[Budget of the United States Government]
[VI. Investing in the Common Good: Program Performance in Federal Functions]
[23. Health]
[From the U.S. Government Publishing Office, www.gpo.gov]
23. HEALTH
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Table 23-1. FEDERAL RESOURCES IN SUPPORT OF HEALTH
(In millions of dollars)
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Estimate
Function 550 1998 -----------------------------------------------------------
Actual 1999 2000 2001 2002 2003 2004
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Spending:
Discretionary Budget Authority.......... 26,386 30,070 30,611 30,971 30,846 30,836 30,836
Mandatory Outlays:
Existing law.......................... 106,588 115,481 122,769 131,625 141,724 152,964 165,038
Proposed legislation.................. ........ 8 -52 693 828 890 683
Credit Activity:
Direct loan disbursements............... ........ ........ ........ N/A N/A N/A N/A
Guaranteed loans........................ 94 73 48 N/A N/A N/A N/A
Tax Expenditures:
Existing law............................ 80,545 85,810 91,795 97,885 104,410 111,640 119,660
Proposed legislation.................... ........ ........ 59 1,235 1,281 1,423 1,577
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N/A = Not available
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In 2000, the Federal Government will spend about $152 billion and
allocate about $92 billion in tax incentives to provide direct health
care services, promote disease prevention, further consumer and
occupational safety, conduct and support research, and help train the
Nation's health care work force. Together, these Federal activities will
contribute to considerable progress in extending life expectancy,
cutting the infant mortality rate to historic lows, preventing and
eliminating infectious diseases, improving treatment and quality of
care, and improving the quality of life for individuals suffering from
chronic diseases and disability. Estimated life expectancy reached a
record-high of 76.5 years for those born in 1997, and infant mortality
has reached a record low of 7.1 infant deaths per 1,000 live births, an
eight-percent reduction from the previous year. Age-adjusted death rates
associated with HIV/AIDS fell 47 percent from 1996 to 1997, and the 1997
rate of 5.9 deaths per 100,000 is the lowest since mortality data have
been available.
The Department of Health and Human Services (HHS), the Federal
Government's lead agency for health, aims: ``to enhance the health and
well-being of Americans by providing for effective health and human
services and by fostering strong, sustained advances in the sciences
underlying medicine, public health, and social services.'' This mission
is supported by the following strategic goals: (1) Reduce the major
threats to health and productivity of all Americans; (2) Improve the
economic and social well-being of individuals, families, and communities
in the United States; (3) Improve access to health services and ensure
the integrity of the Nation's health entitlement and safety net
programs; (4) Improve the quality of health care and human services; (5)
Improve public health systems; and (6) Strengthen the Nation's health
sciences research enterprise and enhance its productivity.
Health Care Services and Financing
Of the estimated $152 billion in Federal health care outlays in 2000,
88 percent finances or supports direct health care services to
individuals.
Medicaid: This Federal-State health care program served about 33
million low-income Americans in 1998, the latest year for which
statistics are currently available The Federal
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Government spent $101 billion, 57 percent of the total, on the program
in 1998 while States spent $76 billion, or 43 percent. States that
participate in Medicaid must cover several categories of eligible
people, including certain low-income elderly, women, and children, and
people with disabilities, as well as several mandated services,
including hospital care, nursing home care, and physician services.
States also may cover optional populations and services. Under current
law, Federal experts expect total Medicaid spending to grow an average
of 7.7 percent a year from 2000 to 2004.
Medicaid covers a fourth of the Nation's children and is the largest
single purchaser of maternity care as well as of nursing home services
and other long-term care services; the program covers almost two-thirds
of nursing home residents. The elderly and disabled made up less than a
third of Medicaid beneficiaries in 1997, but accounted for almost two-
thirds of spending on benefits. Other adults and children made up over
two-thirds of recipients, but accounted for less than a third of
spending on benefits. Medicaid serves at least half of all adults living
with AIDS (and up to 90 percent of children with AIDS), and is the
largest single payer of direct medical services to adults living with
AIDS. Medicaid pays for over one-third of the nation's long-term care
services. Medicaid spends more on institutional care today than it does
for home care, but the mix of payment will be almost equal in 10 years.
