The Biggest Health-Care Winners in the Omnibus Deal

The $1.1 tril­lion spend­ing bill and tax ex­tenders pack­age un­veiled Tues­day and early Wed­nes­day morn­ing is the fi­nale to weeks of lob­by­ing and spec­u­la­tion on a host of is­sues—par­tic­u­larly health care. There are some big win­ners in the year-end bills, in­clud­ing 9/11 first re­spon­ders and sur­viv­ors, Ca­dillac tax op­pon­ents and pos­sibly Sen. Marco Ru­bio. Here’s a closer look:

Za­d­roga Act

The om­ni­bus funds the pro­gram provid­ing health be­ne­fits for 9/11 first re­spon­ders and sur­viv­ors sickened by tox­ic air at the at­tack site through 2090. Also, it reau­thor­izes the Vic­tim Com­pens­a­tion Fund for five years.

Re­new­ing the le­gis­la­tion, known as the Za­d­roga Act, was the cen­ter of a massive lob­by­ing ef­fort in­volving, for one group, at least 22 trips to Wash­ing­ton (with crews of any­where from 12 to 50 people) and an es­tim­ated 600 meet­ings for John Feal, pres­id­ent and founder of the 9/11 ad­vo­cacy group Feal­Good Found­a­tion. It’d been the sub­ject of ral­lies, press con­fer­ences and a seg­ment on The Daily Show, fea­tur­ing a power­ful ad­voc­ate for the bill, Jon Stew­art.

“We’ve met with some mem­bers of the Sen­ate and Con­gress four, five, six times,” Feal told Na­tion­al Journ­al after a press con­fer­ence last week. “Every time we got close, they move the goal­post back on us. Every time we got to the one-yard line, they just kept mov­ing it back, and this time they can’t go nowhere. We’re con­fid­ent we’re go­ing to get it done.” Feal was right.

Obama­care taxes

Re­peal­ing the Ca­dillac tax levied on pricey em­ploy­er-sponsored health cov­er­age has net­ted bi­par­tis­an and bicam­er­al sup­port—and law­makers look­ing to in­clude a two-year delay of the Ca­dillac tax in an om­ni­bus bill got their wish.

Ori­gin­ally slated to start in 2018, the Ca­dillac tax has seen both Demo­crats and Re­pub­lic­ans op­pose the meas­ure. For ex­ample, an amend­ment to re­peal the tax eas­ily passed the Sen­ate in 90 to 10 vote earli­er this month (though it was tacked onto a re­con­cili­ation bill, which Obama won’t sign). But as re­cently as last Wed­nes­day, White House Press Sec­ret­ary Josh Earn­est said the ad­min­is­tra­tion strongly op­poses re­peal­ing the Ca­dillac tax.

Sen. Mark Warner’s wor­ries on the Ca­dillac tax fo­cus on mak­ing sure the fin­an­cing re­mains to sup­port the pricey parts of the law, such as Medi­caid ex­pan­sion. “In a state like mine where we haven’t ex­pan­ded Medi­caid … you give a lot of fod­der if you start tak­ing away the pay-fors,” the Vir­gin­ia Demo­crat told Na­tion­al Journ­alearli­er this month.

Ad­di­tion­ally, the tax ex­tenders deal in­cludes a two year morator­i­um on the med­ic­al device tax, and the om­ni­bus con­tains a one-year morator­i­um on the an­nu­al ex­cise tax on health in­surers for 2017.

Risk cor­ridors 

The risk cor­ridor pro­gram will again be han­di­capped if the om­ni­bus passes and is signed in­to law as stands, as pro­vi­sion stuck in last year’s bill was again in­cluded.

Risk cor­ridors com­pensate in­sur­ance com­pan­ies that sign up sick­er pa­tients than they an­ti­cip­ated and, in turn, are faced with hefty costs. In part, this is be­cause the Af­ford­able Care Act con­tains pri­cing re­stric­tions—such as ban­ning in­surers from char­ging more based on a con­sumer’s med­ic­al his­tory. So, some com­pan­ies are re­quired to pay in­to the risk cor­ridors pro­gram, and oth­ers can col­lect.

Re­pub­lic­ans view this as a bail­out for in­sur­ance com­pan­ies. Last year’s crom­ni­bus con­tained re­stric­tions for the pro­gram, which is slated to last un­til 2016. And in Oc­to­ber, the Cen­ters for Medi­care and Medi­caid Ser­vices an­nounced it would be dol­ing out only a frac­tion of what in­sur­ance com­pan­ies asked for: $362 mil­lion of the $2.87 bil­lion in in­sur­ance claims.

Sen. Marco Ru­bio’s cam­paign is tout­ing last year’s risk cor­ridors re­stric­tions as a Ru­bio vic­tory. A tweet last week from Ru­bio’s ac­count said, “Every­one run­ning wants to dis­mantle Obama­care. I’ve ac­tu­ally done something to­ward achiev­ing that goal,” link­ing to a post on his site with aNew York Times story titled, “Marco Ru­bio Quietly Un­der­mines Af­ford­able Care Act.”

But an As­so­ci­ated Press story has a dif­fer­ent take. It looks at last year’s crom­ni­bus ne­go­ti­ations, say­ing that al­though Ru­bio was one of the first law­makers to rail against risk cor­ridors, he wasn’t solely or ne­ces­sar­ily the one re­spons­ible for last year’s deal.

A sum­mary of the om­ni­bus bill praises last year’s bill for be­ing “able to save over $2.5 bil­lion from po­ten­tially be­ing trans­ferred out of pri­or­ity dis­cre­tion­ary HHS pro­grams fund­ing in the Labor/HHS ap­pro­pri­ations bill to bail­out the Risk Cor­ridor pro­gram es­tab­lished by the Af­ford­able Care Act (ACA).”

Na­tion­al In­sti­tutes of Health

The na­tion’s med­ic­al re­search agency could see the largest boost in fund­ing since fisc­al 2003 with the in­clu­sion of a $2 bil­lion in­crease in funds.

While fund­ing NIH isn’t gen­er­ally con­ten­tious, how much the agency re­ceives comes down to Con­gress’ pri­or­it­ies. Over the course of five years, Con­gress doubled NIH’s fund­ing to $27.1 bil­lion in Fisc­al Year 2003, ac­cord­ing to the Con­gres­sion­al Re­search Ser­vice. But fund­ing hasn’t in­creased at the same pace since, and some Demo­crats and Re­pub­lic­ans alike had called for that to change, a call that was answered in the om­ni­bus bill with NIH slated to re­ceive $32 bil­lion.