FY 2000 BUDGET: Proposal Includes Slew of Health Programs
President Clinton yesterday unveiled a $1.77 trillion budget proposal "that would insure the solvency of Social Security and Medicare for decades," the New York Times reports. The move immediately launched a battle with Republicans over whether the remainder of the budget surplus should go to social programs or a tax cut (Broder, 2/2). Clinton stressed spending for education, environment, health and crime-fighting, the Washington Post reports. The plan includes many previously detailed programs, including a tax break for long term care, a plan to allow disabled people to retain Medicaid and Medicare benefits when they return to work and increased funding for the FDA and NIH (Hager, 2/2). The Wall Street Journal reports that much of the funding for Clinton's new health care initiatives would come from a tobacco tax and by "forcing states to use some of the money they are getting from settlements with the tobacco industry for public health and antismoking programs" -- a total of $9.1 billion in proposed savings. Clinton would save $26.6 billion by "squeezing various government benefit programs, particularly payments to health care providers." The budget plan would also shift "some federal public health responsibilities onto state governments" (Wessel, 2/2). The president would also shift some Medicare costs to states by charging "new 'user fees' for Medicare providers, unprocessable claims and claims not submitted electronically" (Yan, Newsday, 2/2). Medicare payments would be cut by $9 billion over five years, on top of $116 million in cuts scheduled under the Balanced Budget Act of 1997 (Miga, Boston Herald, 2/2).
Long Term Care
Clinton's budget would invest $125 million in the Administration on Aging's "National Family Caregiver Support Program" to assist federal employees and retirees who care for elderly or disabled family members. HHS Secretary Donna Shalala said another $110 million proposal would "expand alternatives to institutional care" through the Home and Community-Based Care Program (HHS release, 2/1). Federal employees could purchase long term care insurance at a 10% to 15% discount through a program administered by the Office of Personnel Management (Barr, Washington Post, 2/2). Up to 2 million people could benefit from the proposed $1,000 per year tax credit for long term care, which would cost about $5.5 billion (Wolfe, Financial Times, 2/2).
The Devil is in the Details
Shalala yesterday unveiled the health care initiatives in the FY 2000 budget:
- Clinton would allow people aged 62 to 65 to buy in to Medicare, and people as young as 55 could buy in if they lose employer-sponsored coverage.
- For the disabled who return to work, the budget would extend lifetime Medicare/Medicaid coverage
- A proposal would allow states to extend Medicaid coverage to foster children up to age 21 (up from age 18), while another would allow states to cover immigrants who lost coverage under welfare reforms.
- An asthma initiative would provide $50 million to state Medicaid programs to improve asthma treatment for children.
- Another Medicaid proposal would require generic drugmakers to pay the same fees as brand name drugmakers if they enact price increases that are higher than the consumer price index.
- HCFA would receive $150 million to address looming Y2K troubles and to continue its crackdown on fraud, waste and abuse.
- A $18 billion, five-year program for the Children's Health Insurance Program.
- A $1 billion program would link academic medical centers with local clinics to provide uninsured workers with access to the full range of primary and specialty care.
- NIH would receive a 2% increase of $320 million for research -- down significantly from last year's 15% increase -- for a total budget of nearly $16 billion.
- The CDC would receive a 7% funding increase to $3.1 billion. Emerging infectious diseases would be targeted through improved communication and coordination of public health facilities under a $15 million initiative.
- A $35 million proposal would support community demonstration projects targeted at reducing racial disparities in rates of infant mortality, cancer, heart disease, diabetes, HIV infections and child and adult immunizations.
- The Substance Abuse and Mental Health Services Administration would receive a $139 million increase, or 5.6%, for a total budget of $2.6 billion. Under that proposal, $359 million would go to the Mental Health Block Grant to increase access to mental health services.
- The Indian Health Service would receive a $170 million increase, about 8%, for a total budget of $2.8 billion. Much of the increase would go to reducing disparities in the health of Indians and other Americans.
- A proposed 18% increase in funding for the FDA. If enacted, it would be the largest in the agency's history. The request follows concerns that congressional pressure for accelerated drug approvals may have undermined safeguards in the FDA's approval process. The budget also contains $17 million in "user fees" that would help the FDA automate its approval process.
- The FDA would use $34 million to target youth smoking, and another $15 million to improve injury reporting from FDA-approved products.
- The Agency for Health Care Policy and Research would receive a 21% increase to expand efforts to shift medical findings into everyday practice; $1.5 million would go to measure the quality of long term care (HHS Budget Summary, 2/1).
- The $44 billion proposed budget for the Department of Veterans Affairs would remain largely unchanged, although a $250 million initiative would step up efforts to fight hepatitis C while another $106 million initiative would improve alternative long term care for veterans (White, Washington Post, 2/2).
A USA Today editorial blasts the Clinton budget for relying on projected budget surpluses and abandoning "fiscal prudence in exchange for votes in the year 2000 election." It concludes, "The proposed budget ... continues to fund the debt with Social Security surpluses. ... To really pay [the public debt] down, the government needs to run a real surplus. And that simply hasn't happened yet" (2/2). The Wall Street Journal writes, "Monica may yet be remembered as the face that launched a thousand new federal programs" (2/2). Rep. Bill Thomas (R-TX), chair of the House Committee on Ways and Means' subcommittee on health, issued a statement calling for proposed Medicare changes to be sidelined until the bipartisan Medicare commission reaches its final conclusions. Thomas said, "Any solution to Medicare should be bipartisan and comprehensive and that's why it's important to let the commission finish its work" (release, 2/2). Health Insurance Association of America President Chip Kahn blasted proposals to raise Medicare provider fees and allow younger retirees to buy into the program, charging that the changes would raise premiums (HIAA release, 2/2). Sen. Chuck Grassley (R-IA), chair of the Senate Special Committee on Aging, said, "I hope the president's action will provide a catalyst in Congress for significant long term care legislation and the long overdue re-authorization of the Older Americans Act" (release, 2/2). Mohammad Akhter, executive director of the American Public Health Association, praised increases in funding for the CDC, but called on lawmakers to "take greater strides in improving the health of our population" (release, 2/2).