The federal government will once again narrowly avoid another shutdown after the House voted 309-118, the Senate voted 79-18, and President Trump is expected to sign into law a $1.070 trillion omnibus package today to fund the government through September 30. The 1,665-page deal includes all 11 of the appropriations bills, with $518.5 billion in non-defense spending and $551 billion in defense spending, along with an additional $78.6 billion in spending from the overseas contingency operations fund for military operations. Healthcare items in the package included addressing the opioid epidemic, funding for the National Institutes of Health (NIH), an extension of coal miners’ health insurance, and additional Medicaid funding for Puerto Rico. The package does not include funding for the ACA’s cost-sharing reduction (CSR) program nor does it make any cuts to federal Planned Parenthood funding.
Many of President Trump’s budget priorities from his March proposal were not included in the package as Republicans required Democratic support to pass both chambers. The president had sought $30 billion in additional defense spending and $3 billion in additional nondefense spending, of which the omnibus includes roughly half of these requests. President Trump’s request for funding to construct a wall on the U.S.-Mexico border was denied and replaced with $1.5 billion for border security, though none of it earmarked for a border wall. Congressional Democrats also struck down the administration’s requests for supplemental funding to hire additional immigration agents, restrictions on federal funds for “sanctuary cities,” eliminating federal funds for Planned Parenthood, and nearly another 150 policy riders on items ranging from the ACA to consumer financial protections and the environment. Democrats claimed that the administration’s decision not to negotiate on the policy specifics of the package allowed them the ability to craft the deal according to their terms.
With regards to healthcare, the omnibus includes an additional $600 million in prescription opioid and heroin response funding, adding onto the $1 billion appropriation through the 21st Century Cures Act. It also adds $2 billion in additional spending to the existing $32 billion annual budget for the NIH, which partly funds former President Obama's “cancer moonshot” program, and is a sharp rebuke of the $5.8 billion cut that was proposed by President Trump in March. Additionally, the omnibus provides more than $1 billion in a long-term extension of health insurance benefits for more than 20,000 retired coal miners and widows that was due to expire today and fills a $296 million shortfall in Medicaid funding for Puerto Rico, which this week filed for bankruptcy protection after it defaulted on more than $70 billion in bond debt last year.