Academy 'Deeply Disappointed' in Bush's Proposed 2008 Budget

The AAFP and family medicine are "deeply disappointed" in President Bush's proposed 2008 federal budget and call on Congress to reject those portions "that will ultimately reduce access to health care," said AAFP President Rick Kellerman, M.D., of Wichita, Kan.

Bush’s 2008 budget calls for reducing Medicare by $76 billion; cutting Medicaid by $26 billion; continuing use of the current formula for Medicare physician payment, which will translate into significant physician pay cuts in 2008 and beyond; and dropping all funding for Title VII primary care education programs.

Kellerman said the Bush administration's budget could "not find room for important health care programs, further threatening health care access and affordability for the most vulnerable people in our country."

The budget "reneges" on promises to ensure access to care for seniors, uninsured children and low-income families, said Kellerman. He called on Congress to "reject budget proposals that will ultimately reduce access to health care."

"It is particularly unfortunate that the administration's 2008 budget proposal offers no creative solution to what everyone knows is an unsustainable (physician) payment formula," said Kellerman in a statement released by the AAFP. "Without a solution, the 43 million Americans on Medicare may not be able to obtain health care in the future."

A 2006 AAFP survey found that 56 percent of respondents likely would stop accepting new Medicare patients in 2007 if physician payment cuts mandated under the current payment formula took effect. That formula is based on the sustainable growth rate, or SGR. Similarly, a 2006 AMA survey indicated that 45 percent of AMA members would limit or stop accepting Medicare patients in 2007 under the SGR-based payment system. At the time of the surveys, the Medicare physician payment was scheduled to fall by 5 percent; under Bush's 2008 budget, payments would drop by 8 percent to 10 percent, plummeting by a total of 40 percent over the next eight years.

Moreover, the administration falls short in its proposal to reauthorize the State Children's Health Insurance Program, or SCHIP, said Kellerman. The budget would add only $5 billion over five years and would limit eligibility to children in households earning up to 200 percent of the federal poverty level.

Sen. Max Baucus, D-Mont., chair of the Senate Finance Committee, said during Feb. 1 hearings on reauthorizing SCHIP (PDF file: 3 pages / 57 KB. More about PDFs.) that the program would need $12 billion to $15 billion over five years to sustain current enrollment.

The administration's plan to restrict eligibility for SCHIP to children living in households earning up to 200 percent of the federal poverty level, which is $41,300 for a family of four in 2007, would affect 15 states that now offer coverage for children in families earning up to 300 percent of the federal poverty level, according to the Georgetown University Center for Children and Families, Washington, D.C.

"By not providing the funding needed to maintain the program, the Bush administration is stripping health care for indigent children and families," said Kellerman. "The AAFP believes the U.S. government should expand the SCHIP, not narrow its reach. Every child in America should have health insurance coverage."

The general public agrees. Recent surveys show that as many as 82 percent of Americans support increasing SCHIP funding to maintain or expand coverage for children.

In what has become an annual tradition in recent years, Bush also proposed no funding for Title VII, the federal program that supports primary care training. Kellerman warned that the proposed cut of Title VII funds, if implemented, "would mean fewer doctors to care for underserved populations. … By zeroing out all funding for these health professions grants for training in family medicine, the administration is compromising access to quality, affordable health care for all Americans."

The federal budget serves as a guide for how Congress will appropriate money in appropriations legislation that specifically funds government agencies and programs. Bush's proposals have received a cool reception from Congress, which must act on the proposals before their provisions can be enacted. Congressional observers expect significant changes to Medicare, Medicaid and Title VII budget measures.