In the first 7 years of the Clinton administration, a number of gaps in the social safety net were filled, but the job has yet to be finished, said Donna E. Shalala, PhD, secretary of the US Department of Health and Human Services, as she described proposed budget expenditures for fiscal year (FY) 2001. “Simply put: the gaps in our public health system and social safety net 7 years ago were real and unworthy of a great nation. At this moment of what the President calls profound promise and possibility, we are within sight of closing these gaps. We have the means. I’m convinced that we have the will,” she said.
The budget she proposed totaled $421.4 billion dollars—an increase of 9% from that of the previous year. One major factor in the coming budget will be increasing access to care. Shalala hopes to capitalize on the previous success of the State Children’s Health Insurance Program (CHIP), which has enrolled 2 million children in 50 states thus far. Now, the administration seeks to expand that coverage to the families of low-income children through a program called FamilyCare. The program, which is expected to cost $50 billion over 10 years as part of an enhanced federal match, should cover the families of children who live in states that provide coverage for children making up to 200% of the official poverty line.
To increase the numbers of children in the program, the administration seeks to allow school lunch programs to share information with state Medicaid workers. “This is just plain common sense because any child eligible for a free lunch is likely to be eligible for one of these programs. We’re also going to give states the option to extend coverage under the Children’s Health Insurance Program up to age 21,” said Dr Shalala. In what is sure to be a controversial move, Dr Shalala also said that states could cover children and pregnant women who are legal immigrants, no matter when they came to the country.
“Even as we take these steps, we recognize that many low-income adults still work in jobs that don’t offer health insurance. These workers frequently rely on what Tennessee Williams called, ‘the kindness of strangers.’ Those kind strangers are local health institutions and professionals who provide services at a reduced or no cost,” said Dr Shalala. To beef up those beleaguered institutions, the administration seeks $125 million to build a seamless system of care for workers who have no other place to go—a increase of $100 million over what had been appropriated in the previous year.
Another access proposal would make it possible for uninsured, displaced workers aged 55 to 65 years and their spouses to buy into Medicare. Former workers aged 62 to 65 years who lack insurance would be allowed to buy into the program. The proposal mirrors those made for the past 2 years but “that has not stopped us from continuing to champion this good idea,” said Dr Shalala.
Shoring up Medicare—a big issue in an election year—should be a major priority, and Dr Shalala echoed President Clinton’s proposal to put $300 billion of the national surplus into the Medicare trust fund over the next 10 years. She promised that such an expenditure would extend the solvency of the trust fund until 2025.
Dr Shalala also promised that the new budget proposal would cover a voluntary prescription drug benefit for seniors at a cost of $38.1 billion over 5 years—providing a safety net for the 3 in 5 Medicare beneficiaries who lack dependable drug coverage. “Does anyone seriously believe that if we were building a Medicare system today, we wouldn’t include a prescription drug benefit? That’s like saying if we built a car today, we wouldn’t include seat belts. Not only would building such a car be illogical—it would be immoral,” she said.
In another move aimed at protecting the nation’s older citizens, Dr Shalala noted that the federal government intends to continue its scrutiny of nursing homes. “If you’re only in business to make a quick buck, we’re going to put you out of business.” The new budget contains $71 million more for ongoing activities to strengthen state and federal oversight of nursing homes and to speed up the investigations of complaints. In addition, the new budget will include $125 million to support people who want to care for aged relatives in their own homes. In the previous budget, the President proposed a $1000 tax credit for families who cared for sick or disabled relatives; this year, Dr Shalala said the amount would be tripled.
In addition, the new budget provides $100 million to help states pilot new asthma management techniques for children covered by Medicaid. Another $80 million will pay for training new pediatricians at freestanding children’s hospitals—double the amount the federal government invested in the program last year.
To maintain momentum in biomedical research, Dr Shalala is proposing a total budget of $18.8 billion for the National Institutes of Health (NIH), which is a $1 billion increase from the budget in FY 2000. “Why the increase? Because we now know that sustained public investment in basic and clinical research pays undeniable dividends. So this is truly a case of throwing good money after good. From detecting genetic disorders to AIDS to new prevention strategies, the National Institutes of Health is the master goldsmith in the golden age of biomedical research,” she said.
The proposal, however, falls short of the $20.6 billion recommended by the Federation of American Societies for Experimental Biology to accelerate the national effort in biomedical research. And it falls short of what the American Society of Microbiology (ASM) had proposed. In a statement, the ASM said it recognizes with appreciation President Clinton and Vice President Gore’s proposed budget increase of $1 billion in FY 2001 for the NIH.
“The Administration’s proposed increase for the NIH is an important step in the direction of achieving a doubling of the NIH’s budget and reflects President Clinton and Vice President Gore’s continuing commitment to improving the nation’s health through medical research,” said Dr Gail Cassell, chair of the ASM’s Public and Scientific Affairs Board.
The ASM endorsed a $2.7 billion increase for the NIH in FY 2001, a 15% increase in funding that would bring the NIH budget to a level of $20.6 billion. Because of the unprecedented opportunities in basic and clinical research, the ASM supports a greater investment in medical research and the goal of doubling the NIH budget by 2003, said the society in a released statement.
However, Dr Shalala said she had tried to be even-handed in choosing programs to receive increases and in doling out those increases. Noting that the budget includes a large increase for research into HIV/AIDS, she said, “I want to be clear. Stopping AIDS the way we stopped smallpox is a top priority for this Department—and our budget reflects that.” Overall, Dr Shalala is proposing $9.2 billion to fight AIDS, an increase of 8.4%.
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