[Budget of the United States Government]
[III. Creating a Better Government]
[12. Health]
[From the U.S. Government Publishing Office, www.gpo.gov]


 
                               12.  HEALTH

  ----------------------------------------------------------------------

                               Table 12-1.  Federal Resources in Support of Health
                                            (In millions of dollars)
----------------------------------------------------------------------------------------------------------------
                                                                               Estimate
               Function 550                   2000   -----------------------------------------------------------
                                             Actual     2001      2002      2003      2004      2005      2006
----------------------------------------------------------------------------------------------------------------
Spending:
  Discretionary Budget Authority..........    33,823    38,858    41,008    45,663    46,882    48,130    49,397
  Mandatory Outlays:
    Existing law..........................   124,521   138,710   152,363   168,913   183,636   199,672   216,553
    Proposed legislation..................  ........     2,500    10,675    13,743    14,571     4,265       121
Credit Activity:
  Guaranteed loans........................         5        32        21        21        22        22        23
Tax Expenditures:
  Existing law............................    91,080    99,750   108,620   117,750   127,500   136,810   147,080
----------------------------------------------------------------------------------------------------------------

  ----------------------------------------------------------------------
   In 2002, the Federal Government will spend about $193 billion under 
existing law and allocate nearly $109 billion in tax incentives to 
provide direct health care services, promote disease prevention, further 
consumer and occupational safety, and conduct and support research. 
These Federal activities aim to improve the health of Americans as 
evidenced by key health statistics such as life expectancy and infant 
mortality. In addition, in 2002 Federal health programs will continue 
efforts to research and understand the causes of diseases such as cancer 
and diabetes, as well as to reduce the incidence of HIV and other 
infectious diseases. The Department of Health and Human Services (HHS), 
as the Federal Government's lead agency for health, will undertake a 
thorough examination across the entire Department to become more 
efficient and ensure a streamlined, rationalized budget and program 
structure.

Health Care Services and Financing

  Of the estimated $193 billion in Federal health care spending in 2002, 
84 percent finances or supports direct health care services to 
individuals.

  Immediate Helping Hand (IHH): The Immediate Helping Hand initiative 
provides critical assistance to our Nation's most vulnerable senior 
citizens for the cost of their prescription drugs. It provides $46.0 
billion for 2001-2005 to States to help low-income Medicare 
beneficiaries pay for their prescriptions. This proposal builds on 
coverage that is already in place in more than half the States and would 
provide benefits to 9.5 million vulnerable Medicare beneficiaries who 
currently do not have any other prescription drug coverage. The plan is 
unique because needy seniors will be able to get help with their 
prescription drug costs this year.
  IHH covers the full cost of drug coverage for individual Medicare 
beneficiaries with incomes up to $11,600 who are not eligible for 
Medicaid or a comprehensive private retiree benefit, and for married 
couples with incomes up to $15,700 (135 percent of poverty) who do not 
have access to coverage. These beneficiaries would receive comprehensive 
drug insurance for no premium with nominal charges for prescriptions.
  IHH covers part of the drug costs for individual Medicare 
beneficiaries with incomes up to $15,000 and married couples with 
incomes up to $20,300 (175 percent of poverty). These beneficiaries 
would receive subsidies for at least 50 percent of the premium for drug 
coverage.

[[Page 98]]

  IHH also provides catastrophic drug coverage for all Medicare 
beneficiaries, giving them financial security against the risk of very 
high out-of-pocket prescription expenditures.

  Medicaid: This Federal-State health care program served about 33.4 
million low-income Americans in 2000. States that participate in 
Medicaid must cover several categories of eligible people as well as 
several mandated services. The Federal Government spent $117.9 billion, 
57 percent of the total, on the program in 2000 while States spent $89.1 
billion, or 43 percent. 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 a third of Medicaid enrollees in 2000, but 
accounted for approximately two-thirds 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 and community-
based care, but the mix of payments is expected to be almost equal in 10 
years.
  Current restrictions and requirements in the Medicaid program may be 
inhibiting the States' ability to operate the program efficiently. In 
addition to taking steps to further address the Medicaid upper payment 
limit loophole, the Administration plans to consult with the States on 
the development of ideas to increase State flexibility, control Medicaid 
costs, improve Medicaid coverage, and ensure the fiscally prudent 
management of the Medicaid program.
  A major Administration priority is to improve the quality of Medicaid 
coverage. Because the Health Care Financing Administration (HCFA) and 
States jointly administer Medicaid, HCFA has worked with State Medicaid 
agencies to develop national performance goals for Medicaid. These 
efforts will continue in 2002. With respect to the goal of increasing 
immunization rates among Medicaid children, HCFA will continue to 
collaborate with States to develop individualized State immunization 
goals, with each State developing its own methodology, baseline, and 
three-year target. In 2002, the first and second groups of States will 
report their progress towards their State goals, and the final group of 
States will establish their baselines and targets. HCFA's goal 
complements the Centers for Disease Control and Prevention's (CDC's) 
broader 2002 goal of helping States ensure that at least 90 percent of 
all U.S. children by age two receive each recommended basic childhood 
vaccine.

