Academy 'Dismayed' at President's Budget

"Family physicians are dismayed that the budget proposed by the Bush administration ... could not find room for important health care programs, thus threatening the health care infrastructure for the most vulnerable people in our country." With that opening statement, AAFP President Larry Fields, M.D., of Ashland, Ky., expressed the Academy's extreme disappointment that President Bush's proposed 2007 federal budget fails to invest in America's health care system.

HHS' portion of the proposed budget, released Feb. 6, calls for initiating pay-for-performance programs. However, it prohibits these programs from increasing taxpayer, Medicare or beneficiary costs and provides no explicit support to encourage adoption of electronic health records, which would enable physicians to participate in P4P programs. The proposal also does not call for abandoning the sustainable growth rate formula, on which current Medicare physician payment is based. The formula has resulted in Medicare cuts in physician payments since 2001; only annual intervention by Congress has prevented those cuts from taking effect.

Although the budget proposal would increase funding for community health centers by $181 million to $1.96 billion, it would eliminate funding for Section 747 of Title VII, which supports family medicine academic departments and residencies. In addition, the budget would cut $133 million from Health Resources and Services Administration programs that support rural health programs. Funds for the National Health Service Corps remained at fiscal year 2005 levels of $126 million.

Bush "calls for significant cuts in important health care programs, threatening the health care infrastructure for the most vulnerable people in our country," said Fields in a Feb. 9 statement about the budget proposal. Failure to support training for primary care physicians "means fewer physicians to care for our most underserved populations -- the elderly, poor, disabled and those who live in rural areas and the urban core. By zeroing out all funding for these training programs, the Americans' access to quality, affordable health care has been compromised," said Fields.

The Bush budget also calls for expanded access to insurance for 8 million Americans through health savings accounts and association plans that allow small businesses to buy health insurance for their employees. And, finally, the budget would provide $500 million in new grants to states to develop methods of providing health care to chronically ill patients.