DEPARTMENT OF HEALTH AND HUMAN SERVICES
The President’s 2009 Budget will:
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Prevent and prepare the Nation for health emergencies,
including pandemic influenza and bioterrorism;
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Prioritize the healthcare of low-income children by
reauthorizing the State Children’s Health Insurance Program;
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Ensure efficient and high-quality care for beneficiaries
and improve the fiscal sustainability of the Medicare and Medicaid
programs;
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Promote market-based and high-tech reforms so that
health care is more accessible and affordable for families;
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Expand and promote the use of health information technology
and increase the transparency of health care price and quality information;
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Improve public health through science that protects
food supplies and research that delivers new advances towards the
cures for tomorrow; and
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Continue to assist low-income children, vulnerable
populations, and families in need, including through the President’s
Faith-Based and Community Initiative.
Preparing the Nation for Health Emergencies
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Prepares against an influenza
pandemic. $507 million to improve America’s readiness
for an influenza pandemic, including working toward the goal of acquiring
20 million courses of pre-pandemic vaccine for the national stockpile.
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Reinforces biodefense and
protects the Nation from health emergencies. Over $4.4
billion to continue efforts to prevent and protect the public from
a bioterrorism attack or other public health emergency.
Reauthorizing the State Children’s Health Insurance Program
(SCHIP)
Modernizing and Improving Medicare
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Encourages and recognizes
provider competition, efficiency, and high-quality care.
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Adjusts annual provider updates to encourage implementation
of best practices that will restrain costs and improve efficiencies.
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Supports payment reforms for providers, such as physicians
and hospitals, that do not increase Medicare spending and that encourage
providers to provide high-quality, efficient care.
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Rationalizes Medicare payment
policies. Refines Medicare payment policies for certain
medical items and services to better align them with appropriate costs.
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Increases beneficiary awareness
and responsibility for their own health care. Gives beneficiaries
who are most able to contribute to the costs of their coverage more
responsibility for their health care utilization and costs.
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Improves fiscal sustainability. Reduces Medicare’s long-term budget shortfall by more than
$10 trillion over 75 years, nearly one-third of the unfunded obligation.
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Improves Medicare program
integrity. Fights waste, fraud, and abuse by recovering
overpayments and collecting criminal fines and penalties, and addresses
other program integrity vulnerabilities.
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Sustains historic reforms
to Medicare.
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Continues successful implementation of the Medicare
prescription drug benefit, which is projected to have over 25 million
beneficiaries enrolled in private Prescription Drug Plans (PDPs) and
Medicare Advantage Prescription Drug Plans (MA-PDs) and saves these
enrollees an average of $1,200 annually on their drug costs.
-
Offers beneficiaries greater choices and higher-quality
health care through access to private health plans, which compete
for their enrollment in Medicare Advantage.
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For additional discussion of these Medicare reforms,
please see the chapter, The Nation's Fiscal Outlook, in this Budget volume.
Enhancing and Reforming Medicaid
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Provides greater access to
health insurance. Extends existing Medicaid eligibility
for welfare recipients transitioning to work; continues Medicare Part
B premium assistance for qualified low-income seniors; and enhances
States’ ability to implement premium assistance programs.
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Increases program flexibility
and efficiency.
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Preserves long-term care benefits for individuals
with limited resources.
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Provides States with greater flexibility to manage
care for special populations and clarifies services States may offer
with managed care savings.
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Supports market-driven prescription drug reforms.
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Creates consistency in, and preserves the integrity
of, the Federal matching rate structure.
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Codifies longstanding Department of Health and Human
Services (HHS) policy not to bill Medicaid when services are provided
free of charge to the public.
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Reduces waste, fraud, and
abuse and increases accountability.
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Provides States with new tools to verify eligibility
and identify improper provider claims.
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Strengthens Medicaid’s position as the payer
of last resort by facilitating payment by other liable third parties
before paying for covered health care expenses.
-
Introduces performance reporting and links State performance
to grant awards.
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Increases transparency through the publication of
an annual financial status report.
Promoting Market-based Health Care
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Fosters a true marketplace
for health care. Encourages competition, improves efficiency,
and reduces the ranks of the uninsured by promoting access to private
insurance.
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Replaces the existing—and unlimited—exclusion
for employer-sponsored insurance with a standard deduction.
