Among some of the other Obama proposals: $14.6 billion over 10 years for healthcare training initiatives. That includes $5.2 billion to support 13,000 new residencies for physicians and $3.9 billion over six years to support the National Health Service Corps. That would increase the number of individuals enrolled in the program from 8,900 to 15,000.
More than $200 million in increased funding in 2015 for mental health programs for children. That includes $130 million aimed at reducing the use of psychotropic drugs for children in foster-care programs.
$770 million in savings by prohibiting pharmaceutical companies from delaying the availability of generic drugs. A similar plan was included in the administration's 2014 budget plan but was not enacted.
Expanding “quality incentives” for Medicare prescription drug plans. This would likely be similar to the star-rating system used to determine whether Medicare Advantage plans qualify for bonus payments. However, the budget doesn't propose any appropriations for the program.$25 million in funding over two years aimed at preventing fraud in the state and federal insurance exchanges.
The president's budget also says Medicare will continue its transformation “from a passive payer to an effective purchaser of high-quality, efficient care.” It highlights the ACA's value-based purchasing program for hospitals and its requirement of the CMS to develop plans to implement value-based purchasing programs for skilled-nursing facilities, home health agencies and ambulatory surgery centers.
Despite criticisms, policy analysts suggest the president's budget might prove useful as congressional committees search for ways to pay the projected $138 billion, 10-year cost of proposed legislation to repeal and replace the Medicare SGR physician payment formula.
Robert Moffit, senior fellow at the conservative Heritage Foundation, argues one such area of agreement with Republicans is the administration's proposal to save about $53 billion by increasing income-related premiums for Medicare beneficiaries. Conservatives long have supported expanding means testing to strengthen the long-term financial solvency of the program. “That would take some serious conversations,” Moffit said. “You're really working in the weeds on this, but it can be done.”
Van de Water also said the president's proposals could be used in the SGR talks. The fact that the president has endorsed certain ideas increases the chances that they'll be adopted. Like Moffit, Van de Water cited the expansion of income-related premiums in Medicare as one possibility.
Whether or not Obama's budget draws serious consideration on Capitol Hill, it's expected to help frame the dialogue for 2014 congressional elections. Republicans need to capture six seats to control the Senate. If that happens, it could impede the administration's efforts to implement the Patient Protection and Affordable Care Act.
“This is an election year and budgets are political documents,” said G. William Hoagland, senior vice president at the Bipartisan Policy Center who served as a budget adviser to former Republican Senate Majority Leader Dr. Bill Frist. “There are proposals in here that clearly lean toward his base as well as what he believes is necessary to improve Democratic chances on Capitol Hill.”
Since the ACA passed in 2010, the main election campaign strategy for Republicans has been to call for repealing the healthcare reform law. But in recent months, they've floated more detailed plans to replace the law. Most notably, GOP Sens. Richard Burr of North Carolina, Tom Coburn of Oklahoma and Orrin Hatch of Utah have introduced their own comprehensive healthcare overhaul bill.
But Chris Jennings, who stepped down in January as a senior White House aide on healthcare reform issues, points out that any serious proposal will present complications for Republicans. “If it's not total repeal, what is it?” Jennings said. “There is no significant consensus there. Some of the very policies that they're advocating would create far more disruption than anything related to the current law.”
Furthermore, Larry Jacobs, a University of Minnesota political science professor, questions whether healthcare will even be an issue of significant importance to voters this year, unlike it 2010 when Republicans took over the House. He argues that Obamacare is now an animating issue only for the GOP's hard-right base. “For the voters who are up for grabs and undecided at this point, health reform is not a big issue for them,” he said.
With Jaimy Lee and Steven Ross Johnson
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