Enrollment in Medicaid managed care arrangements rose from 7.8 million
in 1994 to approximately 15 million in 1997. In 1998, the Federal
Government proposed regulations to improve the quality of care and
patient protections for Medicaid beneficiaries enrolled in managed care
plans.
Because the Health Care Financing Administration (HCFA) and States
jointly administer Medicaid, HCFA must consult with State Medicaid
agencies to develop and test national performance goals for Medicaid.
Understanding that Federal and State Medicaid funding must result in
improved health conditions and quality of care for children and low-
income families, the State agencies are working with HCFA to define
performance goals and measures that are measurable. The States and HCFA
have agreed to increase immunization rates among needy children, to
increase the number of children enrolled in the Children's Health
Insurance program and Medicaid, and to increase enrollment of dually-
eligible Medicare beneficiaries, for example. State cooperation with the
Federal GPRA program will produce quantifiable national goals and
measures during 1999, for 2000 and beyond.
Children's Health Insurance Program: More than 11 million American
children lack health insurance. To increase the number of children with
insurance, the Children's Health Insurance Program (CHIP) was
established in 1997 to provide $24 billion over five years for States to
expand health insurance coverage to low-income, uninsured children. CHIP
provides States with broad flexibility in program design while
protecting beneficiaries through basic Federal standards. In the
program's first year, States have expanded Medicaid, created separate
State programs, and developed programs that combine the two.
A State receives CHIP funding after HCFA approves its child health
plan. Nearly every State submitted and received approval of its State
CHIP plan in 1998. These plans describe the strategic objectives,
performance goals, and performance measures used to assess the
effectiveness of the plan. In addition, HCFA is working with the States
to develop baselines and targets for the CHIP/Medicaid goal as well as
to develop additional goals for CHIP:
Decrease the number of uninsured children by working with
States to implement CHIP and by enrolling children in
Medicaid. In 1999, HCFA will work with the States to establish
performance measurement baselines and performance targets.
Other Health Care Services: HHS supplements Medicare and Medicaid with
a number of ``gap-filling'' grant activities to support health services
for low-income or specific populations, including Consolidated Health
Center grants, Ryan White AIDS treatment grants, the Maternal and Child
Health block grant, Family Planning grants, and the Substance Abuse
block grant. In addition, the Indian Health Service (IHS) delivers
direct care to
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about 1.4 million American Indians and Alaska Natives. In 2000, the
following agencies will work to meet the following goals:
IHS: Increase the proportion of women who have annual pap
screening to 55 percent, from the 1997 baseline of 43 percent.
Substance Abuse and Mental Health Services Administration
(SAMHSA): Reverse the upward trend and cut monthly marijuana
use among 12 to 17-year-olds by 25 percent, from the 1995
baseline of 8.2 percent to 6.2 percent by the end of 2002.
Health Resources and Services Administration (HRSA): Increase
the number of AIDS Drug Assistance Program (ADAP) clients
receiving appropriate anti-retroviral therapy (consistent with
clinical guidelines) through State ADAPs during at least one
month of the year, to a projected monthly average of 82,200 by
the year 2000. This would constitute a 49 percent increase
over the 1998 baseline of 55,000.
HRSA: Increase the number of women served by family planning
clinics by at least two million over the 1995 baseline of 4.5
million women served.
Agency for Health Care Policy and Research: Release and
disseminate Medical Expenditure Panel Survey (MEPS) data and
associated products to the public within nine to 12 months of
data collection.
Consumer Product Safety Commission (CPSC): CPSC, an
independent agency, will reduce product-related head injuries
to children by 10 percent in 2000, from a 1997 level of
650,000.
Public Health Initiative for the Uninsured: HHS has established a new
initiative to increase the capacity and effectiveness of the Nation's
health care safety-net in ways that increase the number of uninsured
people receiving needed health care and improve the quality of care that
is received.
HHS has set the following performance goals for the year 2000 and
beyond:
Increase the number of new integrated health services networks
that are providing care using report card information to
integrate and improve health services for the uninsured.
