Research physicians and the uninsured are likely to end up as the big winners in the federal budget when the new fiscal year begins, according to a report passed by a House-Senate conference committee last month.
The committee agreed May 9 to increase the budget of the National Institutes of Health by $2.8 billion to $23 billion in fiscal 2002, which begins Oct. 1.
Congress also added $28 billion over three years to help the uninsured get coverage. As expected, Congress included a proposal by President Bush to allocate $72 billion in the form of tax credits over 10 years to help the uninsured, bringing the total amount of money earmarked for the uninsured to $100 billion.
Initially, the $28 billion was slated for an expansion in public programs. But legislators, seeking to form bipartisan consensus, left the final language ambiguous, allowing help to come in the form of public programs, additional tax credits or some combination thereof.
The conference committee figures are tentative at best. Appropriations and other committees must approve specific spending levels.
The healthy increase in NIH funding could come at the expense of other healthcare-related items, says Victoria Wachino, associate director of the Washington-based Kaiser Commission on Medicaid and the Uninsured, an affiliate of the Kaiser Family Foundation.
"This (the increase in NIH funding) could be bad news for everything else," as the appropriations committees and Republican leadership try to live within the spending guidelines of the budget resolution and seek ways to keep the healthcare pie from expanding in other areas, Wachino says.
For example, the budget resolution passed by Congress calls for a reduction in funds for health profession training to $140 million from $353 million in fiscal 2001. This includes training for doctors, nurses and other healthcare workers.
It also calls for a spending reduction for graduate medical education training in children's hospitals from $235 million in 2001 to $200 million in 2002.
Finally, the resolution calls for no increase in funding for AIDS care under the Ryan White Care Act, which currently receives $1.8 billion a year.
The conference committee report authorizes spending of $1.952 trillion in fiscal year 2002. The fiscal year 2001 budget was $1.835 trillion.
Doctors are by no means sitting still on such reductions and will lobby against them.
"We think there ought be more primary care research," says Bruce Bagley, M.D., chairman of the American Academy of Family Physicians. But the Albany, N.Y., physician says all of the numbers in the resolution should be taken with a large grain of salt.
"It (the budget resolution) is really kind of an outline," Bagley says. "The next step will put detail on it," he adds, referring to the congressional committees that will produce hard numbers.
Robert Doherty, senior vice president of governmental affairs and public policy at the American College of Physicians-American Society of Internal Medicine, agrees.
The budget resolution is a statement of administration and GOP leadership priorities, Doherty says. "It's important in that sense, as it signals overall direction, though the specifics are very much in flux."
The primary administration priority continues to be tax relief. The budget resolution calls for a $1.35 trillion tax cut over 11 years. To keep deficit spending from occurring, the GOP-controlled Congress had agreed in the resolution to keep nondefense spending increases to 3.8% to 5%, based on analysis by government and nongovernment groups, Doherty says.
While Doherty isn't happy with possible reductions in fiscal 2002, he is far more concerned about budget years that are three to five years down the road.
That's when the revenue loss from the tax cut accelerates, putting much more pressure on Congress to cut spending.
Doherty says it's unclear when the final numbers will be agreed upon, which could be as late as Christmas. In such a scenario, which isn't infrequent, Congress passes continuing resolutions to keep the government going.
Wachino also says the timing is unclear and doubts there will be a final resolution until at least the end of the summer.