AAFP President Calls Bush Budget an 'Affront' to Health Care

In his final budget proposal, President Bush has called for deep reductions in the nation's Medicare and Medicaid programs while also proposing the elimination of other initiatives that are vital to sustaining the nation's primary care infrastructure.

Bush's proposals, made as part of the administration's 2009 fiscal year budget, would slash billions from the Medicaid and Medicare programs, cutting $17 billion from Medicaid and $12.2 billion from Medicare in FY '09. If enacted, the cuts could undermine the provision of Medicaid and Medicare services.

The proposed budget "is an affront to health care," said AAFP President Jim King, M.D., of Selmer, Tenn. "It is hard for me to believe that President Bush, by proposing these large cuts, thinks he is going to improve the health of the public."

In a written statement posted on the Academy's Web site, King called the cuts "draconian" and said, "Refusing to support the programs that help Americans maintain their good health today and that teach the physicians of tomorrow will not increase access to the primary care that is the keystone to a cost-efficient, effective and compassionate health care system."

Bush's budget, which was released on Feb. 4, supports CMS' proposal to eliminate funding for graduate medical education, or GME, in Medicaid programs. In addition, it recommends abolishing duplicate payments made by Medicare Advantage plans to teaching hospitals for indirect medical education, or IME. Some GME and IME programs are used by hospitals to support primary care training.

The administration's budget also would abolish funding for training programs under Title VII of the Public Health Service Act, including Section 747 of the act, which provides the only federal grants for training primary care physicians.

"It is a standard procedure for the president to call for the elimination of primary care training programs under Title VII," said King. "But with the budget crunch, Congress may not put the money back this year."

"We have a primary care workforce shortage," he added. "Anything that may lead to fewer physicians and fewer family doctors is going to be a problem as we try to advance the patient-centered medical home."

The president's budget briefly acknowledges that Congress passed a bill in December providing a 0.5 percent increase in the Medicare physician payment level for the first six months of 2008. However, without congressional intervention, a 10.6 percent reduction in the payment level will take place on July 1.

"We are obviously going to have a robust debate about this in June, and (HHS) will be a full participant in that," said HHS Secretary Michael Leavitt during a press conference announcing the release of the president's budget.

Part of that debate may include discussion about what the federal government pays for services provided by Medicare Advantage plans. The Bush administration has adamantly opposed attempts to reduce subsidies for Medicare Advantage to provide an increase in Medicare physician payment rates or to pay for an elimination of the sustainable growth rate on which Medicare physician payments currently are based.

Leavitt defended the Bush administration's promotion of Medicare managed care, saying that Medicare Advantage is "part of the future of bringing Medicare into a place where it is sustainable.”

"Medicare Advantage plans provide Medicare patients with additional services, including care management programs in some cases," said King. "But the subsidies directed to Medicare Advantage, especially for private Medicare fee-for service (programs), are clearly excessive."

Bush, meanwhile, proposed a $19.7 billion increase in funding for the State Children's Health Insurance Program, or SCHIP, for the next five years, far more than the administration was willing to accept last year. But the proposal caps income eligibility for SCHIP at 250 percent of the federal poverty level, a level that will "lead to more children not having health care coverage," King said.

The Bush administration's FY '09 budget proposal also