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Just over $7 billion was provided for community health centers and Medicare’s therapy caps were repealed.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

Obesity Plagues Rural America

Drotumdi O

June 19, 2018 by Dennis Thompson, Healthday Reporter

(HealthDay)—Country folk are being hit harder by the U.S. obesity epidemic than city dwellers, two new government studies show.

Nearly 40 percent of rural American men and almost half of rural women are now statistically obese, U.S. Centers for Disease Control and Prevention researchers reported Tuesday.

And rural men, women and children are more likely to be severely obese than their counterparts from .

Further, rates of severe in adults grew much faster in rural areas than metropolitan areas during the past decade and a half, said senior researcher Cynthia Ogden.

"If you look at the trends in men, severe obesity more than tripled in rural areas," said Ogden, a CDC epidemiologist. "In women, severe obesity more than doubled."

Experts categorize obesity according to body mass index (BMI), a measurement based on height and weight. Severe obesity—a BMI of 40 or more—increased in rural men from less than 3 percent in 2001-2004 to almost 10 percent in recent years.

Severe obesity also increased among urban-dwelling men during the same period, but only from 2.5 percent to roughly 4 percent.

In non-metropolitan women, severe obesity leapt from about 6 percent to almost 14 percent, while creeping up from about 6 percent to just over 8 percent among urban women.

"It increased for urban residents, but it didn't increase as much," Ogden said.

Health experts said they are puzzled by the studies' results, given the popular notion that urban dwellers have less access to healthy food and regular physical labor than rural dwellers.

"I wasn't surprised that obesity was a problem in rural areas. I was just surprised that it was higher than in urban areas. I kind of expected it to be the other way," said Dr. Robert Wergin, a country doctor in Milford, Neb. He's also past president of the American Academy of Family Physicians.

Obesity is linked to an array of health problems, including type 2 diabetes, heart disease and stroke, certain types of cancer and pregnancy complications.

For the reports, the researchers relied on data from the CDC's National Health and Nutrition Examination Survey, which regularly monitors the health and nutritional status of adults and children in the United States.

They found more obesity (a BMI between 30 and 40) in than urban settings for men (39 percent versus 32 percent), women (47 percent vs. 38 percent) and children (about 22 percent vs. 17 percent).

Differences were even more striking when it came to severe obesity.

Rural men have twice as much severe obesity as urban males, nearly 10 percent vs. just over 4 percent. There also are large differences in women (almost 14 percent vs. a little more than 8 percent) and children (over 9 percent vs. just over 5 percent).

It's particularly troubling that nearly 1 in every 10 rural children is severely obese, said Aaron Kelly, co-director of the University of Minnesota's Center for Pediatric Obesity Medicine.

"These kids with really need to have access to specialized medical care to treat their obesity, in the form of weight management services," Kelly said. "The severity of the disease makes it such that it can't be effectively treated in the primary care environment."

Unfortunately, those sorts of services are available only in urban settings.

"That's a huge issue," Kelly said. "They just aren't going to be able to reasonably drive to the bigger cities where these obesity specialists are who can help them."

There's no way to tell at this point why rural people seem to struggle more with obesity than city residents, Wergin said.

But rural doctors need to be more proactive in talking with patients about their weight, he added.

"Family physicians like myself are in an ideal position. Being a whole-person approach to medicine, we don't just look at your heart or your lungs," Wergin said. "We need to be ready to say, 'Your BMI is now 29, that makes you overweight. Let's talk a little bit about food choices and physical activity.' "

The researchers also found other factors that influence .

For example, people who had a college degree were less likely to be obese or severely obese.

"It may have to do with nutritional education and outlook and importance of physical well-being," Wergin said. "You're more aware of food choices and proper eating with more fruits and vegetables."

The studies were published in the June 19 issue of the Journal of the American Medical Association.

Explore further: In US, obesity, smoking more common in rural areas: study

More information: Cynthia Ogden, Ph.D., CDC epidemiologist and branch chief, U.S..National Health and Nutrition Examination Survey analysis; Robert Wergin, M.D., Milford, Neb., past president, American Academy of Family Physicians; Aaron Kelly, Ph.D., co-director, Center for Pediatric Obesity Medicine, University of Minnesota; June 19, 2018, Journal of the American Medical Association

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about obesity's health effects.