Del. Eleanor Holmes-Norton (D-D.C.) (Andrew Harnik/AP)

The $1.1 trillion spending bill approved by congressional leaders early Wednesday morning includes a rider that District advocates say marks a strike against home rule.

The rider, which appears on Page 603 of the bill, creates a significant obstacle to the District’s ability to assess and spend excess surplus dollars collected by the Washington region’s largest health insurer.

District insurance regulators last year ordered CareFirst BlueCross BlueShield to spend $56 million out of its billion-dollar cash reserves on local community health needs, effectively upholding a D.C. law passed in 2009 that required assessments of the company’s surplus dollars every three years.

That decision marked the culmination of a 10-year battle between public advocates and CareFirst, and it set the stage for District authorities to pour the excess $56 million into local health initiatives that could range from premium reductions to the construction of clinics.

That money has yet to be spent. And advocates say the CareFirst rider will make it difficult to evaluate any future surpluses because it requires a tri-jurisdictional agreement that includes Maryland and Virginia to do so.

The District’s non-voting representative to Congress, Del. Eleanor Holmes-Norton (D), said that the rider effectively renders the 2009 law “gone.” But she said that as far as she was concerned, it’s not as bad for the city as it could have been because it will only affect future surpluses, not the $56 million that the company is already required to spend down.

Keeping that on the table was a “real victory for D.C.,” she said.

A number of members of Congress from Maryland and Virginia opposed the District’s surplus spending, arguing that spending down the surplus funds would interfere with the Affordable Care Act, Holmes-Norton said. She attributed that view to lobbying efforts by CareFirst, but she would not name the specific representatives or senators who backed the rider, saying there was no single advocate for it.

Walter Smith, executive director of the D.C. Appleseed Center for Law and Justice, the nonprofit that led the fight to get city access to CareFirst surplus dollars, said the $56 million has yet to be spent, but that it would be.

“The excess surplus that was determined last December must still be spent down, and will be spent down, and nothing in today’s rider changes that,” he said.