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What's In, What's Out: Healthcare Provisions from the Bipartisan Budget Deal

By Jack O'Brien  
   February 09, 2018

Eliminated: Medicare spending ‘death panel’ and Medicaid Part D ‘donut holes’

Outside of providing two years’ worth of federal funding to health programs, the budget deal also eliminated the IPAB and the Part D “donut hole.”

IPAB was a 15-member board created through the Affordable Care Act to lower Medicare spending growth. The board, nominated by the president and confirmed by the Senate, would offer recommendations for Medicare spending restrictions if rates rose above a certain level.  

Since its inception in 2010, IPAB has been subject of ire from Republicans, most notably when former Alaska Governor Sarah Palin referred to the provision as promoting government-sponsored “death panels.”

Related: Congress Poised to Kill Medicare Board Smeared as 'Death Panel'

Another federal policy impacted by the budget deal is the Medicare “donut hole” loophole, in which individuals paid out-of-pocket costs for prescription drugs until reaching a yearly limit, at which point the costs would be covered by health plans.

The provision passed by Congress moves the deadline for when drug manufacturers take on the bulk of Part D prescription drug costs up from 2020 to 2019. The move is in contradiction to the support expressed by Alex Azar, Secretary of the Department of Health and Human Services, at his confirmation hearing last month.

Excluded: Two bipartisan Obamacare stabilization bills

Omitted from the final legislation were two bipartisan bills aiming to stabilize the federal insurance markets created under the Affordable Care Act.

Both Alexander-Murray and Nelson-Collins seek to lower premiums and keep enrollees covered for the remainder of the year.

The Collins-Nelson proposal focuses on instituting a federal reinsurance program, while Alexander-Murray would the restore cost-sharing reduction (CSR) payments discontinued by the Trump administration in September.

Neither has received a floor vote, and they were not included in the omnibus deal, despite McConnell’s promise to Sen. Susan Collins, R-Maine, that the upper chamber would take up the measure in 2018.

Jack O'Brien is an associate editor at HealthLeaders. 

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