  State Children's Health Insurance Program: The State Children's Health 
Insurance Program (S-CHIP) was established in 1997 in the Balanced 
Budget Act to provide $24 billion over five years for States to expand 
health insurance coverage to low-income, uninsured children. S-CHIP 
provides States with broad flexibility in program design while 
protecting beneficiaries through basic Federal standards.
  Each State's S-CHIP plan describes the strategic objectives, 
performance goals, and performance measures used to assess the 
effectiveness of the plan. HCFA has been working with the States to 
develop baselines and targets for the S-CHIP/Medicaid goal of decreasing 
the number of uninsured children by enrolling children in S-CHIP and 
Medicaid. In 2000, 3.3 million children were enrolled in S-CHIP, a 70-
percent increase over 1999 levels. However, more than twice as many 
children remain uninsured.

  Other Health Care Services: In addition to Medicare and Medicaid, HHS 
administers a number of other programs, some of which have been added to 
the inventory of HHS activities over the last several years. As a 
result, HHS has evolved into a sprawling, loosely organized bureaucracy 
where several programs are serving similar populations. During 2002, HHS 
will ensure strong centralized control and coordination to eliminate 
overlap and duplicative activities. Selected health-related 2002 
performance goals are highlighted below.
   Access to health care: The budget includes a Community and 
          Migrant Health Center (CMHC) initiative to increase access to

[[Page 99]]

          health care by supporting 1,200 new and expanded community 
          health center sites over five years. In 2001, 3,263 CMHC sites 
          delivered high quality, culturally competent care to millions 
          of uninsured and underserved Americans. In 2002, the number of 
          health center sites will increase by almost 100. By increasing 
          the number of health care access points, CMHCs will be able to 
          help assure the provision of preventive and primary health 
          care to almost one million more individuals than were served 
          in 2001.
   Healthy Communities Innovation Fund (HCIF): The 2002 Budget 
          includes an HHS-wide HCIF initiative that will make available 
          approximately $400 million within existing grant activities to 
          target innovative solutions in areas of health risks such as 
          heart disease, adult and childhood Type II diabetes, and 
          childhood obesity. HHS will ensure that the best and broadest 
          range of innovative solutions are funded across the country.
   Indian Health Service (IHS): IHS is committed to addressing 
          the major health problems afflicting Native Americans and 
          Alaska Natives and has targeted diabetes because of the high 
          prevalence of this disease in this population. IHS' efforts in 
          disease monitoring, prevention education, and treatment focus 
          on improving the average blood sugar levels of IHS' diabetic 
          patients. In 2002, IHS will demonstrate a continued trend in 
          improved glycemic control in the proportion of Native American 
          patients with diagnosed diabetes.
   Substance Abuse and Mental Health Services Administration 
          (SAMHSA): SAMHSA is committed to narrowing the treatment gap 
          between those in need of treatment and those with access to 
          it, which is almost three million individuals. SAMHSA also 
          seeks positive, measurable outcomes for those people who do 
          receive treatment. By 2007, SAMHSA expects that those who 
          complete substance abuse treatment programs will achieve a 10-
          percent increase in full-time employment status, a 10-percent 
          increase in educational status for adolescents, a 10-percent 
          decrease in illegal activity, and a 10-percent increase in 
          general medical health.
   Youth drug treatment: While drug use among youth increased 
          for much of the last decade, there has been some encouraging 
          news in the most recent data. The percent of youths age 12 to 
          17 who reported current use of illicit drugs decreased from 
          11.4 percent in 1997 to nine percent in 1999. In 2002, SAMHSA 
          will aim to cut monthly marijuana use in this population by 25 
          percent, from the 1998 baseline of 8.3 percent to 6.2 percent.
   Services for the mentally ill: The Surgeon General's 1999 
          report on mental health states that one in five Americans is 
          living with a mental health disorder. Mental health services 
          funded in SAMHSA will advance the goal of increasing the 
          percent of adults with serious mental illness who are 
          employed, are living independently, and have had no contact 
          with the criminal justice system.

