Tuesday, February 2, 2010

Health reform and the Obama budget

Does the President's new budget mean that the White House is shifting toward smaller-scale health reforms in lieu of comprehensive legislation?

Time magazine's Katie Pickert blogs that "the HHS budget doesn't do what massive health reform legislation was supposed to do." She notes that an AP reporter asked HHS Secretary Kathleen Sebelius "to clarify what was obvious already - that the 2011 HHS budget doesn't make any real headway toward solving the country's health care crisis." Sebelius responded that the "budget 'in no way replicates the efforts in the health reform legislation to reach out to the 30 some million Americans who have no health insurance at all and those who are woefully underinsured, … This budget - absent health reform - will still leave a major gap.'"

The National Journal writes that the budget "focuses more on the economy than on health reform." ABC's Jake Tapper explains that "the budget assumes $150 billion in deficit reduction from enactment of the health reform legislation," while the Wall Street Journal's Janet Adamy blogs that the budget offers a "back up" plan should the "embattled" health reform legislation fail. Jacob Goldstein reminds readers of the WSJ's health blog that "the big [cost] drivers are mandatory spending on Medicare and Medicaid - huge, rapidly growing costs that are outside the purview of Obama's (or any president's) annual recommendations for discretionary spending."

My take is that the President's budget doesn't itself signal a retreat health reform, but tries to have it both ways - pledging fealty to enactment of a comprehensive bill, while suggesting ways to advance smaller-scale reforms should the broader effort fail. Among the President's health funding priorities are:

-- Primary care training: $2.5 billion for community health centers, enough to fund current centers and create 25 new ones; $169 million to the National Health Service Corps, to train up to 400 more primary care physicians, nurse practitioners, and dentists to serve in underserved areas, bringing the total to 8,500 clinicians. $54 million for Title VII primary care training programs, the same as FY2010, but the current preference for family medicine programs (over internal medicine) would be eliminated.

-- Health information technology: $110 million for "continuing efforts to improve health IT policy, coordination and research activities."

-- Comparative effectiveness: $286 million for the Agency for Healthcare Research and Quality to study the effectiveness of different medical options.

-- Coverage: $25.5 billion to support State Medicaid programs by temporarily increasing Federal Medicaid funding for six months through June 2011.

-- Delivery system reforms: "new Medicare and Medicaid demonstration projects that evaluate reforms to provide higher quality care at lower costs, improve beneficiary education and understanding of benefits offered, and better align provider payments with costs and outcomes. Special emphasis will be placed on demonstrations that improve care coordination for beneficiaries with chronic conditions, that better integrate Medicare and Medicaid benefits, and that provide higher value for dollars spent."

-- Medicare physician payment: the budget includes an increase in Medicare baseline spending of more than $200 billion to accommodate enactment of legislation to end the annual cycle of SGR cuts. (Congress, though, appears to be leaning toward setting aside enough money to prevent cuts for the next five years but not enough to permanently repeal the SGR.)

For the past year, President Obama has pursued a "Big Bang" approach to health reform, centered on getting Congress to pass sweeping expansions of coverage coupled with other reforms to make insurance more affordable and available - yet the effort remains (hopelessly?) stalled in Congress. The new budget doesn't necessarily mean that he is walking away from big changes. But the budget does suggest to me a grudging awareness, if not acceptance, by the White House, that smaller, incremental steps could be all that he will get.

Today's question: What is your reaction to the President's budget?


PCP said...

It is a budget that throw money at Democrats pet projects, even if they are inefficient ways of putting band aids on the problem. Witness the extra money thrown at CHCs and their expansion.
CHCs are huge Democratic supporters and their clientele and staff likewise almost uniformly vote Democratic.
They are reimbursed however on a "cost based reimbursement" schedule(wouldn't we all like that). They are bloated, bureaucratic, over staffed, encourage improper mid-level provider use and are hopelessly cost inefficient, compared to most lean private practices. Additionally their clientele are fostered to use health care resources improperly and excessively. The reason for their existence has more to do with the hopeless state of Primary care reimbursement and therefore access than anything else.
Of course, you will not hear about any of this in Mr. Obama's budget.
Sadly you will not hear about this either in ACPs advocacy efforts either.shl

Rich Neubauer MD said...

The President faces multiple challenges (our COUNTRY faces multiple challenges). The growing deficit is one of them and if unchecked, could literally "bring us down" in coming years. The job crisis is yet another. Reform of the health care system in the ways we've been discussing for months on this blog is yet another, even as it has fallen on the rocks politically at the moment.

From the preliminary analyses I've seen and heard so far, the President's budget is more honest than many past budgets. I've heard it likened to a "cry for help" in acknowledging that we are on an unsustainable course.

I for one feel that if we don't get a substantial health care reform bill from Congress, we will remain on a collision course with disaster in our health care system that will have many negative consequences.

Unknown said...

I am dismayed when I see health care bloggers such as yourself pay homage to so-called "health care reform." The Obama plan would not only strangle our struggling economy further but also increase overall costs of healthcare (allbeit shifting those costs mainly to the middle class and wealthy with increased taxes). The plan does NOTHING to address the TRUE causes of rising health care costs... ie. malpractice litigation, lack of competition in free market for health insurance plans, etc. What we definately dont need in this country are more entitlement programs. The glimmer of hope I see in all this is that americans are starting to wake up and smell the coffee... and it seems like the president's coffee stinks. Sorry Bob.