ACP Recommendations on the FY '05 Budget Resolution

Letter sent to entire House Budget Committee

March 9, 2004

The Honorable Brian Baird
1421 Longworth House Office Building
Washington, DC 20515
Via Fax: (202) 225-3478

Dear Congressman Baird:

As the House Budget Committee prepares to begin work on the FY 2005 budget resolution, I am pleased to share the following views and recommendations of the American College of Physicians (ACP). ACP is the largest medical specialty society in the United States, representing 115,000 doctors of internal medicine and medical students.

Uninsured, Medicaid and S-CHIP

ACP strongly urges that the House Budget Resolution include sufficient funding and reconciliation instructions for addressing the serious problem of uninsured Americans this year. The issue of uninsured Americans is not only devastating to families without insurance, but also impacts every American because of the added costs to the healthcare system. The College advocates adoption of H.R. 2402, the bipartisan Health Coverage, Affordability, Responsibility, and Equity Act of 2003 (HealthCARE Act). This legislation, introduced by Representative Steve LaTourette (R-OH) and Marcy Kaptur (D-OH) includes the best available solutions offered by Democrats and Republicans to address the issue of the uninsured.

The proposals in the HealthCARE Act are sensible and achievable approaches to expanding health insurance coverage. Specifically, this bill would give states new options to expand state programs that cover the poor without imposing unfunded federal mandates or undermining existing safety net programs. The bill also creates a program of refundable tax credits that will allow eligible consumers to purchase insurance from a wide choice of private sector health plans offered by state purchasing pools modeled after the Federal Employees Health Benefit Program (FEHBP).

These measures provide a practical roadmap for expanding coverage to uninsured working Americans with incomes up to two hundred percent of the federal poverty level. Therefore, we respectfully request that the Budget Resolution include sufficient funding for tax credits that are a real option for low income families and individuals, as well as expansion of public programs that have a proven track record of expanding health insurance to children and families.

The College also strongly opposes reconciliation instructions that would direct reductions in funding for the Medicaid program as part of the fiscal year 2005 Budget Resolution. As you know, states are just beginning to recover from the worst fiscal crisis since World War II, and federal cuts to the Medicaid program will further weaken the health care safety net that is already under tremendous strain. Medicaid cuts will have a devastating impact on the ability of physicians to serve the most vulnerable populations in their communities including seniors, children, pregnant women and the disabled.

ACP also urges that the Budget Resolution include reconciliation instructions directing that unspent S-CHIP funds be retained and redistributed to the states rather than reverting to the treasury. The S-CHIP program is vital to ensuring that our nation's children have access to health insurance coverage.

Discretionary Spending Caps and Function 550 Programs

The College strongly supports the essential health programs funded in Section 550 of the budget resolution. There is strong justification for fully funding these vital programs that advance medical research, help translate that research into practice, train health professionals to provide basic primary care services in rural and urban underserved areas, and protect the public from the spread of disease and unsafe food. Funding for the Agency for Healthcare Research and Quality (AHRQ) and Title VII Health Professions programs are of particular concern to the College:

  • The work of AHRQ helps to ensure that advancements in medical research are fully utilized where patient care is delivered. AHRQ encourages the use of "best practices" to advance quality, improve access and conserve scarce health resources. The agency has contributed significantly to our knowledge of patient safety and will be a driver in the advancement of electronic health technology in the healthcare system.

  • The training and education provided by Title VII Health Professions programs has proved vital in filling an unacceptable deficit of primary care services in underserved areas. Title VII programs also advance racial and ethnic diversity in the health care workforce that is essential to the elimination of unacceptable health disparities in this country.

ACP believes that discretionary spending caps would be inadvisable at this time. Investment in public health programs is crucial to our overall efforts to address escalating health care costs and growing numbers of uninsured. Great harm to the nation's health could result if the ability of Congress to address new problems and priorities is limited as proposed through 2009.

Veterans Health Care

The College supports sufficient funding for the health care needs of our nation's veterans. We are pleased that the Senate Budget Resolution, currently being debated on the floor of the Senate, increases budget authority and outlays for Veterans benefits and services for FY 2005. We strongly support the decision by the Senate Budget Committee not to include the President's proposed reduction in Medical and Prosthetic Research. Likewise, we are also pleased that the Senate did not include the President's proposal to establish new enrollment fees or to increase insurance and prescription drug co-payments for certain classes of veterans. We hope that the House Budget Resolution will also provide sufficient funding for Veterans health care and avoid reconciliation instructions that direct new user fees and co-payments.

Medicare User Fees

The administration's budget would impose new user fees on physicians and others who appeal Medicare claim denials to Qualified Independent Contractors (QIC). The budget also proposes to charge user fees for submitting duplicate or unprocessable claims, a proposal that has repeatedly been rejected by the Congress. Together the new fees would cost physicians and others who serve America's seniors more than $1.1 billion over the next five years.

The College urges Congress not to include these fees in the assumptions underlying the Medicare spending totals in the budget resolution that the Committee will report. Imposition of new Medicare user fees would amount to a hidden tax on physicians and other healthcare providers. Seniors' access to health care could be threatened by making it more difficult for physicians who treat them to participate in the program.

The proposal to charge a fee whenever QIC appeals are filed seems particularly poorly timed given the enactment of legislation late last year that made the most sweeping changes to the Medicare program in forty years. It is expected that there will be an increase in the numbers of appeals filed as beneficiaries, physicians and other providers learn and adjust to these changes. Physicians often file appeals on their patients' behalf. The imposition of this user fee could hamper seniors' access to full review of denials of claims for coverage of services.

Thank you for your consideration of ACP's views.

Sincerely,

Munsey S. Wheby, MD, FACP
President

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