  Consumer Product Safety Commission (CPSC): In 1999, there were an 
estimated 670,000 product-related head injuries to children under 15 
years old. As a part of CPSC's effort to reduce head injuries by 10 
percent by 2006, this independent agency recalled or took corrective 
actions on 20 products in 1999 and 32 in 2000 that presented a 
substantial risk of head injury. In 2002, CPSC projects pursuing another 
30 recalls or corrective actions of products that present substantial 
risk of head injury.
  Bioterrorism: HHS' Office of Emergency Preparedness will work with 
localities to establish 25 new Metropolitan Medical Response Systems, 
which develop and link local public health, public safety, and health 
services capabilities to respond to a chemical/biological/nuclear 
terrorist incident, for a total of 122 systems in various stages of 
development by the end of 2002. HHS will spend $52 million in 2002 on a 
civilian stockpile of therapeutics to meet potential threats caused by 
the agents listed in the 1999 Antibioterrorism Plan: anthrax, plague, 
tularemia, smallpox, and nerve and blister agents. In 2002, HHS plans to 
meet preparedness targets for treating victims of these agents as 
specified in the Plan. Two new agents have been added to the list, and 
HHS

[[Page 100]]

has begun determination of both treatment methods and victim numbers for 
these agents. Preparedness percentages will rise each year, with an 
expected readiness level of 100 percent to be reached for each agent on 
the list, including the two new agents, by 2004.
  HHS' HIV/AIDS Prevention and Care Activities: HHS spends approximately 
$2.7 billion for the Centers for Disease Control and Prevention (CDC) 
and the Health Resources and Services Administration (HRSA) to prevent 
the spread of HIV/AIDS both domestically and increasingly, 
internationally, and provide appropriate treatment for those living with 
HIV/AIDS.
   By 2005, CDC will reduce the incidence of new HIV infections 
          in the United States by 50 percent, from 40,000 in 1999 to 
          20,000 in 2005. As part of its efforts to achieve this goal, 
          CDC will reduce the number of new infections by approximately 
          six percent by 2002.
   Internationally, working with other countries, the U.S. 
          Agency for International Development, and international and 
          U.S. Government agencies, CDC will reduce the number of new 
          infections among 15 to 24 year-olds in sub-Saharan Africa from 
          an estimated two million, by 25 percent by 2005.
   There are an estimated 800,000 to 900,000 persons in the 
          United States living with HIV infection, two-thirds of whom 
          are aware of their status. HRSA's Ryan White CARE Act 
          treatment efforts will increase the number of AIDS Drug 
          Assistance Program (ADAP) clients receiving HIV/AIDS 
          medications during at least one month of the year through 
          State ADAPs from 65,387 in 2000 to approximately 72,000 
          clients in 2002.