-
Increases small employers’ power to negotiate
lower-priced health premiums, allows competition among health plans
across State lines, and reforms the medical liability law.
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Provides $75 million in both 2009 and 2010 to help
high-risk populations gain access to health insurance.
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Promotes the use of health savings accounts, including
allowing health plans with at least 50-percent coinsurance to qualify
as a high-deductible health plans.
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Advances affordable insurance
options. Pursues opportunities to work toward State-based,
budget-neutral initiatives to expand access to affordable insurance.
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Facilitates health information
technology advancements. Supports adoption of health information
technology as a normal cost of doing business, including policies
that will encourage physicians and others to adopt electronic health records and through furthering
technologies for safe, secure health information exchange.
Improving Public Health through Science
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President George W. Bush tours the Erlanger Hospital, Baroness Campus in Chattanooga, Tennessee.
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Supports the Nation’s
biomedical research efforts. $29 billion for the National
Institutes of Health to enhance research on the fundamentals of diseases,
disorders, and conditions while testing new therapeutics, tools, technologies,
and applications.
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Protects the Nation’s
food supply. Builds on the Administration’s Import Safety Action Plan and the Food and
Drug Administration’s (FDA’s) Food Protection Plan by providing $662 million to protect
against intentional and unintentional contamination.
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Establishes a pathway for
FDA’s approval of follow-on biologics. Proposes new FDA authorities to approve follow-on protein products
through a new regulatory pathway that protects patient safety, promotes innovation, and includes a financing structure to cover
the costs of this activity through user fees.
Expanding Care for Vulnerable Populations
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Strengthens access to priority
drug treatment and prevention activities. $40 million
for drug court services, and $56 million to integrate screening, brief
intervention, and referral to treatment of drug abuse in emergency
departments and other health care settings.
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Expands health care access.
$2 billion for Health Centers, including an increase to
create up to 40 new Health Centers in high-poverty areas.
Strengthening Programs for Children
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Promotes school readiness. $7 billion to provide comprehensive, high-quality educational, health,
nutritional, and social services to approximately 895,000 disadvantaged
children and families through Head Start.
-
Increases adoption incentives. $20 million to build on the substantial increases in the number
of adoptions since the mid-1990s.
Supporting Faith-Based and Community Programs
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Builds capacity of faith-based
and community organizations. $75 million to help grassroots faith-based and community-based
organizations expand their capacity to provide social services for poor and low-income individuals
and families, of which $35 million is for Communities Empowering Youth, a grant aimed at presenting young
people with alternatives to gang involvement and violence.
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Mentors children of prisoners. $50 million to improve long-term outcomes for vulnerable children
with parents in prison. Since 2004, the program has made 70,425 mentoring
matches.
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Expands access to substance
abuse treatment. $98 million to expand substance abuse
treatment capacity, including clinical treatment and recovery support
services. The Access to Recovery program has served more than 199,000
people since 2004.
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Educates youth about abstinence. $204 million to prevent teenage pregnancy, pre-marital sexual activity,
and the incidence of sexually transmitted disease.
Major Savings and Reforms
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13 programs representing nearly $2.8 billion have
been identified for major termination or reduction, including:
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Recovery Community Services Program, because services
provided, such as manicures and other non-traditional therapies, are
not based on evidence-based practices for recovery and grantees have
not consistently met all performance measures.
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Health Professions Grants, because evaluations have
found these activities do not have a demonstrated impact on the placement
of health professionals in underserved areas.
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Medicare continues to reduce its improper payment
rate, down from 4.4 percent of payments in 2006 to 3.9 percent in
2007—the lowest since HHS began tracking the statistic in 1996.
Since 2001, the Department of Health and Human Services has:
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Surpassed in 2007 the President’s goal of creating
1,200 new or expanded Health Center sites. By 2009, Health Centers
will have served over 100 million low-income patients.
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Continued the work of the landmark 1996 welfare reform
by reauthorizing the Temporary Assistance for Needy Families program
through 2010, including $150 million for the healthy marriage and
responsible fatherhood programs.
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Worked with States to make strong gains in child support
collections, which reached $23.9 billion and served an estimated 16
million child support cases in 2006.
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Implemented the voluntary Medicare prescription drug
benefit, which is projected to have over 25 million enrollees in private
PDPs and MA-PDs and receives consistent satisfaction rates around
75 percent; most recently, a Wall Street Journal poll found satisfaction rates as high as 87 percent.
