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Highlights of the Federal Spending Agreement

Publication date: 
Wednesday, February 21, 2018

Last week, Congress reached an agreement on a federal spending plan that would lift spending caps on defense and non-defense spending, put off a raising of the debt ceiling to March 2019 (after this year’s November elections), put the annual deficit over $1.2 trillion and push the nation’s debt over $20 trillion. The following chart summarizes some of the major spending provisions in the agreement.



Community Health Centers

$7 billion

Opioid Epidemic

$6 billion

Child Care Development Block Grant

$5.8 billion

Veterans Hospitals and Clinics

$4 billion

Maternal, Infant and Early Childhood Home Visiting (MIECHV) 

$400 million

Affordable Care Act – Public Health and Prevention

-$1.35 billion

In addition to the above authorized spending, Congress re-authorized the Children’s Health Insurance Program (CHIP). The bill also includes an additional four-year extension of funds for the program, from 2024 through 2027, on top of a six-year extension that Congress approved last month. This brings total CHIP re-authorization to ten years.

Children’s Health Insurance Program

Currently, CHIP serves nearly nine million children across the country. In California, approximately 2 million children are served. The federal government provides more than $2.4 billion to California to operate CHIP, accounting for more than 80 percent of the state’s total budget for the program.

Reauthorization for CHIP will provide certainty to the state and prevent a loss of health coverage to qualifying children. The California Budget and Policy Center provides an in-depth analysis of CHIP funding, which can be accessed here.

Child Care and Development Block Grant

This grant provides subsidized childcare for working families. In California, a quarter of childcare subsidies are provided through federal dollars, with the rest coming from state dollars. About 450,000 children under age 13 are in California’s state-subsidized childcare, preschool and after-school programs.

Community Health Centers

The adopted federal spending plan provides $7 billion nationally for community health centers for two more years. Community health centers are community-based and patient-directed organizations that deliver comprehensive, culturally competent, high-quality primary health care services. Health centers also often integrate access to pharmacy, mental health, substance abuse and oral health services in areas where economic, geographic or cultural barriers limit access to affordable health care services.
For California, this means that 176 sites across the state can continue their service. In 2016, community centers served 4.4 million Californians in 2016 of whom, nearly half a million are migrant/seasonal agricultural workers, 306,000 are persons experiencing homelessness and 30,000 are veterans. Seventy-three percent of persons served are at or below the poverty rate. For more data on California’s community health centers, you can access this fact sheet.

Maternal, Infant and Early Childhood Home Visiting

Renewed for five years, this program provides a comprehensive array of resources and supports for pregnant women, families and at-risk parents of children under the age of five and is designed to improve the coordination of these services and overall outcomes for these families. Home visiting is a preventive intervention that aims to promote maternal health, improve child development and strengthen families and communities.
In Southern California, the counties of Los Angeles, Kern and Riverside participate in the California Home Visiting Program. Over half of women served in the program identify as Latinx and over 90 percent of children served are 0-2 years of age. The California Department of Public Health provides a summary of persons served by the program. 

Opioid Epidemic

The agreement provides new grants, prevention programs and law enforcement monies to combat the opioid epidemic. States with the highest mortality rates would get the most federal dollars. Consequently, California is not likely to receive a significant portion of federal funds to address the opioid epidemic. The Center for Disease Control has a map of 2016 mortality rate. States with the highest mortality rates are in Appalachia, the Rust Belt and New England. 

Veterans Hospitals and Clinics

Congress approved $4 billion for the Veterans Affairs’ Capital Investment Program to fund the construction of VA hospitals and clinics, including community-based outpatient clinics. Most facilities in California receiving these dollars are located in Sacramento, Palo Alto and San Diego. However, Long Beach’s VA Health Center will receive funding to correct deficiencies in the ward that treats Legionella, a bacterial-caused respiratory disease and renovate the Intensive Care Unit. Los Angeles may receive money to replace pipes and valves at its West Los Angeles VA campus. A full list of projects can be found starting on page 267 of the summary provided by the VA. 

Affordable Care Act (ACA) Prevention and Public Health Fund

The ACA established the Prevention and Public Health Fund (PPHF) with the goal of creating sustained, mandatory funding for public health, wellness and prevention efforts. Congress initially set aside $15 billion for the PPHF over its first 10 years, but over time, legislators have tapped into the fund to pay for other healthcare programs. In California, the state has five Big Cities Health Coalition sites, relying on $300 million of grants from the Center for Disease Control (CDC) over the next four years. Additionally, the state draws more than $7 million in vaccine funding and approximately $13 million in chronic disease funding from the Fund. It is unclear how the $1.5 billion cut in the spending deal would affect the flow of these federal dollars to the state.
If you have any questions or comments, please contact Seyron Foo, Director, Public Policy and Government Relations at [email protected] or (213) 680-8866 ext. 221. 


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