In a rare show of bipartisanship for the mostly polarized 115thCongress, Republican and Democratic Senate leaders announced atwo-year budget deal that would increasefederal spending for defense as well as key domestic priorities,including many health programs.

Not in the deal, for which the path to the president’s deskremains unclear, is any bipartisan legislation aimed at shoring upthe Affordable Care Act’s individual health insurance marketplaces.Senate Majority Leader Mitch McConnell (R-Ky.) promised Sen. Susan Collins (R-Maine) a vote on healthlegislation in exchange for her vote for the GOP tax bill inDecember. So far, that vote has not materialized.

The deal does appear to include almost every other healthpriority Democrats have been pushing the past several months,including two years of renewed funding for community health centersand a series of other health programs Congress failed to provide forbefore they technically expired last year.

“I believe we have reached a budget deal that neither side lovesbut both sides can be proud of,” said Senate Minority Leader ChuckSchumer (D-N.Y.) on the Senate floor. “That’s compromise. That’sgoverning.”

Said McConnell, “This bill represents a significant bipartisanstep forward.”

Senate leaders are still negotiating last details of the accord,including the size of a cut to the ACA’s Prevention andPublic Health Fund, which would help offset the costs of thislegislation.

According to documents circulating on Capitol Hill, the dealincludes $6 billion in funding for treatment of mental healthissues and opioid addiction, $2 billion in extra funding for theNational Institutes of Health, and an additional four-yearextension of the Children’s Health Insurance Program (CHIP), whichbuilds on the six years approved by Congress last month.

In the Medicare program, the deal would accelerate the closingof the “doughnut hole” in Medicare drug coverage that requires seniors to paythousands of dollars out-of-pocket before catastrophic coveragekicks in. It would also repeal the controversial Medicare Independent Payment Advisory Board (IPAB), which ischarged with holding down Medicare spending for the federalgovernment if it exceeds a certain level. Members have never beenappointed to the board, however, and its use has not so far beentriggered by Medicare spending. Both the closure of the doughnuthole and creation of the IPAB were part of the ACA.

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Kaiser Health News is a nonprofit news servicecovering health issues. It is an editorially independent program ofthe Kaiser Family Foundation that is not affiliated with KaiserPermanente.

The agreement would also fund a host of more limited healthprograms — some of which are known as “extenders” because theyoften ride along with other, larger health or spending bills.

Those programs include more than $7 billion in funding for thenation’s federally funded community health centers. The clinicsserve 27 million low-income people and saw their funding lapse last fall — a delay advocates said had already complicated budgeting and staffing decisions for manyclinics.

And in a victory for the physical therapy industry and patientadvocates, the accord would permanently repeal a limit onMedicare’s coverage of physical therapy, speech-language pathologyand outpatient treatment. Previously, the program capped coverage after $2,010 worth of occupational therapy andanother $2,010 for speech-language therapy and physical therapycombined. But Congress had long taken action to delay those caps orprovide exemptions — meaning they had never actually takeneffect.

According to an analysis by the nonpartisan Congressional Budget Office, permanently repealingthe caps would cost about $6.47 billion over the next decade.

Lawmakers would also forestall cuts mandated by the ACA toreduce the payments made to so-called Disproportionate Share Hospitals, which serve high rates oflow-income patients. Those cuts have been delayed continuouslysince the law’s 2010 passage.

Limited programs are also affected. The deal would fund for fiveyears the Maternal, Infant and Early Childhood Home VisitingProgram, a program that helps guide low-income, at-risk mothers in parenting. It servedabout 160,000 families in fiscal year 2016.

“We are relieved that there is a deal for a 5-yearreauthorization of MIECHV,” said Lori Freeman, CEO of advocacygroup the Association of Maternal & Child Health Programs, inan emailed statement. “States, home visitors and families have beenin limbo for the past several months, and this news will bring thestability they need to continue this successful program.”

And the budget deal funds programs that encourage doctors topractice in medically underserved areas, providing just under $500million over the next two years for the National Health Service Corps andanother $363 million over two years to the Teaching Health CenterGraduate Medical Education program, which places medical residentsin Community Health Centers.

Kaiser Health News correspondent Emmarie Huetteman contributedto this article.

Kaiser Health News is a nonprofit news servicecovering health issues. It is an editorially independent program ofthe Kaiser Family Foundation that is not affiliated with KaiserPermanente.