House and Senate Pass Cromnibus Spending Bill

Thursday, January 1, 2015

Before adjourning for the year, the House and the Senate passed H.R. 83, referred to as the Cromnibus (i.e., combined continuing resolution and omnibus appropriations bill).

In general, H.R. 83 would extend fiscal year (FY) 2015 federal funding until September 30, 2015 for all federal agencies with the exception of the Department of Homeland Security (DHS). The funding for DHS extends only through February 27, giving the Republican House and Senate the leverage they seek to defund or scale-back the President's executive actions that allow certain undocumented immigrants to remain in the United States and become eligible for various benefits, such as Social Security and Medicare.

The omnibus spending bill provides for the following:

$5.4 billion of the $6.2 billion requested by the president for Ebola response and preparedness;
$30.1 billion for the National Institutes of Health (NIH), a $150 million increase;
$3.7 billion for program management at the Centers for Medicare and Medicaid Services (CMS);
$6.9 billion for the Centers for Disease Control and Prevention (CDC), a $21 million increase;
A directive that the National Institute of Allergy and Infectious Diseases (NIAID), the Biomedical Advanced Research and Development Authority (BARDA) and the CDC hold a workshop within 180 days to develop a comprehensive plan with a timeline and measurable objectives to help develop antibiotics for resistant bacteria;
A directive that CMS educate providers on how to reduce the backlog of appeals of decisions by Medicare Recovery Audit Contractors (RACs).

The legislation also includes the following provisions related to the Patient Protection and Affordable Care Act (PPACA):

A provision to prohibit CMS from providing new funding to subsidize potential revenue losses by health insurers under the law's risk corridor provision (however, payments to CMS from insurers whose revenues are higher than expected could still be used to pay for insurer losses);
A cut of $350 million in the Internal Revenue Service (IRS) budget intended to impede the agency's activities related to the law;
A provision prohibiting funds from the law's Prevention and Public Health Fund to be used for other PPACA activities;
A provision to decrease funding of the Independent Payment Advisory Board (IPAB) by $10 million;
A directive that CMS report on the cost of PPACA administrative and information technology services, benefit reviews, and enrollment and market reviews;
A directive that the U.S. Department of Health and Human Services (HHS) increase the transparency of abortion coverage within federal exchange health-care plans and language directing HHS to quickly respond to claims filed by health-care providers on conscience-clause violations; and
An exemption for expatriate health care plans from the PPACA coverage requirements.

These provisions trimming PPACA-related activities are the first steps taken by Republicans who are expected to increase efforts in 2015 to repeal major portions of the law, including the individual mandate and related tax credits, Medicaid expansion, and the employer mandate threshold of 30 hours.