Congress Looks to Raise Discretionary Funding Levels

The Democrat-controlled Congress may adopt a final budget resolution within the next few weeks that provides about $21 billion more in funding for domestic discretionary programs than the amount proposed by President Bush in his fiscal year 2008 budget. And that is likely to mean more money for certain health-related programs, according to analysts interviewed by AAFP News Now.

House and Senate members are expected to approve a final budget resolution by late April or early May that outlines congressional spending limits for the next fiscal year. In the meantime, the budget resolution process has spotlighted certain budget priorities that are likely to end up in later House and Senate appropriations bills, even if they don't make it into the final budget resolution.

The Senate-approved resolution, for example, contains a provision known as the Specter-Harkin amendment that increases funding for health programs by $2.2 billion more than the amount contained in the underlying Senate resolution. This increase is meant to restore funding for the health professions training programs authorized under Title VII of the Public Health Service Act to fiscal year 2005 levels. The president's proposed 2008 budget essentially eliminates funding for the training programs.

The Specter-Harkin amendment also allows increases in funds for the CDC and the NIH.

However, the Senate resolution finances the Specter-Harkin amendment by moving money from other parts of the budget, making the amendment unlikely to survive the conference process that produces a final budget resolution. Still, passage of the amendment sends a strong signal that the Senate supports increased health program spending, and, as a result, Sen. Robert Byrd, D-W.Va., chair of the Senate Committee on Appropriations, could provide additional funds for the Subcommittee on Labor, Health and Human Services, Education and Related Agencies.

"I think Senators Harkin and Specter offered their amendment to get other senators on record as supporting it," said Tim Leeth, principal at Lincoln Capitol Solutions, a consulting firm in Washington, and a former Capitol Hill staff member. "Whether the amendment makes it into the final budget resolution is academic because it represents a high priority for them when they mark up their appropriations bill."

The House and Senate budget resolutions call for a major expansion of the State Children's Health Insurance Program, or SCHIP, a direct challenge to the Bush administration and some congressional Republicans, who want to narrow the focus of the program by limiting SCHIP coverage to children who are considered poor while excluding their parents and other adults.

"There is no question that this Congress and this budget resolution will include increases for SCHIP," said Marcia Mabee, Ph.D., executive director of the Coalition for Health Funding, a nonprofit alliance of 50 national health organizations working to ensure that health discretionary spending remains a high priority for Congress and the Bush administration. The Academy is a member of the coalition.

The Senate budget resolution contains an amendment sponsored by Sen. Gordon Smith, R-Ore., that employs a tobacco tax to pay for a major expansion of SCHIP during the next five years, another amendment that House and Senate members are likely to endorse as part of a final budget resolution.

"Democrats have a particular interest in SCHIP expansion, and it is something that the states have a need for," said Leeth.

Both the House and Senate budget resolutions include a reserve fund for the possibility of increasing payment rates for physicians while protecting beneficiaries from associated premium increases. The reserve fund has a "decent chance" of passing the House and Senate appropriations process if lawmakers can find offsets in other parts of the budget to pay for the fund, said Leeth.