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Obama's budget includes boost for training doctors in underserved areas


By Paul Demko
Posted: March 3, 2014 - 3:15 pm ET
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While some are calling President Barack Obama's budget dead on arrival, one expected provision in his budget long has had bipartisan support—funding to train new physicians to serve in high-need areas.

On Tuesday, the president is expected to propose $14.6 billion in new funding for healthcare training as part of his 2015 budget plan. That includes more than $5 billion over 10 years to train 13,000 doctors to serve in high-need areas. The president's budget also is expected to propose nearly $4 billion over six years to expand the National Health Service Corps—a program previously championed by President George W. Bush and other leading Republicans—to 15,000 providers. Those individuals receive scholarships and loan repayment assistance in return for serving in areas with high medical needs.

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Federally qualified community health centers, another program that traditionally has enjoyed bipartisan support, rely heavily doctors and other clinicians funded through the National Health Service Corps. The centers are key to expanding healthcare access under the Patient Protection and Affordable Care Act, given the national shortage of primary-care providers.

In addition, Obama is expected to seek more than $5 billion in increased payments to providers who serve Medicaid patients. The boost is designed to increase the number of doctors accepting Medicaid at a time when the program is being significantly expanded to lower-income adults under Obamacare. More than 6 million Americans have signed up for Medicaid since Oct. 1, when many states expanded income eligibility to 138% of the federal poverty level.

Providers hailed Obama's expected proposals. “If passed into law, these proposals would be a game-changer, incentivizing the next generation of aspiring clinicians to enter primary care and to serve those most in need,” said Tom Van Coverden, president and CEO of the National Association of Community Health Centers, in a statement.

Despite past bipartisan support for these programs, Obama's budget proposals are seen as unlikely to draw much interest on Capitol Hill. That's in large part because congressional leaders signed off on a deal in December that sets the budget for 2014 and 2015. Senate Budget Committee Chairman Patty Murray (D-Wash.) indicated last week that the Senate won't release a budget.

But House Budget Committee Chairman Paul Ryan (R-Wis.) has signaled that he intends to propose a fiscal 2015 budget, though it's likely to have little or no overlap with Obama's budget.

On Monday, Ryan issued a report, The War on Poverty: 50 Years Later, that included a sweeping critique of Medicaid and other federal programs designed to help the poor. The report suggests that Medicaid discourages individuals from seeking employment and does little to improve health outcomes. In past years, Ryan has proposed essentially turning Medicaid into a state block grant program and sharply capping federal spending. It's expected that his proposed budget will be a blueprint for his conservative social-policy agenda heading into the 2016 presidential election.

Meanwhile, hospitals are nervously awaiting Obama's budget proposal. They have warned that further cuts to Medicare reimbursements would cause financial stress for facilities. Hospital groups say that they have already sustained $117 billion in Medicare cuts since 2010. Observers say the president has to seek funding from somewhere to pay for a reform of the Medicare sustainable growth-rate formula and for other benefit improvements.

Follow Paul Demko on Twitter: @MHPDemko


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