  Centers for Disease Control and Prevention: CDC is the leading 
prevention agency within the public health service and focuses on 
preventing and controlling disease, injury and disability. CDC's 
activities cover a broad range of programmatic areas from childhood 
immunizations to HIV/AIDS prevention to occupational safety and health 
research to infectious disease control and chronic disease prevention. 
In 2002, CDC will continue its efforts to improve State and local public 
health capacity to detect and respond to emerging infectious diseases. 
Fifty-three State health departments will have increased epidemiologic 
and laboratory capacity, which is an increase from 33 in 1999. CDC will 
also continue to work to improve its financial management, accounting 
and budgetary systems so that the total costs of CDC's activities will 
be presented more accurately and fairly.
  Health 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 supports nearly 60,000 awards and 
contracts to universities, medical schools, and other research and 
research training facilities while conducting over 1,200 projects in its 
own laboratories and clinical facilities. In 2002, NIH-supported 
research will aim to add to the body of knowledge about biological 
functions, develop new and improved instruments and technologies for use 
in research and medicine, and develop new or improved approaches to 
diagnosing and treating diseases and disability. NIH performance goals 
include:
   Continuing the progress of genome sequencing by completing 
          two-thirds of the human genome sequence with 99.99 percent 
          accuracy by the end of 2002. This goal builds on a recent 
          announcement of the completion of a draft sequence and initial 
          analysis of the human genome. While this draft is extremely 
          useful, the next stage will involve finishing the sequence 
          completely with no gaps and with a 99.99 percent accuracy. 
          Currently about one-third of the sequence is in finished form.
   Additionally, progress toward development of a vaccine for HIV/AIDS 
by 2007 is encouraging. Diverse approaches to HIV vaccine design are 
being pursued, including refinements in the envelope protein strategy, 
using other HIV accessory proteins as immunogens, and improved DNA 
vaccine strategies.
   By 2002, NIH funding will have grown by $9.5 billion, or 70 percent, 
since 1998. NIH is working to meet the management challenges that can 
arise when an agency receives a substantial infusion of resources over a 
short period of time. During the 2000 financial audit, for instance, the 
Inspec

[[Page 101]]

tor General noted that NIH's decentralized and non-standard accounting 
processes resulted in numerous errors that were not corrected until 
several months later, significantly delaying NIH preparation of reliable 
financial statements. NIH is in the process of identifying strategies 
and policies that would be implemented in 2002 and 2003 and beyond to 
maximize budgetary and management flexibility in the future. Such 
strategies would include funding the total costs of an increasing number 
of new grants in the grant's first year and supporting some one-time 
activities such as high-priority construction and renovation projects.
   Besides NIH, eight other HHS agencies supported over $1.2 billion of 
public health, health services and policy research in 2001. In light of 
the initiative to double funding for NIH, there is an opportunity now to 
examine the HHS health research portfolio to streamline management of 
the research agenda, identify any overlap in funding for similar 
research, and set priorities. Over the coming year, HHS will examine 
these issues closely and develop recommendations for reforming the 
Department's health research activities. In particular, HHS will 
prioritize its research agenda to focus on activities where the Federal 
mission and interests are clear, and focus less on research that is more 
traditionally and appropriately supported by universities and other 
research institutions.

  Agency for Healthcare Research and Quality (AHRQ): AHRQ will continue 
efforts to gather data on the effectiveness and delivery of treatments. 
In 2002, AHRQ will conduct, support, and disseminate research on the 
organization, quality, financing, and content of health services. A 
minimum of 60 projects will be funded that will reduce medical errors 
and enhance patient safety. Evidence-based Practice Centers will produce 
a minimum of 18 evidence reports and technology assessments that can 
serve as the basis for interventions to enhance health outcomes and 
quality by improving practice.
  Office of the Secretary (OS): The OS will take the lead across HHS in 
ensuring that operations and investments are managed effectively and 
produce results. Funding for OS will grow by 14 percent in 2002, which 
will include major, new investments in information technology. The 
budget supports efforts to streamline HHS' decentralized approach to 
departmental management with the goal of enhancing coordination, 
eliminating costly duplication of efforts, and developing unified 
approaches and measurable outcomes for several of the key management 
challenges. For example, HHS will move toward a unified financial 
management system to streamline accounting operations throughout the 
Department and consolidate Department-level financial reporting. OS will 
also promote a Department-wide information technology (IT) system 
design, to find efficiencies in the Department's current internal IT 
spending base of $1.5 billion. Additionally, HHS will also review 
opportunities for managing and consolidating similar programs.
  Public Health Regulation and Food Safety Inspection: The Food and Drug 
Administration (FDA) spends over $1.2 billion a year to promote public 
health by ensuring that foods are safe and wholesome and drugs, 
biological products, and medical devices are safe and effective. It 
leads Federal efforts to review new products and ensure that regulations 
enhance public health without unnecessary burden. The FDA also supports 
important research and consumer education.
   To allow innovative new drugs, medical devices, and other products to 
be made available to the public more quickly, FDA has set the following 
performance goals for 2002:
   Review and act on 90 percent of standard original new drug 
          application submissions within 10 months of receipt and 90 
          percent of priority original new drug application submissions 
          within six months of receipt, while handling a new drug 
          application workload that grows annually; and,
   Complete first action on 90 percent of new medical device 
          applications (known as pre-market applications) within 180 
          days, compared to 74 percent in 1999.
   To allow for more thorough inspection of imported foods, FDA has set 
the following performance goal for 2002:
   Increase the number of import inspections of high-risk foods 
          to 60,000 in 2002.

