U.S. budget proposal cuts health programs

April 2005

President George W. Bush’s 2006 budget proposal undermines health care programs critical to those living with HIV/AIDS and children on Medicaid, according to officials with IDSA, the HIV Medical Association (HIVMA) and the American Academy of Pediatrics.

“Although we recognize that fiscal constraint is necessary during a time of war and significant federal budget deficit, we urge the administration and Congress to acknowledge the need for a sufficient investment to protect Americans against infectious diseases,” IDSA President Walter E. Stamm, MD, said in a prepared statement.

IDSA is lobbying Congress to increase funding for pandemic influenza planning, immunization, HIV/AIDS research, biodefense preparedness, combating antimicrobial resistance and researching emerging infections.

The AAP, March of Dimes and the National Association of Children’s Hospitals (N.A.C.H.) echoed IDSA’s sentiments, urging Congress to reject the Bush administration’s proposed Medicaid cuts, which could tally to around $40 billion over the next several years. Such cuts would weaken the entitlement program’s guarantee to provide all eligible children with adequate and essential health care coverage, AAP officials charge.

“Children are being put on waiting lists for enrollment and losing access to doctors,” said AAP President Carol Berkowitz, MD. “If these Medicaid cuts are implemented, the health of our nation’s children will suffer.”

These three organizations stressed the need for adequate funds to Medicaid, to protect entitlement, and provide recipients with timely access to quality benefits and services.

“The huge federal deficit is undeniable,” added Berkowitz. “But this isn’t a choice to make based only on numbers. It is a choice to make based on our values and priorities. We need to protect the most vulnerable among us — the youngest, the poorest and the sickest who have no other options.”

Insufficient HIV/AIDS funding

The substantial cuts proposed to Medicaid will have serious consequences for people with HIV. More Americans with HIV get treatment under Medicaid than from any other single payers.

“Funding for HIV programs is a matter of life or death for the people who depend on them,” said HIVMA Board of Directors Chairman Paul Volberding, MD. “It’s not discretionary.”

Bush’s proposal reauthorizes the Ryan White CARE Act, the nation’s largest program dedicated to caring for people with HIV.

Yet, despite the growing number of HIV cases, the budget proposal provides no increase in funding for Ryan White programs outside the AIDS Drug Assistance Program (ADAP).

Furthermore, the $10 million increase proposed for ADAP will not be sufficient to correct problems at the state level, HIVMA officials charge. Many state ADAPs have already been forced to cap enrollment, establish waiting lists, or limit access to some life-saving drugs.

HIVMA and IDSA are calling on Congress to reject the budget proposals for discretionary AIDS programs and the Medicaid program, and to provide appropriate funding to tackle the growing AIDS pandemic.

“We cannot abandon our obligation to ensure that people living with HIV/AIDS have access to state-of-the-art medical care and drug therapies,” Volberding said. “The president’s budget proposals, if enacted, will threaten the health care safety net for HIV care and treatment, and undercut prevention and research efforts.”

Medicaid cuts

Children make up more than half of Medicaid enrollees and based on per capita spending, they cost less than any other population covered by Medicaid, AAP officials said in a release.

In addition, proposed changes to Medicaid in the administration’s budget could impact Early and Periodic Screening, Diagnosis and Treatment (EPSDT) for children, which provides them with preventive health services and treatments if needed.

EPSDT coverage includes comprehensive health and developmental history, appropriate immunizations, vision services, dental services, health education, and lead toxicity screening.

“We should be strengthening, not weakening this program so essential to the health of mothers and children,” said March of Dimes President Jennifer L. Howse, PhD.

Howse said that Medicaid is an important source of maternity service coverage and accounts for 1.4 million (37%) hospital births. At the same time as proposing cuts, the budget calls for outreach and enrollment of more eligible children into Medicaid, which AAP officials said, “would negatively affect service reimbursements to pediatricians and children’s hospitals, providers of a disproportionate share of patient care to children dependent on Medicaid.”

Budget cuts spending

While additional funding for the FDA and for bioterrorism and pandemic influenza preparedness is encouraged, IDSA officials said they are disappointed by steep cuts in funding for the CDC and the Health Resources and Services Administration.

The budget proposal cuts spending at CDC just as the agency embarked on a major prevention initiative to identify more people with undetected HIV infections.

“The administration proposes to simultaneously cut spending on prevention and effectively reduce funding for care and treatment. People who are being encouraged to be tested, and test positive, could find themselves without treatment options,” said HIVMA Executive Director Christine Lubinski.

Some argue that the NIH deserves more than the 0.7% increase in funding that the budget proposal allows. The HIV/AIDS pandemic continues to grow, but in recent years there have been virtually no funding increases for AIDS prevention and care services in the United States, Stamm and colleagues wrote.

HIVMA and IDSA officials both applauded the $3.2 billion proposed for the President’s Emergency Plan For AIDS Relief. However, Bush proposed spending $15 billion over five years on the program in his 2003 State of the Union address.

The current rate of spending falls short of that goal, officials said.

Disease threats

Topping the health care agenda of the Senate leadership is a broad “biopreparedness” bill that is aimed at protecting the nation against bioterrorism, antimicrobial resistance, pandemic influenza, and other emerging infectious threats.

Naturally occurring infectious diseases are the second leading cause of death worldwide and are the third leading cause of death in the United States.

“Infectious diseases don’t respect borders and, in the current era of high-speed global travel, can move easily from one part of the world to another,” said Stamm.

“We saw this with SARS (severe acute respiratory syndrome), and many experts fear we may see it with avian influenza,” he added. “Add to this threat the risk that microbes resistant to existing antibiotics could be developed by terrorists or by Mother Nature, and the value offered by strong public health prevention and control and infectious diseases research programs is crystal clear.”

The influenza pandemic of 1918 resulted in more than 500,000 fatalities in the United States and nearly 21 million deaths worldwide. Should even a modest influenza pandemic occur in the United States. today, CDC estimates up to 200,000 deaths could result.

The budget increases funding for pandemic influenza preparedness by $21 million, to $120 million.

“The pressing question about the next pandemic is not whether it will occur, but when, and will we be ready,” Stamm said. “The challenges of this past influenza season clearly demonstrate the need to strengthen pandemic influenza and other immunization programs.”

Equally challenging is the threat posed by antimicrobial resistance.

An estimated 2 million people acquire bacterial infections in U.S. hospitals each year, and 90,000 die as a result. About 70% of these infections are resistant to at least one drug, according to CDC.

Total cost of antimicrobial resistance to the U.S. is nearly $5 billion annually, according to the Institute of Medicine. Although drug resistance is on the rise, very few new antibiotics are being developed.

“We must reinvigorate the anti-infectives market so that infectious disease doctors have the drugs we need to take care of our patients,” Stamm added.