The budget bill that Congress passed and President Trump signed March 23 as the clock ran down on federal funding supports important primary care initiatives, but leaves one important patient need unsettled.
The Consolidated Appropriations Act "moves in the right direction on addressing violence involving a gun and the opioid misuse crisis," AAFP President Michael Munger, M.D., of Overland Park, Kan., said in a statement issued the same day.
The new legislation clarified that the CDC has authority to conduct research on gun violence without running afoul of the 1996 Dickey Amendment that prohibits use of federal funds to promote gun control, although no new funding was provided.
"There is no single answer for preventing violence involving a gun, and we need better information about its causes and treatments," Munger said. "The (legislation) will enable the CDC to approach this from a public health standpoint and study all the facets of inappropriate gun use -- including mental health and law enforcement -- and develop recommendations that can improve the safety of all Americans."
The legislation includes $4.6 billion to combat opioid abuse, representing a $3 billion increase over the 2017 level. Funding will be distributed to several agencies devoted to prevention, treatment and enforcement.
"We must prevent addiction, treat those already suffering from opioid misuse disorder, understand the causes of the problem and develop alternative pain management options," Munger said. "This legislation does that by increasing funding for opioid misuse prevention and treatment, as well as for research into the causes of opioid addiction and nonpharmacological management of chronic pain."
The AAFP also applauded a provision of the budget that preserves the independence of the Agency for Healthcare Research and Quality and increases its funding by $10 million. The agency is a crucial source of support for primary care initiatives through evidence-based research that helps reduce morbidity and mortality. The AAFP and others have advised Congress not to eliminate the agency, and not to reduce its budget or authority by placing it under another institution.
Importantly, however, Munger noted the AAFP's disappointment that the budget failed to provide premium reductions and cost-sharing reductions that could alleviate high health care expenses for millions of individuals. The AAFP and other organizations have directed Congress to analyses by Avalere Health(avalere.com) and Oliver Wyman Health(health.oliverwyman.com) that indicate such measures could reduce premiums by 27 percent in 2019 and increase the number of Americans with health insurance by 1.7 million.
"Despite its overall funding increases for health programs, the legislation fails to address the health security of Americans by funding cost-sharing reductions or reinsurance provisions that would reduce insurance premiums," Munger said. "Without these provisions, the cost of insurance premiums and out-of-pocket expenses will climb sharply."
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