Robert Lowes
President Barack Obama yesterday released a budget for fiscal 2015 that delighted champions of primary care, even as Congressional Republicans called the overall dollar figures "unserious" and "irresponsible."
Given that reception on Capitol Hill, no one expects the Republican-controlled House to give the president’s budget the time of day, but organized medicine can hope that Democrats and Republicans will salvage his primary care proposals.
One proposal directly affects physician revenue: The White House wants to add 1 more year to a provision of the Affordable Care Act that raises Medicaid reimbursement to Medicare levels for evaluation and management services and for vaccination administration performed by primary care physicians. The act authorized this parity in Medicaid-Medicare pay for 2013 and 2014 to entice more clinicians to accept Medicaid patients, whose number would grow by the millions under the law.
The American College of Physicians (ACP), the American Academy of Family Physicians, and other medical societies have lobbied Congress to extend the Medicaid pay hike, if not make it permanent.
The president’s budget not only would continue Medicaid-Medicare parity into 2015 but also would apply it to nurse practitioners and physician assistants. The cost, spread out over 10 years, would come to $5.4 billion.
Organized medicine also has urged Congress to bolster the nation’s healthcare workforce, particularly in primary care. The White House budget reserves more money in 2015 for that cause. Four billion dollars would expand the National Health Service Corps, which works in underserved communities, from 8900 clinicians to 15,000. Another $5.2 billion would support 13,000 residency training slots in primary care.
ACP President Molly Cooke praised Obama’s budget proposal for understanding "the important role that primary care places in ensuring access to high quality and cost-conscious care."
"The [ACP] urges Congress to provide the funding requested by administration to help train the next generation of primary care physicians and stem a growing shortage," Dr. Cooke said in a news release.
These expenditures amount to rounding errors in a proposed $3.9 trillion budget, with more than two thirds of that amount in mandatory spending for government entitlement programs such as Social Security, Medicare, and Medicaid. Obama’s budget divvies up roughly $1 trillion dollars in discretionary spending, in keeping with the level set by the Bipartisan Budget Act of 2013, passed in December.
Hospitals Warn That Medicare Cuts Could Limit Access to Care
Not all the reaction from the healthcare industry to the president’s budget was positive.
The White House said it would trim $402 billion over the course of 10 years from Medicare with thrifty reforms it has set forward in previous years. The savings would come mostly from reduced payments to healthcare providers, particularly hospitals, and drug manufacturers. The American Hospital Association and the Federation of American Hospitals complained that the cuts affecting their members would threaten seniors" access to care. Likewise, the American Society of Clinical Oncology said the administration’s plan to reduce spending on chemotherapy and other drugs administered in ambulatory settings by $6.8 billion over 10 years "threatens access to convenient care nationwide."
The White House also drew criticism for giving the National Institutes of Health and the US Food and Drug Administration only scant increases in funding, considering their public health roles.
The reaction of Congressional Republicans to the budget proposal went beyond criticism to disdain: "After years of fiscal and economic mismanagement, the president has offered perhaps his most irresponsible budget yet," said House Speaker John Boehner (R-OH) in a news release. "Spending too much, borrowing too much, and taxing too much, it would hurt our economy and cost jobs."
Senate Minority Mitch McConnell (R-KY), speaking on the floor of the Senate, said that "this kind of unserious budget" appeased "the far left" at the expense of the middle class. "Why do we want a budget that grows the federal budget while the middle class shrinks?" McConnell asked.
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