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US Congress extends CHIP, funds opioid crisis response following temporary shutdown

Publish date: February 9, 2018


Gregory Twachtman 

Oncology Practice










Congress, despite a second shutdown in less than a month, was able to pass a number of financial extenders to fund key health care programs.

The bipartisan spending bill (H.R. 1892), passed in the early morning hours on Feb. 9 by a 71-28 vote in the Senate (16 Republicans and 12 Democrats voted against it, and Sen. John McCain [R-Ariz.] was not present) and a 240-186 vote in the House (67 Republicans and 119 Democrats voted against and 5 representatives did not vote). President Trump signed the bill later that morning.


The spending bill and continuing resolution to fund the government through March 23 includes $6 billion to fund treatment for opioid addiction and other mental health issues, $2 billion in additional funding for the National Institutes of Health, and 4 additional years of funding for the Children’s Health Insurance Program. The additional CHIP funding extends the program for a total of 10 years.

The funding bill also made a technical correction to the Merit-based Incentive Payment System (MIPS) track of the Medicare Quality Payment Program. It removes Part B drug reimbursement from the MIPS payment adjustment, so any positive or negative change to physician payments based on the MIPS score will only be applied to physician fee schedule payments.

The bill also repeals the Independent Payment Advisory Board, a panel created by the Affordable Care Act that would have the power to slash Medicare spending under certain budget circumstances. That board was never convened.

The funding legislation also accelerates closure of the Medicare Part D “donut hole,” the coverage gap in which beneficiaries must pay 100% of medication costs prior to entering catastrophic coverage.

Just over $7 billion was provided for community health centers and Medicare’s therapy caps were repealed.

While the funding bill was written in the Senate with bipartisan input and received bipartisan support, Sen. Rand Paul (R-Ky.) held up votes over objections to the more than $1 trillion it will add to the nation’s debt, as well as for the fact that there was no opportunity to introduce and vote on amendments, leading to an hours-long government shutdown.

There also were concerns about two issues that could have derailed the vote in the House. Democrats wanted to add language to address immigrants brought to this nation illegally as children, while some Republicans did not want to increase the federal debt. However, there were enough votes to pass the funding legislation.

Irritable Bowel Disease vs Irritable Bowel Syndrome

Drotumdi O

Irritable Bowel Syndrome vs. Inflammatory Bowel Disease

Medically reviewed by Judith Marcin, MD on September 14, 2017 — Written by Michael Kerr and Kristeen Cherney

When it comes to the world of gastrointestinal diseases, you may hear a lot of acronyms such as IBD and IBS. Inflammatory bowel disease (IBD) is a broad term that refers to chronic swelling (inflammation) of the intestines. It’s often confused with the non-inflammatory condition irritable bowel syndrome (IBS). Although the two disorders share similar names and some of the same symptoms, they have distinct differences. Learn the key differences here. Be sure to discuss your concerns with a gastroenterologist.

IBS is extremely common. In fact, the International Foundation for Functional Gastrointestinal Disorders estimates that it affects up to 15 percent of the population worldwide. According to Cedars-Sinai, about 25 percent of Americans complain of IBS symptoms. This is also the most common reason why patients seek out a gastroenterologist.

IBS is a distinctly different condition than IBD. Still, a person who has been diagnosed with IBD may display IBS-like symptoms. It’s also important to know that you can have both conditions at the same time. Both are considered chronic (ongoing) conditions.

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Some types of IBD include:

  • Crohn’s disease
  • ulcerative colitis
  • indeterminate colitis

Unlike IBD, IBS isn’t classified as a true disease. Instead it’s known as a “functional disorder.” This means that the symptoms don’t have an identifiable cause. Other examples of functional disorders include tension headaches and chronic fatigue syndrome (CFS).

Contrary to popular belief, IBS isn’t a psychological condition. IBS has physical symptoms, but there is no known cause. Sometimes the symptoms are called mucous colitis or spastic colitis, but those names are technically incorrect. Colitis is an inflammation of the colon, whereas IBS does not cause inflammation.

People with IBS show no clinical signs of a disease and often have normal test results. Although both conditions can occur in anyone at any age, it seems to run in families.

IBS is characterized by a combination of:

  • abdominal pain
  • cramps
  • constipation
  • diarrhea

IBD can cause the same symptoms, as well as:

  • eye inflammation
  • extreme fatigue
  • intestinal scarring
  • joint pain
  • malnutrition
  • rectal bleeding
  • weight loss

Both can cause urgent bowel movements.

IBS patients may experience a feeling of incomplete evacuation as well. Pain may be experienced across the entire abdomen. It most often manifests in either the lower right or lower left side. Some people will also experience upper right side abdominal pain without any other symptoms.

IBS differs in the amount of stool produced. IBS can cause loose stools, but the volume will actually fall within the normal limits. (Diarrhea is defined by volume, not necessarily by consistency.)

IBS sufferers with constipation typically have normal colonic transit times — the amount of time it takes for stool to travel from the colon to the rectum — as well.

Depending upon the main symptom, IBS patients are classified as constipation-predominant, diarrhea-predominant, or pain-predominant.

Since the inflammation of IBD is absent in people with IBS, it’s difficult for researchers to understand the precise causes of the latter condition. One notable difference is that IBS is almost always exacerbated by stress. Stress reduction techniques may help. Consider trying:

  • meditation
  • regular exercise
  • talk therapy
  • yoga

IBD may flare up in both low-stress and high-stress situations.

According to Dr. Fred Saibil, author of the book “Crohn's Disease and Ulcerative Colitis,” many people don't feel they can discuss IBS because of social stigmas. "You don't hear a lot of people talking about their 'tension vomiting' or 'tension diarrhea' or 'tension bellyaches,'" he says, "even though these are every bit as common."

Dr. Saibil notes also that there’s still some confusion over IBD because doctors once believed that the condition was caused by stress. There’s no evidence that that is the case, however, and IBD patients should in no way feel they brought the condition on themselves.


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IBS may be treated with certain medications such as intestinal antispasmodics like hyoscyamine (Levsin) or dicyclomine (Bentyl).

Dietary and lifestyle changes seem to help the most. People with IBS should avoid aggravating their condition with fried and fatty foods and caffeinated beverages.

IBD treatment depends on the form diagnosed. The primary goal is treating and preventing inflammation. Over time, this can damage the intestines.

IBD and IBS may seem to share similar symptoms, but these are two different conditions with very different treatment requirements. With IBD, the goal is to reduce inflammation that causes symptoms. IBS, on the other hand, may not be treatable with medications because there is not an identifiable cause. A gastroenterologist can help determine your specific condition and offer the best treatment plan and resources to help you manage symptoms.


Which natural remedies will help ease the symptoms of IBS and IBD?


There are several natural remedies and lifestyle changes that may improve your IBS symptoms such as slowly increasing the fiber in your diet, drinking plenty of fluids, avoiding foods that make symptoms worse such as alcohol, caffeine, spicy foods, chocolate, dairy products, and artificial sweeteners, exercise regularly, eat at regular times, and use caution with laxatives and anti-diarrheal medications.

The recommendations differ a little for patients with IBD. If you have IBD, you may need to avoid dairy products, alcohol, caffeine, and spicy foods and you may need to also limit your fiber intake and avoid fatty foods. It is still important to drink plenty of fluids with IBD. You should also eat smaller meals and consider taking a multivitamin. Finally, you should avoid smoking and reduce your stress level with techniques such as exercise, biofeedback, or regular relaxation and breathing exercises.

Graham Rogers, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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