In his first address to a joint session of Congress, President Barack Obama
pledged a "historic commitment to comprehensive health care
reform" that aims to reduce costs and expand access to "quality,
affordable" health care for all Americans.
"The cost of health care eats up more and more of our savings each
year, yet we keep delaying reform," Obama told members of Congress on
Obama's recently submitted proposed federal budget for Fiscal 2010 shows
his determination to follow through on campaign promises to expand access to
health care. He described his budget as building on the enactment of
legislation in the first weeks of the new Congress that expanded access to the
State Children's Health Insurance Program to 4 million more children of the
working poor and unprecedented funding to transition toward the use of digital
medical records (see Incentive Payment Will Go to M.D.s Who Adopt Electronic
The health reform provisions of the proposed budget—which include
broad goals and few health care line items—will act as a "down
payment on the principle that we must have quality, affordable health care for
every American," said Obama, by addressing inefficiencies in the health
care system to help reduce future deficits.
The budget calls for setting aside $634 billion over the next 10 years in a"
reserve fund for health care reform" to expand
government-subsidized health coverage The expansion would be funded from taxes
on high-income earners and from cuts in Medicare payments to insurance
companies, hospitals, and insurers.
The reserve would be used to fund affordable insurance programs for
individuals and employers. It also would help finance disease prevention,
wellness programs, and research on cost-effective treatments that aim to cut
health care costs.
One item that could particularly impact physicians is the proposed budget's
assumption that Congress will refrain from cutting Medicare clinician payments
scheduled to occur under current law, including a 21 percent reduction planned
"Widespread physician shortages coupled with aging baby boomers
highlight the urgent need for permanent Medicare physician payment system
reform to preserve seniors' access to health care," said Nancy Nielsen,
M.D., president of the AMA, in a statement regarding Obama's proposed
The president's budget also would expand eligibility for Medicaid benefits
while requiring drug companies to give bigger discounts, or rebates, to
Medicaid and saving $37 billion over the next decade from payments to home
The president said his plan will unfold through discussions with the public
and various health care groups.
"Now, there will be many different opinions and ideas about how to
achieve reform, and that is why I'm bringing together businesses and workers,
doctors and health care providers, Democrats and Republicans to begin work on
this issue next week," Obama said in his February address.
"The passage of health insurance parity and the elimination of the
discriminatory Medicare copay for mental health care are landmarks in the
evolution of American health care," APA President Nada Stotland, M.D.,
M.P.H., commented to Psychiatric News about Obama's proposal."
Efforts to reform the health care system as a whole, however, have been
politically challenging. That makes it especially exciting to see the
commitment of the Obama administration both to reform and to the full
inclusion of psychiatric care. I hope that we will see incentives for the
integration of psychiatric care with all the other medical care our patients
need, and that we will see real incentives—not just rhetoric—to
attract medical students into relatively low-income medical specialties like
family medicine, general internal medicine, geriatrics, and psychiatry. APA is
ready, willing, and able to work with the new administration to bring these
good intentions to fruition."
The president's plan comes as a growing number of congressional leaders and
health care advocates have begun pushing for action to overhaul the health
care system and expand access sooner than the 2010 timeframe congressional
leaders had previously planned.
Sen. Max Baucus (D-Mont.), chair of the Senate Finance Committee and a
leader of health reform efforts, said several elements in the president's
budget are consistent with his health care reform goals released late last
year. They include provisions to base hospital and clinician payments on
high-quality outcomes and to eliminate waste, fraud, and abuse in the
"We can and must achieve comprehensive health care reform this year,
and this budget gives us a launching pad to move forward," Baucus said
in a written statement.