Increase the number of uninsured people receiving primary
care, mental health, substance abuse, and other health
services and expand the number of services supported.
Reduce, where appropriate, hospital admissions for ambulatory
care-sensitive conditions for uninsured people living in
project service areas.
Strengthening Graduate Medical Education at the Nation's Children's
Hospitals: The budget includes a significant new investment in training
pediatric care-givers at the Nation's free-standing children's
hospitals. In 2000, this program has the following two goals:
Increase the number of pediatric care-givers receiving
training; and Increase the number of children with acute
illnesses receiving appropriate care in their communities.
Prevention Services: Measures to protect public health range from
providing sanitation to prevent bacteria from developing resistance to
antibiotics. State and local health departments traditionally lead such
efforts, but the Federal Government--through HHS' Centers for Disease
Control and Prevention (CDC)--also provides financial and technical
support.
Working with HCFA, CDC will continue to help States ensure
that at least 90 percent of all U.S. children by age two
receive each recommended basic childhood vaccine.
With FDA and SAMHSA, CDC will work to reduce the number of
children in grades nine through twelve who smoke from 36.4
percent to 21 percent by 2010 by conducting education
campaigns, providing funding and technical assistance to state
programs, and working with nongovernmental entities.
CDC will increase purchase of vaccines in support of the
World Health Organization's goal to eliminate polio globally
by December 31, 2000.
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Public Health Electronic Surveillance: Increase the number of State
and local health departments that have integrated their electronic
surveillance systems for infectious disease, food safety, and
bioterrorism, and have electronic linkages to the medical community.
Bioterrorism: While research and product regulation are primarily
Federal roles, enhancing surveillance, epidemiologic capabilities, and
laboratory capacities, and medical response systems, are activities
where the Federal government can work in partnerships with states,
providing leadership and funding early in this multi-year effort. States
should be expected to assume more responsibility for their share of
partnership expenses over time.
Implement the plan developed in 1999 to ensure ready
availability of a national pharmaceutical stockpile to respond
to terrorist use of potential biological or chemical agents,
including the ability to protect four million civilians from
an anthrax attack.
Develop blood and urine analytical chemistry methods that
will rapidly measure 50 chemicals likely to be used in
chemical terrorism.
Create a network of twelve state or major city laboratories
to provide rapid and accurate diagnostic and/or reference
support for 10-15 select biologic agents.
Biomedical Research: The National Institutes of Health (NIH) supports
and conducts research to gain knowledge to help prevent, detect,
diagnose, and treat disease and disability. NIH conducts research in its
own laboratories and clinical facilities; supports research by non-
Federal scientists in universities, medical schools, and hospitals
across the Nation, and helps train research investigators. NIH supports
over 50,000 grants to universities, medical schools, and other research
and research training institutions while conducting over 1,200 projects
in its own laboratories and clinical facilities. Examples of recent
research advances include new discoveries of genes associated with
diseases, including a form of Parkinson's disease that occurs early in
life; discovery that a drug used to treat breast cancer can also reduce
breast cancer in high-risk women; and the use of high-energy X-rays to
visualize how HIV begins to attack the body's immune system. NIH
performance goals for the next century of research, include:
increasing the rate of sequencing to 190 million base pairs a
year in 2000 in order to complete the human genome sequencing
project by 2003; and
promoting private sector participation and investment in
applications of novel research discoveries by increasing the
number of executed cooperative development agreements by five
percent over the 1998 level.
Additionally, NIH is leading the national effort to meet the
President's goal of developing an AIDS vaccine by 2007.
Public Health Regulation and Safety Inspection: The Food and Drug
Administration (FDA) spends $1 billion a year to promote public health
by helping to ensure that foods are safe, wholesome, and sanitary; human
and veterinary drugs, biological products, and medical devices are safe
and effective; and cosmetics and electronic products that emit radiation
are safe. It leads Federal efforts to ensure the timely review of
products and ensure that regulations enhance public health, and not
serve as an unnecessary regulatory burden. In addition, the FDA supports
research, consumer education, and the development of both voluntary and
regulatory measures to ensure the safety and efficacy of drugs, medical
devices, and foods.
