President Donald Trump's new budget proposal for 2019 could provideenough funding for the Affordable Care Act (ACA) cost-sharing reduction subsidy program to make$8.1 billion in outlays in 2019.

The program helps low-income ACA public exchange plan usershandle their health insurance co-payments and deductibles.

Trump and officials in his administration cut off subsidypayments to health insurers in the middle of 2017, and theyare still trying to repeal and replace the ACA. But the budgetproposal shows that, if the proposal were adopted as written,outlays could increase a little next year, from an estimated totalof $8 billion this year.

It's not clear whether the estimated total for 2018 reflects thefact that the Trump administration has stopped making the subsidypayments.

Trump has questioned whether the U.S. Department of Health andHuman Services (HHS) has a valid authorization from Congress tomake the CSR subsidy payments, but his administration says in adetailed discussion of the budget proposal that, under current law,insurers must offer reduced cost-sharing to eligible consumers.

"The [fiscal year] 2019 budget provides a mandatoryappropriation for cost sharing reduction (CSR) payments for fiscalyear 2018 through the end of calendar year 2019," officialswrite.

Administration officials prepared the proposal to outlinespending plans for federal fiscal year 2019, which starts Oct. 1,and, in some cases, for calendar year 2019.

The Trump administration was also in charge of a budget proposalfor 2018 released about a year ago, but it was not clear then howmuch of the proposal for 2018 was the work of actual Trumpadministration officials and how much was the work of Obamaadministration holdovers. The new budget proposal was prepared withTrump administration appointees in place at the top of HHS and theU.S. Department of Labor.

Members of Congress often start from scratch and develop budgetproposals of their own, but the administration's proposal createsthe framework for the coming negotiations.

Links to budget-related documents are available here.

Here are six other facts about the budget proposal of interestto agents and brokers. Most are drawn from a detailedadministration analysis of the HHS budget which is availablehere.

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1. Funding for the ill-fated ACA Consumer Operated andOriented Plans could temporarily increase.

Some of the moderate Democrats who voted for the Affordable CareAct lobbied for making the Consumer Operated and Oriented Plan(CO-OP) program a substitute for a government-run "Medicare forall" option.

The CO-OPs were nonprofit, member-owned health plans startedwith federal loans.

Most of the CO-OPs have faced severe financial problems, in partbecause of delays and sudden changes in federal ACA subsidyprograms, and have already failed.

The Trump budget shows HHS spending no money on CO-OPs in 2019,but it shows spending on CO-OPs increasing to $259 million thisyear, from $82 million last year.

2. Some HHS agencies you may have never heard of couldgo away.

The Trump administration has proposed eliminating the Agency forHealthcare Research and Quality and the National Institute onDisability, Independent Living and Rehab Research, and foldingwhatever might be of value in their operations into the NationalInstitutes of Health.

3. National Institutes of Health funding could fallsharply.

The Trump administration has proposed cutting the NationalInstitutes of Health (NIH), which pays for medical research, to$3.7 billion, from $4.2 billion.

Funding for research on neurological disorders and stroke couldfall slightly, to about $1.3 billion.

In the past, however, Congress has usually resisted whenadministrations of tried to make big cuts in medical researchspending.

4. Spending on federal Affordable Care Act publicexchange grant programs could wind down.

Drafters of the Affordable Care Act wanted the ACA publicexchange programs to have an independent life of their own after afew years, and the Trump administration's 2019 budget proposalwould force the issue.

The proposal shows outlays dropping to $24 million in 2019, from$135 million this year, with the 2019 spending coming from unpaidobligations brought forward.

Employment at the office that oversees the public exchange grantprograms could fall to zero, from 26 this year.

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5. The Pre-Existing Condition Insurance Plans Program isstill there, after a fashion.

The Pre-Existing Condition Insurance Plans (PCIP)Program was supposed to provide affordable coverage, on aguaranteed-issue basis, for people with serious health problemswhile HHS was setting up the major Affordable Care Act coverageprograms that came to life in January 2014.

Enrollees turned out to be much sicker than anyone had expected,with about $30,000 per year in medical claims, and program managersquickly did what they could to hold down enrollment and limitspending on the people who had signed up for coverage.

It's not clear whether PCIP managers ever paid many agents andbrokers the modest fees they were supposed to pay producers whohelped consumers sign up for PCIP coverage.

The program shut down in January 2014, when the ACA Medicaidexpansion program, the birth of the ACA public exchange system, andthe ACA ban on use of personal health information, other than ageand smoking, in health insurance underwriting gave people withhealth problems new coverage options.

But the Trump administration budget shows that the program couldstill have $84 million in outlays this year, and $56 million inoutlays in 2019.

The outlays "reflect program close out and claims run out costs,as well as allowable administrative costs in the current year,"officials write.

6. Funding for many benefits-related agencies could beabout the same as it is this year.

Funding for the Employee Benefits Security Administration(EBSA), the Labor Department arm in charge of overseeing groupbenefits, could increase to $189.5 million in 2019, from $184million this year.

EBSA's head count could increase to 875, from 860 this year,although that would be down from a head count of 913 in 2017.

Outlays at an Affordable Care Act-created agency, thePatient-Centered Outcomes Research Institute (PCORI), couldincrease to $98 million next year, from $32 million this year, withan infusion of cash made available by folding the Agency forHealthcare Research and Quality into NIH. The PCORI head countcould hold steady at five.