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Any healthcare implications in the President's proposed budget?


 Today we're gonna take a look at President Biden's 6.8 trillion budget, and what's in it with regard to healthcare.

 My name is Bill Russell. I'm a former CIO for our 16 hospital system and creator of this week Health. A set of channels dedicated to keeping health IT staff current and engaged. We want to thank our show sponsors who are investing in developing the next generation of health.

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 All right, let's get to it. I'm gonna pull from a Becker's article, Biden's 6.8 trillion budget, 15 healthcare takeaways. And try to remember, , we don't do politics on this show, so we're essentially, the reason we're going through this is to understand the business of healthcare and the policy changes impact healthcare significant.

right? So not only from a payer, their, the United States government is one of the biggest payers out in the market, but also policies impact us in a lot of different ways. So anyway, we'll try to get through the 15. Here we go. Medicare, their proposed budget would extend the solvency of Medicare Hospital Insurance Trust fund by 25 years.

The fund projections run out of money by 2028. The budget would extend the life of the trust fund without cutting benefits through tax increases on Americans making more than $400,000 a year, raising the tax rate from 3.8% to 5% a year. President Biden proposed expanding Medicare's power to negotiate drug prices with manufacturers, the proposed budget.

Would increase the number of drugs on which the program can negotiate and the price and, , cut the number of years before new drugs can be negotiated. The budget would also cap Medicare copays at $2 for more generic medications. All right, so any changes to Medicare are, , significant? , I don't think Medicare.

Is in danger of not being funded. It is something that both parties agree should continue to be funded. , the argument here will be how do you fund it, right? So it will, , we'll let, we'll let them really talk about that. The impact on us on the first one, not much on the second one, probably not much either.

As healthcare providers, probably not much impact based on what's being said there. Medic. The proposed budget would require states to adopt 12 month postpartum Medicaid coverage. At least 30 states have voluntarily, , voluntarily expanded postpartum Medicare Medicaid coverage. The proposed budget would establish a Medicaid like insurance option for low income adults in states that have not expanded Medicaid.

President Biden also proposed allocating 150 billion over 10 years to fund Medicaid home healthcare services. The funding for home healthcare I think is gonna be an important move by the federal government. I'm not gonna comment on the Medicaid stuff. The Medicaid stuff, state, state specific, , states that didn't expand their Medicaid, they're trying to go around that to essentially say, look, you should have expanded it.

It was free money. And it helps your people. And if you're not gonna do that, we're gonna find another way to help those people. So, , that is what it is. But home health, home health and home healthcare, , funding, this is gonna be an important move and it's gonna be an important move for a couple things.

We need, we need parody on the delivery of care out of the home in terms of some reimbursement. Now, the reason you don't want par. across the board on it in reimbursement is because the delivery of home care should cost less. We're not looking for parody like the cost of healthcare needs to go down and the move to the home, not only from a convenience standpoint and a desirability standpoint for the patient, but it should also drive the cost of care home.

So if we're essentially gonna say we're gonna pay the same for home care that we were paying in the hospital, we're going to miss the boat here significantly on the opportunity to drive down the cost of healthcare. So, But there has to be a move towards incentivizing the move to home and moving people out of the hospital building itself.

But again, the purpose of that is to, I mean, besides all the experience aspects of it is to drive down the cost of healthcare. Number three, discretionary HHS funding. President Biden is asking Congress to approve 144 billion in discretionary budget funding for HHS in fiscal 2024, representing a 14.8 billion increase from 2023.

All right, so, , HHS must have at least 130 billion right now. In, , discretionary spending and they're asking for 14 billion more. , I'm fine. Always fine with that as long as there's oversight, , in how that's being spended as spent and some governance in terms of how it's being spent. So, , healthcare workforce, the budget asks for 32 million.

To grow the nursing workforce and 28 million to support innovative approaches to recruit and re retain new providers. It expands the National Health Service Core, which provides loan repayment and scholarships to healthcare professionals who practice in underserved areas. Additionally, it aims to bolster the high school two career pipeline, proposing a $200 million expansion of dual enroll.

Work-based learning programs. Oh, so this is federal government stepping up. , this is usually the case. By the time a problem has been recognized, it's okay. Let's, let's do something to support this. And then, , typically by the time it's having an impact, , it's too late. And we've actually created an overabundance.

I remember when I was going into. . I said, we don't have enough qualified computer workers. And there was all sorts of incentives and crazy things to get more computer workers. Well, essentially, fast forward like six years later, there's an abundance of computer workers, right? There's too many of them.

They're everywhere. And so it's, , I, to a certain extent, the market does work itself out over time. If there's a shortage of healthcare, then, , the, , you know, labor, the rates that we're paying for the healthcare workers will go up. It'll become more desirable to go into that career. , in theory it will become more desirable to go into that career.

We will work on things like, , better work life balance. We will work on things like a better, , environment and experience for those workers, and it'll become more desirable and therefore there will be more workers over time. All that being said, , you know, again, not the worst thing for the government to, , to support this.

And we're not talking about huge amounts of money here. 32 million in, , 28 million. , that's not a, , a significant amount of investment, to be honest with you. , number five, rural hospital assistance. This is gonna be a big, big, big issue. President Biden proposed budget calls for 30 million to provide assistance to rural hospitals at risk of closure and to support expansion of hospital service lines to meet rural community needs.

The budget also supports rural healthcare workforce development training programs and telehealth. In addition, it provides dedicated funding. For rural health clinics to support behavioral health, there's a phrase right in the middle of this. I think that's gonna be important. , let's, and to support expansion of hospital service lines to meet rural community needs.