To speed the review process, FDA has set the following performance
goals for 2000:
review and process 90 percent of complete new drug
applications within a year of submission;
review and process 85 percent of new medical device
applications (know as pre-market applications) within 180
days, compared to 79 percent in 1997. To give the public
useful health information, FDA has set the following
performance goal:
Ensure that, by the year 2000, 75 percent of consumers
receiving new drug prescriptions will get more useful and
readable information about their product.
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The Food Safety and Inspection Service (FSIS) in the U.S. Department
of Agriculture uses $600 million annually to inspect the Nation's meat,
poultry, and egg products, ensuring that they are safe, wholesome, and
not adulterated. In 1996, FSIS began implementing a modernized
inspection system, Hazard Analysis and Crisis Control Point (HACCP)
system, that will begin shifting responsibility for ensuring meat and
poultry safety from FSIS to the industry. Together with FSIS, HHS has
the following food safety goals:
By 2000, 99 percent of Federally-inspected meat and poultry
plants will comply with the HACCP.
80 percent of the domestic seafood industry will be operating
preventive controls for safety as evidenced by functioning
HACCP systems.
Increase the frequency of inspection of high-risk domestic
food establishments to once every year, from once every three
to four years.
More than double the number of inspections conducted of
foreign food processors from 100 to 250.
Establish and enhance eight active FoodNet food-borne
surveillance sites. Expand state health department capacity to
subtype and rapidly exchange information using PulseNet for
E.coli (currently 29 labs) and Typhimurium Salmonella
(currently 15 labs) to 40 labs for each.
Increase the number of outbreaks of diarrheal and/or food
borne illness that will be detected and investigated to 24.
Workplace Safety and Health
The Federal Government spends $620 million a year to promote safe and
healthy workplaces for over 100 million workers in six million
workplaces, mainly through the Labor Department's Occupational Safety
and Health Administration (OSHA) and Mine Safety and Health
Administration (MSHA). Regulations that help businesses create and
maintain safe and healthy workplaces have significantly cut illness,
injury, and death from exposure to hazardous substances and dangerous
employment. In 1997, workplace injuries and illnesses fell to the lowest
rate on record.
To improve workplace safety and health for all workers, by
September 30, 2000, OSHA will: (1) reduce injury/illness rates
20 percent in at least 50,000 of the most hazardous
workplaces; and (2) initiate investigation of 95 percent
worker complaints within one working day or conduct an on-site
inspection within five working days.
MSHA will, in 2000, reduce fatalities and lost workdays in all
mines to below the average number recorded for the previous
five years. From 1993-1997, there was an average of 95.8
fatalities and 4.29 lost workdays.
Federal Employees Health Benefit Program (FEHBP)
Established in 1960, the FEHBP is America's largest employer-sponsored
health benefit program, providing $17 billion in health care benefits a
year to about nine million Federal workers, annuitants, and their
dependents. About 85 percent of all Federal employees participate in the
FEHBP, and they select from nearly 300 health care plans. The Office of
Personnel Management administers the FEHBP. By the year 2000, the FEHBP
will be fully compliant with the President's Patients' Bill of Rights.
The Patients' Bill of Rights is an Administration initiative to provide
health care consumers with rights of information disclosure, choice of
providers and plans, access to emergency services, participation in
treatment decisions, respect and nondiscrimination, confidentiality of
health information, and rights of complaint and appeal.
Tax Expenditures
Federal tax laws help finance health insurance and care. Most notably,
employer contributions for health insurance premiums are excluded from
employees' taxable income. In addition, self-employed people may deduct
a part (60 percent in 1999, rising to 100 percent in 2003 and beyond) of
what they pay for health insurance for themselves and their families.
Total health-related tax expend
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itures, including other provisions, will reach an estimated $91.8
billion in 2000, and $525 billion from 2000 to 2004. The exclusion for
employer-provided insurance and related benefits (including deductions
by the self employed) accounts for most of these costs ($79 billion in
2000 and $455 billion from 2000 to 2004).