Health Reform WK-EDGE Administration budget requests Medicare and Medicaid reductions, HIV funding
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Tuesday, March 19, 2019

Administration budget requests Medicare and Medicaid reductions, HIV funding

By Cathleen Calhoun, J.D.

Could HIV be eliminated in the US by 2030?

The Trump Administration’s FY 2020 budget proposes reductions in Medicare and Medicaid over 10 years, continual financing to advance regulations for the oversight of e-cigarettes and combat the opioid crisis, and new funding dedicated to the elimination of the HIV epidemic in America by 2030, among other requests. The document, which is a statement of administrative priorities and has no force of law unless acted upon by Congress, also proposes funds to implement provisions to lower the cost of prescription drugs, to reform the individual market for health insurance, to strengthen individuals’ economic and social well-being, and to make advances in the sciences. Members of the administration praised the budget, including the FDA commissioner, while others predicted that it would be rejected by Congress.

Medicare and Medicaid. The budget proposal creates an out-of-pocket cap in Medicare Part D to lower senior’s out-of-pocket expenses. The proposal provides the HHS Secretary with authority to consolidate certain drugs currently covered under Part B into Part D when savings can be gained from price competition, among other changes. The budget for Medicaid gives more flexibility to the states. For example, Medicaid regulations implementing the Affordable Care Act (ACA) (P.L. 111-148) increased the federal match rate for Medicaid eligibility workers to 75 percent by linking costs to state system operation. The proposal would phase down this match rate to 50 percent by 2024.

The budget seeks to expand value-based payments in Medicare. Two of the reforms proposed are: (1) a value-based purchasing program for hospital outpatient departments and ambulatory surgical centers; and (2) a consolidated hospital quality program in Medicare to reduce requirements.

Opioid crisis. Allowing states to provide full Medicaid benefits for one-year postpartum for pregnant women diagnosed with a substance use disorder is proposed. Collaboration between CMS and the Drug Enforcement Administration (DEA) is also proposed to stop providers from prescribing opioids inappropriately. Over 399,000 people have died from overdoses involving prescription or illicit opioids in the United States from 1999 to 2017.

HIV. Accelerating public health strategies, with the goal of reducing new HIV infections by 90 percent within 10 years, is proposed through new funding. Patients receiving medical care through the Ryan White HIV/AIDS Program (RWHAP) were virally suppressed at a record level of 85.9 percent in 2017. The budget includes new funds for RWHAP within the Health Resources and Services Administration (HRSA) to increase direct health care and support services, in the hope of further increasing viral suppression.

Other items. The budget calls for strengthening economic and social well being as well as making sustained advances in the sciences. Among the changes, the budget proposes to:

  • strengthen the Indian Health Service (IHS);
  • support investment to accelerate pediatric cancer research; and
  • increase investment in health care fraud.

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