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Increased enrollment in Medicare private plan options
through the Medicare Advantage program to nine million beneficiaries.
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Promoted quality health care through the expanded
use of health information technology as part of the President’s
goal of most Americans having access to an electronic health record
by 2014.
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Invested more than $9 billion to support public health
systems improvements at the State and local levels and to increase
hospital preparedness against a bioterrorism attack or other public
health emergencies.
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Enhanced readiness of the U.S. Public Health Service
Commissioned Corps, whose officers provide medical and health advice
and services to the American people in times of peace and crisis.
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Strengthened mechanisms for detection of, mitigation
of, and response to biological weapons attacks on the United States
through coordination among Federal agencies and cooperation with State,
local, international, and tribal governments.
Department of Health and Human Services
(Dollar amounts in millions)
|
2007 Actual |
Estimate |
2008 |
2009 |
|
|
|
|
Spending |
|
|
|
Discretionary
Budget Authority: |
|
|
|
Food and Drug
Administration 1 |
1,760 |
1,413 |
1,771 |
Program level (non-add) |
2,029 |
2,270 |
2,400 |
Health Resources
and Services Administration |
6,408 |
6,860 |
5,779 |
Indian Health
Service |
3,180 |
3,347 |
3,325 |
Centers for Disease
Control and Prevention |
5,983 |
6,067 |
5,691 |
National Institutes
of Health |
28,880 |
29,307 |
29,307 |
Substance Abuse
and Mental Health Services Administration |
3,206 |
3,234 |
3,025 |
Agency for Healthcare
Research and Quality |
— |
— |
— |
Program level (non-add) |
319 |
335 |
326 |
Centers for Medicare
and Medicaid Services (CMS) 2 |
3,141 |
3,151 |
3,272 |
Discretionary
Health Care Fraud and Abuse Control |
— |
— |
198 |
Administration
for Children and Families |
13,839 |
14,071 |
13,247 |
Administration
on Aging |
1,383 |
1,411 |
1,381 |
General Departmental
Management |
356 |
354 |
380 |
Office for Civil
Rights |
35 |
34 |
40 |
Office of the
National Coordinator for Health Information
Technology |
42 |
42 |
18 |
Program level (non-add) |
61 |
61 |
66 |
Office of Medicare
Appeals |
60 |
64 |
65 |
Public Health
and Social Services Emergency Fund |
694 |
729 |
1,396 |
Office of the
Inspector General |
40 |
43 |
46 |
All other |
66 |
48 |
−454 |
Total, Discretionary
budget authority |
69,073 |
70,175 |
68,487 |
|
|
|
|
Memorandum: Budget authority from enacted
supplementals |
63 |
307 |
— |
|
|
|
|
Total, Discretionary
outlays |
69,041 |
70,879 |
70,876 |
|
|
|
|
Mandatory Outlays: |
|
|
|
Medicare: |
|
|
|
Existing law 3 |
370,806 |
391,266 |
420,077 |
Legislative proposal 4 |
— |
— |
−12,437 |
Medicaid/SCHIP: |
|
|
|
Existing law |
196,624 |
211,353 |
223,634 |
Legislative proposal 4 |
— |
140 |
500 |
All other programs: |
|
|
|
Existing law |
34,015 |
34,142 |
33,893 |
Legislative proposal |
— |
5 |
329 |
Total, Mandatory
outlays |
601,445 |
636,906 |
665,996 |
|
|
|
|
Total, Outlays |
670,486 |
707,785 |
736,872 |
|
|
|
|
|
Number of Programs |
|
2009 Savings |
Major Savings, Discretionary |
|
|
|
Terminations |
9 |
|
−1,656 |
Reductions |
4 |
|
−1,140 |
|
|
|
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1 2007 and 2008 FDA net budget authority increased
by $186 million and decreased by $307 million, respectively, due to
the timing and availability of user fee collections.
2 Amounts appropriated to the
Social Security Administration (SSA) from the Hospital Insurance and
Supplementary Medical Insurance accounts are included in the corresponding
table in the SSA chapter.
3 Includes $31 million in 2007 and $60 million in 2008 of CMS Program
Management mandatory funding.
4 The costs for the Qualified Individuals proposal ($105
million in 2008 and $270 million in 2009) are included in the Medicaid
totals and excluded from the Medicare totals.
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