On Tuesday the Trump Administration issued its FY2018 budget proposal that would slash programs covering low-income adults and children, as well as programs funding medical research.

The budget would cut Medicaid funding by $610 billion over 10 years, on top of the Medicaid cuts included in the original House version of the American Health Care Act (AHCA).  While President Trump’s proposal would extend the Children’s Health Insurance Program (CHIP) by two years, through FY2019, the proposed budget eliminates increased federal matching funds to CHIP from the Affordable Care Act, thereby cutting CHIP funding by $5.8 billion.

While drastic cuts to the National Institutes of Health (NIH) were hinted at in a brief budget outline the administration released earlier this year, the actual proposed cut of $5.7 billion contained in Tuesday’s budget proposal still managed to shock those in the medical community. The Trump NIH cuts include $1 billion in reductions to the National Cancer Institute, $838 million in cuts to the National Institute of Allergy and Infectious Diseases, and $355 million in cuts to the National Institute of Diabetes & Digestive and Kidney Diseases.

“Compassion needs to be on both sides of the equation,” said Office of Management and Budget director Mick Mulvaney, explaining that the needs of people receiving benefits through government programs must be balanced against those paying taxes to fund the programs.

In an appearance on the WGBH-TV program “Greater Boston,” with the  Boston Globe’s  Dante Ramos and former State Treasurer Joe Malone, MHA President & CEO Lynn Nicholas, FACHE, noted that 25% of Massachusetts residents are eligible for Medicaid, including approximately half of the children in the state. As for the NIH cuts, Nicholas said, “We are built on research and innovation that powers part of Massachusetts and the excellence of healthcare here.” She added that Massachusetts receives the second highest total of NIH funding in the U.S. (behind California) and that Massachusetts General Hospital receives more NIH funding than any other single U.S. hospital.

Democrats slammed the budget proposal, but criticism also came from across the GOP. Presidential budgets never survive Congressional review; they are usually just a statement of the administration’s intents. Nicholas on “Greater Boston” concurred with the prevailing consensus that the president’s budget proposal was most likely dead in the water.

“This budget is like a giant, humungous tweet,” she said to chuckles from the panel, “and most of [ the president’s ] tweets have proven not to be realistic.”

The Congressional Budget Office (CBO) on May 24 issued its analysis of the Republican-drafted American Health Care Act (AHCA) H.R. 1628, which the U.S. House had passed on May 4.

The House Republican leadership had been criticized for voting on the controversial bill to repeal and replace parts of the Affordable Care Act before the CBO had issued its report. CBO in March had scored a previous version of the House bill that was subsequently redrawn. 

CBO’s scoring of the passed bill this week mirrors in many ways its March score. According to CBO and the staff of the Joint Committee on Taxation (JCT), in 2018 14 million more people would be uninsured under H.R. 1628 than under current law. That number would rise to 19 million in 2020 and 23 million in 2026. The AHCA would reduce the cumulative federal deficit over the 2017-2026 period by $119 billion, which is $32 billion less than the deficit cutting that CBO found in the March version of the bill.  CBO and JCT arrived at the $119 billion figure by combining the bill’s reduction in spending (including cutting Medicaid by $834 billion over 10 years) with reductions in revenue (including $664 in repealed taxes levied against high-income people and manufacturers).

The U.S. Senate – where criticism of the House bill has come from both sides of the aisle – is now working on its own version of health reform legislation. 

The MHA Board of Trustees voted unanimously on Thursday to advocate for the creation of supervised injection facilities (SIFs) in Massachusetts. A SIF is a facility where people can inject illicit drugs under the supervision of trained staff.  Currently, there are no legally authorized SIFs in the United States, but data from facilities located internationally illustrates strong success in mortality prevention and enhanced participation in substance use disorder treatment. The Massachusetts Medical Society voted in April to endorse pursuing the creation of SIFs in Massachusetts. MHA’s Board voted to support the MMS proposal that calls for the creation of a pilot SIF under the direction and oversight of a state-led taskforce convened by a state authority, such as DPH.

Also this week, the Massachusetts Senate adopted an amendment during its budget deliberations directing DPH to evaluate the feasibility of SIFs, as well as the public safety and health effects of such interventions. The amendment, which MHA supported, was offered by Sen. Joe Boncore (D-Winthrop).

The Massachusetts Senate wrapped up its deliberation on more than 1,000 proposed amendments to its FY2018 budget proposal  on Thursday night. The state’s budget process now moves to a conference committee where select members of the House and Senate will negotiate to bring their two budget documents into line.

As healthcare is a major component of the state’s economy, issues of interest to the hospital community appear throughout the legislature’s budgets. Among several amendments the Senate approved was an  MHA-endorsed amendment that calls on the Health Policy Commission to study and issue a report on quality and safety concerns related to the emerging health insurance industry practice of requiring the “brown-bagging” and “white-bagging” of cancer and chronic-illness-related pharmaceuticals. Sen. John Keenan (D-Quincy) was the lead champion on the amendment.

Brown bagging is when insurers require cancer and chronic disease patients to obtain certain injected or infused medications through a specialty pharmacy. In many cases, these medications are no longer covered by insurance companies unless the patient self-administers the medication; uses a visiting nurse; or brings the drug to their healthcare facility or physician’s office to be administered by a clinician. “White bagging” is where insurers require medications to be dispensed by a specialty pharmacy and delivered to a hospital, infusion center, pharmacy or physician’s office for administration to a specific patient.  In addition to patient safety concerns, both practices pose troublesome legal predicaments with the state’s prohibition on the re-dispensing of pharmaceuticals. 

Amy Rosenthal has been named executive director of Health Care for All, effective June 26. She replaces Rob Restuccia who has served as interim director since the resignation of former Executive Director Amy Whitcomb Slemmer in September 2016. Rosenthal most recently was director of external affairs and campaigns at Community Catalyst where she has worked since 2006.