[[Page 102]]

   The Food Safety and Inspection Service (FSIS), in the U.S. Department 
of Agriculture (USDA), inspects the Nation's meat, poultry, and egg 
products at over 6,000 establishments nation-wide. In 1996, FSIS began 
implementing a scientifically-based inspection system (Hazard Analysis 
and Critical Control Point (HACCP)) that requires meat and poultry 
plants to implement food safety controls and conduct sanitation and 
microbiological testing. In addition to in-plant inspection, FSIS 
conducts foreign and State program reviews, risk assessments, and 
consumer education to reduce the prevalence of harmful pathogens on U.S. 
meat and poultry that contribute to foodborne illness. USDA has the 
following food safety goal:
   In 2002, make continued progress towards the five-year goal 
          of reducing by 50 percent the prevalence of salmonella on 
          certain raw meat and poultry products by 2005.

Workplace Safety and Health

   In 2002 the Federal Government will spend over $670 million to 
promote safe and healthful conditions for over 100 million workers in 
six million workplaces, primarily through the Department of Labor's 
Occupational Safety and Health Administration (OSHA) and Mine Safety and 
Health Administration (MSHA). Through a combination of compliance 
assistance and targeted enforcement, these agencies protect workers from 
illness, injury, and death caused by occupational exposure to hazardous 
substances and conditions. Although occupational fatalities, injuries, 
and illness are at record-low levels, the Government must maintain its 
commitment to partner with employers and workers to reduce the over six 
thousand fatalities and 5.7 million injuries and illnesses that occur 
annually.
   In 2002, OSHA will: reduce injury and illness rates by 20 
          percent in at least 100,000 hazardous workplaces where OSHA 
          initiates action; reduce injuries and illnesses by 15 percent 
          at work sites engaged in voluntary, cooperative relationships 
          with OSHA; and initiate an investigation of 95 percent of 
          worker complaints within one working day or conduct an on-site 
          inspection within five working days.
   In 2002, MSHA will reduce fatalities and lost-workday 
          injuries to below the average number recorded for the previous 
          five years.

Federal Employees Health Benefits Program (FEHBP)

   Established in 1960 and administered by the Office of Personnel 
Management, the FEHBP is the largest employer-sponsored health insurance 
program in the Nation, providing over $20 billion in health care 
benefits a year to about nine million Federal employees, annuitants, and 
their families.
   FEHBP offers a wide range of health insurance plans that enable 
employees to choose the benefits package that best suits their 
particular health care needs and budgets. Because choice and competition 
are hallmarks of the program, the FEHBP reports one of the highest 
levels of customer satisfaction of any health care program in the 
country. About 85 percent of eligible Federal employees participate in 
the FEHBP.
   FEHBP is one part of the Government's total compensation package, 
and, like other health plans, has seen its costs outpace inflation over 
the last few years. The Administration will consider the following: 
options to ensure that the Program offers high quality and cost 
effective health plans; incentives to Federal employees and annuitants 
to choose their plans wisely; and coordination of annuitant health 
benefits with future reforms to Medicare.

  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, costing $92 billion in 2002 
and $540 billion from 2002 to 2006. In addition, self-employed people 
may deduct a part (60 percent in 2001, rising to 100 percent in 2003 and 
beyond) of what they pay for health insurance for themselves and their 
families. Total health-related tax expenditures, including other 
provisions, will cost an estimated $109 billion in 2002, and $638 
billion from 2002 to 2006.

[[Page 103]]

   To encourage private health insurance coverage, the budget includes a 
new refundable tax credit for individuals and families who are not 
covered by an employee plan nor eligible for public programs. The budget 
also includes new tax provisions to reform and permanently extend 
Medical Savings Accounts (MSAs). The budget proposes to help those with 
long-term care costs by providing a deduction for long-term care 
insurance premiums and an additional personal exemption to home 
caretakers of family members. In addition, the budget would improve 
flexible spending accounts by allowing up to $500 in unused benefits to 
be distributed as taxable income rolled over into an MSA, or rolled over 
into a 401(K) or similar plan.