.

Mental Health Programs: Provides more than $2.3 billion in new funding for various mental health programs.

Drug-Related Provisions: Physicians will continue to receive enhanced payments for the first few years a drug/biological is on the market to assist in the costs of adopting new drugs and technology.

Graduate Medical Education: The Children’s Hospitals graduate medical education program received a $15 million funding increase, for a total of $315 million. Congress also provided an additional $15 million for the Rural Residency Program to expand the number of rural residency training programs with a focus on developing programs that can be self-sustainable.

Other Notable Health Care Spending Increases: The National Institutes of Health received significant increase in funding to support research into Alzheimer’s disease, the Brain Initiative, the universal flu vaccine and antibiotic-resistance efforts. The CDC also received additional funding for diabetes programs.