Federal health budget, abortion language OK'd

The giant omnibus spending package heralds lean times ahead for the federal funding of medical research and health information technology efforts.

By Joel B. Finkelstein — Posted Dec. 27, 2004

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Washington -- President Bush recently signed into law a fiscal year 2005 appropriations package that leaves little room for funding new programs but includes a controversial measure that could limit payment for providing abortion services.

Language inserted into the $143 billion budget for the Labor and Health and Human Services departments is designed to allow health insurers, hospitals and other medical institutions to choose not to offer or pay for abortions or abortion counseling and referrals. State governments and federal agencies found to be discriminating against these institutions for not offering these services risk losing federal funding.

According to proponents, the measure simply expounds on a law that has been on the books for more than 25 years but that some jurisdictions have interpreted as referring only to individual physicians, nurses and others.

"My experience as a physician -- and I still see patients -- is that the majority of nurses, technicians and doctors who claim to be pro-choice, who claim to support Roe v. Wade, always say to me that they would never want to participate in an abortion, perform an abortion, or be affiliated with doing an abortion," the provision's author, Rep. Dave Weldon, MD (R, Fla.), said in a statement.

Reproductive rights groups have used loopholes in current law to coerce hospitals and health plans into offering abortion services and to require that physicians provide referrals, said Gene Rudd, MD, associate executive director of the Christian Medical & Dental Assns.

"How can we force people to do something morally unconscionable like that when it's clearly such a controversial issue that people have strong emotions about? Ironically, the pro-choice people don't want to allow people to have that choice," he said.

But the provision could have the effect of limiting women's access to abortion services and jeopardizing physicians' ability to inform patients of all of their medical options at federally funded family planning clinics, "effectively gagging physicians across the country," said a letter to Congress from Vivian M. Dickerson, MD, president of the American College of Obstetricians and Gynecologists.

So far, the Weldon provision also has been challenged in two lawsuits, including one filed by California Attorney General Bill Lockyer, who called it a "back-door attempt to overturn Roe v. Wade." He also said it raises state sovereignty issues.

The National Family Planning and Reproductive Health Assn. also has filed a lawsuit claiming that the provision is at odds with regulations requiring all family planning clinics receiving federal funding to provide referrals for women requesting information on abortion.

On the appropriations end of the measure, Congress managed to cut about $3 billion from the original House and Senate proposals for the Labor and HHS departments. One victim of the belt tightening is the National Institutes of Health, which received a lower funding increase than research advocates had expected.

"It was anticipated that there would be a slowdown in support in the post-doubling era," said Bill Leinweber, who is the vice president of Research!America, a public education and advocacy alliance of which the American Medical Association is a member. The goal to double the NIH budget in five years successfully ended in 2003.

"The research community worked diligently to make that a soft landing, but as we look at the numbers now, this can be termed nothing less than a crash landing," he said.

Overall, the NIH received $28.6 billion in the 2005 budget, a $573 million or 2% increase over 2004. Much of that money will go to support ongoing multiyear research. But at that funding level, the NIH can afford to increase the average grant budget by only 1.3%, while the cost of doing research has gone up by 3.5%, according to estimates by the American Assn. for the Advancement of Science.

The new funding level also means that NIH likely will fall far short of its anticipated funding of 515 more research grants in 2005.

The HHS budget also fails to deliver new funding for the Office of the National Coordinator for Health Information Technology, run by David Brailer, MD.

Having come into the office a couple of months after the president submitted his budget proposal, Dr. Brailer had little time to make his case to Congress. "Money is important, it's the starting point of programs, but I don't think the act was intentional," he told AMNews.

Dr. Brailer and his staff will keep receiving their paychecks but will have to convince other offices and agencies within the department to provide funding for their projects.

The IT office also will continue to work closely with the Agency for Healthcare Research and Quality, which received $50 million for investing in health information technology initiatives.

In contrast, some public health initiatives did well in the 2005 budget. For example, another funding boost was secured for community health centers, which are a Bush administration priority for dealing with the problem of uninsured Americans.

The health centers received an additional $131 million over 2004 levels, for a total of $1.6 billion in 2005. The increase fell $88 million shy of the president's request. About $31 million will go toward supporting existing grants to help with the rising cost of providing health care.

With other health-related priorities being cut back, health centers can't really complain about getting less of an increase than originally proposed, said a spokeswoman for the National Assn. for Community Health Centers.

At current levels, HHS still can fund only about one in every four clinics that apply for federally qualified status.

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Growth slowdown

Appropriations for the National Institutes of Health continue to increase each year, but the rising cost of administering grants and maintaining infrastructure cuts into research and development funding, as shown here.

R&D spending
(in billions)
2005 $27.43
2004 $27.22
2003 $26.74
2002 $23.39
2001 $20.76
2000 $18.48
1999 $16.41
1998 $14.53
1997 $13.71
1996 $13.04

Note: 2004 and 2005 are estimated figures. Source: American Assn. for the Advancement of Science, November

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External links

Thomas, the federal legislative information service, for bill summary, status and full text of the Consolidated Appropriations Act of 2005 (HR 4818) (link)

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