By James Chesney, Ph.D.
The Obama Administration’s health care agenda emphasizes funding for primary care, health information technology and comparative effectiveness research. The health care blueprint for the new administration is contained in the American Reinvestment and Recovery Act (ARRA), the Consolidated FY 2009 Appropriations legislation and the outline of President Obama’s spending plan for FY 2010. Each of these documents contains opportunities for expanded federal funding for primary care, health information technology and comparative effectiveness research. These three initiatives are the three legs of the stool for President Obama’s health reforms, which are key steps toward reducing the long term federal budget deficit.
Expanding primary care is a principal component of ARRA, which increases the federal match for Michigan’s Medicaid program and sets funds aside for community health centers. ARRA funds will increase Michigan Medicaid funds by $2.27 billion in the nine quarters from October 1, 2008 to December 31, 2010. The Medicaid program is also strengthened by increases in disproportionate share funds and extension of Transitional Medical Assistance. This increase in Medicaid funding is vital for community health centers because they receive enhanced payments for services provided to Medicaid beneficiaries. The ARRA also contains $2 billion specifically for Federally Qualified Health Centers (FQHC). $1.5 billion is for infrastructure, construction and information technology and $500,000 is set aside for additional operational funding. The additional operating funds have already been distributed. Detroit FQHCs received about $3 million in additional operational funding. The Capital funds will be distributed based on a process the Health Resources and Services Administration (HRSA) is required to announce within 90 days of ARRA’s becoming law. AARA also contains $500 million to strengthen the primary care work force.
The Consolidated FY 2009 Appropriations bill supports primary care by including an additional $125 million for FQHCs bringing their total funding to $2.2 billion. The bill also includes $75 million for state access grants that fund programs to expand coverage for targeted groups. Detailed allocation for Federally Qualified Health Centers is not included in the President’s budget proposal, but administration reports indicate that those funds could increase to $8 billion.
The Obama administration is clearly willing to invest in health information technology. The ARRA includes $19 billion for health information technology and provides $33 billion for incentive payments to Medicare and Medicaid providers who use electronic medical records. The AARA investment in health information technology is amplified in the FY 2010 budget proposal, which calls for continued incentive payments for providers that can demonstrate use of a certified electronic medical record. The electronic medical record incentive becomes a penalty in 2015.
“Comparative effectiveness research” is the Obama Administration’s phrase for determining which medical treatments work for a given condition. President Obama’s budget chief, Peter Orszag, has been a consistent voice for reducing health care costs by providing incentives to providers that use effective, scientifically based treatments. The ARRA contained $1.1 billion for research on the comparative effectiveness of medical and surgical treatments. For 2010 and beyond the work of organizations like the Agency for Health Care Quality and Research and the U.S. Preventive Services Task Force will be expanded and rolled into public insurance programs. President Obama’s FY 2010 budget clearly states that in addition to clinical effectiveness research, the Department of Health and Human Services will begin to build clinical decision support tools that can make information available to providers as they meet with patients.