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Three Key Health Issues Congress Could Consider in 2018 Budget Deal

Budget bill considerations by Congress
  • After a tumultuous year in health policy, the February 8 vote is a small window for bipartisanship on health care

  • Congress should consider adding to its budget deal funding for community health centers, prescription drug price reform, and the CHRONIC Act for chronically ill patients

The government shutdown last month revealed how partisan gridlock is making it very difficult for lawmakers to maintain vital public services. Even programs that have enjoyed decades of bipartisan support, such as the Children’s Health Insurance Program (CHIP), have been caught in the wrangling. The continuing resolution that extended government funding until February 8 did, fortunately, reauthorize CHIP for six years. Congress could have opted to extend CHIP for 10 years, which would have reduced the deficit by $6 billion, according to the Congressional Budget Office (CBO). And it could still find a way to extend the program for four more years to see additional savings.

Building on that precedent, Congress could consider at least three other major health provisions with strong bipartisan appeal for inclusion in its hoped-for February 8 action to keep the government open.

1. Funding for community health centers still hangs in the balance.

Across the United States, more than 10,000 community health centers (CHCs) provide primary care to one of 13 Americans. CHCs have long enjoyed support on both sides of the political aisle because they give people access to critical medical services, regardless of their ability to pay. CHCs play a vital role in the health care safety net; in particular, when it comes to public health crises like the opioid epidemic, they are on the front lines.

If Congress does not quickly reauthorize the program, for which funding expired on Sept. 30, CHCs would lose billions of dollars and a quarter of sites could close. The damage would be considerable: 51,000 workers would be laid off and 9 million people (more than one-third of all CHC patients) would lose access to services. Moreover, many children who receive health care through CHIP do so at CHCs — so shutting them down will detract significantly from CHIP’s ability to serve American children.

2. The CHRONIC Care Act would improve care for chronically ill Americans.

Another potential area for bipartisan cooperation is reforming the way health care is delivered for the nation’s sickest, most complex, and costly patients. Treating those with multiple chronic conditions and major frailty often costs many times more than treating healthier patients. The Senate unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act last fall to improve health outcomes for these patients.

Most importantly, the Act would break down the barrier between medical and nonmedical support services for sick and frail seniors. Currently, Medicare does not cover long-term supports and services, like home modifications, home health aides, and transportation, that can help keep people stable and living in the community. Home-based care is only accessible to Medicare patients for a short time, and after they have been hospitalized for three days.

The act also would transform Medicare Advantage, which covers more than a third of Medicare patients. Specifically, it would make Medicare Advantage plans more flexible, make home-based specialized care more easily available, and expand telehealth services.

3. The CREATES Act would make lower-priced generic drugs available.

Both Republicans and Democrats agree that controlling the prices of prescription drugs is an urgent priority. The CREATES Act tackles one of several factors driving high drug prices: drug manufacturers’ use of anticompetitive tactics to slow the development of generic drugs that could compete with brand-name products and drive down prices.

As former Congressman Henry Waxman and his team describe in their recent report, Getting to the Root of High Prescription Drug Prices, brand-name manufacturers are misusing a congressionally mandated requirement to monitor the safety of their drugs as an excuse not to share samples with generic manufacturers. This prevents generic manufacturers from proving, as required by law, that their cheaper alternative is biologically equivalent to the branded product.

The CREATES Act would enable generic manufacturers facing these delays to take action in federal court to obtain the samples they need, or to enter into court-supervised negotiations with brand-name manufacturers. The Act also would save money for the federal government — more than $3 billion over 10 years, according to Congressional Budget Office estimates (although the bill does not have an official score yet).

After a tumultuous year in health policy, the time before the February 8 vote is a small window for bipartisanship on some of the key issues ailing our health system. While far from a comprehensive list, keeping community health centers open, improving care for sick and frail elders, and lowering prescription drug prices are pressing issues on which Democrats and Republicans might be able to find common ground.

Publication Details



David Blumenthal, Former President, The Commonwealth Fund

[email protected]


D. Blumenthal and S. Seervai, “Three Key Health Issues Congress Could Consider in 2018 Budget Deal,” To the Point, The Commonwealth Fund, Feb. 2, 2018.