GOP targets mandatory funding for health reform law

Democrats defend the mode of spending for the provisions, but Republicans say the money should be scrutinized during the appropriations process.

By Charles Fiegl — Posted March 21, 2011

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House Republicans want Congress to reprioritize its health care budget by cutting spending for several programs in the health system reform law, but first they would need to extricate some of the dollars from the mandatory spending side.

Members of the House Energy and Commerce health subcommittee held a March 9 hearing to discuss budgeting priorities. GOP lawmakers were critical of sections in the reform law relying on mandatory spending, and they questioned whether the expenditures were needed when the nation is already wrestling with large federal budget deficits.

Republicans targeted a Prevention and Public Health Fund that is set to receive $17.8 billion for various programs between 2012 and 2021, $230 million for expanded primary care residence programs, and $200 million to build and expand school-based health centers.

These mandatory spending provisions should be subject to the annual appropriations process, said Ernest Istook, a former Republican congressman who works for the Heritage Foundation, a conservative Washington think tank.

Lawmakers spent several minutes during the hearing debating funding for school health centers. Republicans blasted the funding plan for the program, saying it fails to provide money for doctors and nurses.

Funding to actually staff the centers is subject to the annual appropriations process, according to a Republican memo.

"The other issue is $223 billion in structural debt for the month of February," said Rep. Michael Burgess, MD (R, Texas).

"There are going to be all kinds of programs I supported in the past that we simply cannot fund. We simply cannot pay for everything."

Rep. Lois Capps (D, Calif.), a former school nurse, defended the program. She said new centers will be staffed because of a requirement in the federal application process. A school must show it has adequate funding for staffing before it receives approval for a grant.

"The interest in expanding school-based health centers is so great that [the Dept. of Health and Human Services] has received 350 applications for this funding," Capps said.

"Requests come from 44 different states, including the congressional districts of nine of our Republican colleagues that are part of this subcommittee. So let's be clear -- the need is there."

Joseph Vitale, a Democratic state senator from New Jersey, told the subcommittee the money from the prevention fund is needed in his state and is going to the right people.

For example, New Jersey has received $3 million from the fund administered by HHS. A portion of that money has provided needed primary health care services to patients in the mental health care setting, he said.

Medicare pay swept up in budget fight

At this article's deadline, lawmakers continued to spar over a House GOP plan to fund the government through the rest of fiscal 2011 while cutting more than $60 billion in discretionary funding.

The Obama administration criticized the effort, saying it would delay payments to health professionals caring for Medicare patients, among other negative effects.

HHS Secretary Kathleen Sebelius wrote in a March 8 letter to Senate Finance Committee Chair Max Baucus (D, Mont.) that payments to Medicare Advantage plans would be suspended and new rates for traditional fee-for-service would need to be calculated, delaying timely payments to physicians for months. "As a result, providers and suppliers, many of which are small businesses -- would experience significant disruption," she said.

But Sen. Orrin Hatch (R, Utah), the top GOP member of the Finance panel, said Sebelius' statements were baseless. He accused Sebelius of attempting to scare senior citizens by suggesting that they would lose Medicare coverage if Republican spending plans were enacted. The effects of a House continuing resolution to fund the government for the rest of the year depend on how the Obama administration decides to interpret the House bill and other relevant statutes, Hatch said, citing a Congressional Budget Office report on the GOP measure.

"As secretary of HHS, we know you understand that this appropriations bill does not change the fact that Medicare is a mandatory program, and, therefore, seniors are still entitled to their full benefits under the law," Hatch and House Ways and Means Committee Chair Dave Camp (R, Mich.) said in a March 9 reply to Sebelius.

Medicare pay board elimination effort

Meanwhile, efforts continue to roll back one provision of the health reform law that is opposed by many physicians.

Two Democrats signed onto a bill that would eliminate the Medicare Independent Payment Advisory Board, which could recommend pay cuts to physicians and others starting as early as 2015 in an effort to control Medicare spending. The Medicare Decisions Accountability Act of 2011, introduced in January by Rep. Phil Roe, MD, (R, Tenn.), has 47 co-sponsors, including Reps. Shelley Berkley (D, Nev.) and Michael Capuano (D, Mass.). The bill has been referred to the Energy and Commerce health subcommittee.

The American Medical Association is among the organizations that supports rescinding the 15-member board.

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