Health Reform WK-EDGE GAO aims high with fiscal year 2020 budget request
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Friday, March 8, 2019

GAO aims high with fiscal year 2020 budget request

By Donielle Tigay Stutland, J.D.

The GAO released its fiscal year 2020 budget request—with a request for a $58 million increase for its fiscal 2020 budget, an increase of nearly 10 percent—in part to address rising health care spending, as well as science and technology issues, cyber security developments, and increased investments in the Department of Defense.

On February 27, 2019, U.S. Comptroller General Gene Dodaro presented the Government Accountability Office’s (GAO) 2020 fiscal year (FY) budget request to Congress. In order to increase its capacity, the GAO requested a $58 million increase for its FY 2020 budget—an increase of nearly 10 percent. For 2020, the GAO is requesting $646.6 million in appropriated funds, and authority to use $38.3 million in offsetting receipts and reimbursements. Dodaro also noted that in FY 2018, the GAO’s work yielded a record $75.1 billion in financial benefits, a return of about $124 for every dollar invested in the GAO. The office also identified 1,294 other benefits that led to improved services and public safety programs and operational improvements across the government (GAO Report, GAO-19-403T, February 27 2019).

The report noted that the GAO supports congressional oversight across a wide array of government programs and operations. In particular, for FY 2020, the report provides ways that the GAO would increase its capabilities to review the opportunities and challenges associated with four key areas: evolving science and technology issues; the risks and management needs to address complex and growing cyber security developments; increased investments in the Department of Defense; and rising health care costs.

Managing Rising Health Care Costs. With rising health care costs contributing to the increase in fiscal spending, the budget proposal outlined where the GAO has previously allocated resources with respect to health care and how the GAO will continue to deliver health care services.

The report noted that growth in federal spending for health care has historically exceeded growth of the GDP and is projected to continue to grow faster than the economy. Federal health care spending supports the following programs, Medicare, Medicaid, the Children’s Health Insurance Program, as well as subsidies for the health insurance purchased through the marketplaces established by the Patient Protection and Affordable Care Act (ACA) and related spending. In particular, Medicaid and Medicare are each projected to top $1 trillion in annual expenditures within the next decade.

The report notes that increases in federal health care spending are due to rising per person spending costs and increased enrollment, in part caused by the aging of the population.

The report also identified health care areas of risk for the GAO. The 2017 Biennial High Risk Report identified Indian Health Service as a high risk area, joining the following other high risk areas related to health care: Medicare, Medicaid, the FDA, and the Department of Veteran Affairs Health Care. As such, the GAO will continue to identify and focus on such emerging and continuing high risk areas within the health care industry.

The report pointed out that the increased budgetary request is also to address informal requests for assistance with health care policy and programs. In 2018 the GAO, had increased demand for this type of assistance due to complex health care policy changes and considerations regarding committee changes. The GAO’s response to these changes were such things as providing subject matter experts to help answer detailed questions as well as providing time-sensitive data analysis. The GAO is also responsible for appointing members to health-related commissions, and resources go towards the office’s careful consideration of such appointments, using a high degree of professional judgment and a significant amount of time by senior health care staff within the office.

The report pointed out that with additional resources would allow the GAO to respond more quickly to congressional requests related to health care issues, such as focusing on examining the growth of Medicaid and Medicare spending relative to other components of the health care system, in particular looking at policies that drive excess and inappropriate utilization of services. The GAO will also continue to examine how these health care programs and markets affect the daily lives of Americans, with specific examinations into: the complexities of the prescription drug market; the ongoing opioid epidemic; and a high risk designation of veterans’ health care issues.

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