Health Surprises In The Budget: Nixing Taxes, Raising Tobacco Age, Gun Research : Shots - Health News The bill includes some policy surprises and increases in funding for several key public health priorities. And it cuts the few remaining taxes that were paying for Obamacare.
NPR logo

Some Big Health Care Policy Changes Are Hiding In The Federal Spending Package

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
Some Big Health Care Policy Changes Are Hiding In The Federal Spending Package

Some Big Health Care Policy Changes Are Hiding In The Federal Spending Package

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


President Trump has signed the $1.4 trillion spending package that Congress passed last week. We're going to take a look now at some of the measures in the bill that are related to health.


This Congress came to power in part due to promises to protect consumers from high health care costs. Here to tell us whether Congress made good on those promises are NPR health policy reporter Selena Simmons-Duffin and science correspondent Nell Greenfieldboyce.

Welcome to you both.



SHAPIRO: Selena, one significant piece of this package is the elimination of three taxes related to health care. Explain what's happening here.

SIMMONS-DUFFIN: So when President Obama signed the Affordable Care Act into law in 2010, he said it is paid for. It is fiscally responsible.

SHAPIRO: Paid for by taxes.

SIMMONS-DUFFIN: Yes. But many of those taxes designed to cover the costs of things, like expanding coverage to 20 million people, have been derailed. And this package permanently repeals the so-called Cadillac tax on generous employer health plans and taxes on health insurance companies and medical device makers, so industry groups are very pleased by this. I don't know...

SHAPIRO: But it's going to add to the debt.

SIMMONS-DUFFIN: Exactly. So this spending package is said to cost around half a trillion dollars. Nearly 400 billion of those dollars are because of the elimination of these taxes. So it's a really significant thing that adds to the deficit. And it means that we're still spending money on all of the things that Obamacare created, but we're not paying for those things.

SHAPIRO: Nell, what about public health elements of this package? What's in it?

GREENFIELDBOYCE: Well, one thing that public health experts like is that it raises the federal age limit - the minimum age - for buying tobacco products from 18 to 21, which is something that's already been done by at least 16 states and Washington, D.C. And the American Lung Association really supports this. It says it's going to reduce tobacco use by younger people and save thousands of lives. And I think that one reason this got momentum is because of the surging numbers of teenagers who are vaping. So the Trump administration signaled that it was going to raise the age limit for buying tobacco products. And some big tobacco companies, you know, accepted the idea and endorsed it.

SHAPIRO: Interestingly, this bill also has some provisions to do research into gun violence, which has been controversial in Congress before.

GREENFIELDBOYCE: That's right, yes. So for about a couple decades now, there's been a thing called the Dickey Amendment, which prohibited public health agencies, like the Centers for Disease Control and Prevention, for doing anything that might advocate or promote gun control. And so that had a sort of chilling effect on doing certain kinds of gun violence prevention research. This bill puts $25 million split between the CDC and the National Institutes of Health to do that research.


GREENFIELDBOYCE: And people say that's significant because, you know, last year in a bill, Congress put some language saying, oh, CDC, you can do this kind of research. But now it's actually allocated the money and specifically said, you know, we want you to research ways to prevent gun violence and injuries.

SHAPIRO: That seems like a real shift. Selena, give us some highlights about what's in here besides the repealed taxes on the health care front.

SIMMONS-DUFFIN: So the so-called CREATES Act went through as part of this package. It's been kicking around Congress for a long time. It aims to make sure that drugmakers of brand-name drugs sell samples to companies that want to make generic versions. Also, funding for Medicaid in the U.S. territories, like Puerto Rico and Guam, came through in this bill, and that was significant. They were facing a really dramatic shortfall, so this is good news for them. And the Trump administration's plan to end the HIV epidemic also got 300 million for its first year.

SHAPIRO: You're not talking about prescription drug prices or surprise billing, both of which were supposed to have bipartisan support. They didn't make the cut.

SIMMONS-DUFFIN: No. The House did pass a prescription drug bill last week, but it is not clear when there might be a compromise between the two chambers and the two parties to actually get something on drug prices through Congress. But even more disappointing for people hoping for health consumer-type reforms is that surprise billing didn't make the cut either. This is something that consumers are really outraged about, and there is a lot of bipartisan agreement. But it turns out the details of that fix for the problem is - are actually quite tricky. And there's been a huge amount of lobbying - 340 groups and 1,200 lobbyists have been working on this issue.

SHAPIRO: So not totally off the table but not in this package.


SHAPIRO: NPR's Selena Simmons-Duffin and Nell Greenfieldboyce, thank you both.



Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.