I think that's what's gonna happen here. I think we're gonna see service lines from urban areas get extended into, , rural areas with the use of some technology and the use of just a focus on that. There's not a ton of money there, so when there isn't a lot of money there, that's where the government steps in.

To support, , the lack of a market that would drive that. Number six, ACA subsidies. The proposed budget would make permanent ex ex, , expanded income based tax credit subsidies for ACA marketplace. I'll skip that again. We're going through this. Just so you understand, healthcare is impacted significantly by policy changes and budget change.

in decisions that happen on the on the hill. So important to understand these and to consider what their impact is on your specific health system. And some of these things might impact your health system and they may not impact another health system, so just something to keep in mind. Number seven, pandemic preparation.

The budget calls for 400 million in new discretionary funding to prepare for pandemic and biological threats, as well as supporting advanced development and procurement of vaccines, therapeutics and diagnostic capabilities. Against known and unknown high priority threats. Again, , good to, good to be prepared.

400 million is a fair amount of money. I'd like oversight on that and, , governance around that. So, , number eight, vaccination. The budget includes a new program to give uninsured adults access to free routine and outbreak vaccines. Additionally expands the Vaccines for Children's Program to include all children younger than 19 enrolled in the children's health insurance program.

So, , obviously that will have, that will go back and forth between the, , two parties and they will discuss the effectiveness of vaccines and the, , the way that they were administered during the pandemic. And that will be an ongoing conversation. Number nine, cancer Moonshot. The budget calls for 2.8 billion for the Cancer Moonshot Initiative revived under President Biden last year.

well, , of that total 1.7 billion would go to HHS to support dedicated activities at the National Cancer Institute, cdc, health Resource and Services Administration, and Indian Health Services. , . It's interesting how that money's being allocated. I'd want to see how that money's being allocated. I love the Cancer Moonshot.

We've already done a show on that, and I thought it was one of the, , things that we could look forward to in a, in a Biden presidency. , but if that money's being funneled towards not a moonshot, like not curing cancer in some way, shape, or. , if it's being moved to operational things, , then I think that is a misappropriation of that money.

I'd like to see all 2.8 billion going to finding a cure for cancer. , and that's really what I was excited about when the, , for the Biden presidency. And if that's not what they're gonna do with that money, if they're just going. , , you know, if we're gonna read about how the money was allocated and it ended up being spent on other things, , I'm not, I'm not jumping up and down about it.

So I'd like to see a little bit more detail around that. Community Health Centers, the proposed budget would grow the health centers program reach and put it on track to double in size. It would also expand the Teaching Health Center Graduate medical education program, which trains residents in rural high need community health.

again, I'm not well versed on that, so I'm not gonna comment on it. VA Healthcare President Biden proposes 121 billion in discretionary VA medical funding, 2.3 billion above the 2023 enacted level. The budget also includes 20.3 billion for the cost of war toxic exposure fund, which increases healthcare and benefits delivery for veterans exposed to environmental hazards such as burn pits.

The proposed the proposal is 50.3 billion above the 2023 enacted. Again, just oversight. And, , , you know, clearly no one's gonna say that these things shouldn't be funded. They're already funded at a, a pretty high level. The question becomes how is that additional money going to be utilized and is it gonna go directly to caring for those veterans?

Or are we gonna be reading articles two years from now about, , victims of burn pits and how they have not been cared for? So, Just make sure the money's going where we intended to go.

12 maternal health crisis. The budget allocates 471 million to support the White House's blueprint for addressing the maternal health crisis. And it goes on and talks more about those things. , I would like to see the definition of maternal health crisis. How does this impact your health system? , I think it depends on what, where your health system's located and what, what is the definition of the maternal health crisis.

I would want to know that. I would want to know if that impacts our community and impacts our health system. , and if it doesn't, , it doesn't. And if it does, then I would want to know what that, , money is going, is slated to be used for in how we could utilize it at our health system. Title 10. The budget proposes providing 512 million.

In funding for the Title 10 family planning program, which provides family planning and other healthcare services to low income individuals, if approved, that would be 79% increase above the enacted 2023 level to increase the number of patients served to 4.5 million. I don't know anything about Title 10, so I can't speak to it, but again, if that is something that impacts your health system, important to know.

, HIV and he Hepatitis C reduction. The budget proposed 850 million to help HHS reduce new H hiv cases. It supports programs that would expand access to both curative and preventative medications. Okay. , it's important to know that and understand that that is out there. Behavioral Healthcare President Biden proposes significant investments in behavioral health.

The budget aims to eliminate the 190 day lifetime limit on inpatient psychiatric facility services requires Medicare to cover three behavioral health visits without cost sharing. Permanently extended FA funding for community health centers and authorized labor department to impose civil monetary penalties for mental health parody and addiction equity act, non-compliance among other adjustments.

Wow. , , there's no, there's no mention of the budget in here, so it just, you know, significant investments in behavioral healthcare. So I'd, I'd want to know what's actually going to be invested, where it's going to be invested, if that impacts our facility or not. So there's 15 things that are going on in this budget.

Important to know, and this isn't final by any stretch. , this has to go through the whole process. This will get modified. , it's important to know what the starting place is on all these things. Again, Medicare, Medicaid. , HHS Discretionary HHS funding healthcare workforce and what they're doing there.

Rural Hospital assistance, ACA subsidies, pandemic preparation vaccinations, cancer moonshot, , community health centers, VA healthcare, , maternal health crisis Title 10, HIV and Hepatitis C, reduction in behavioral healthcare. Understand this is, , this is where the conversation's gonna be around this budget.

And understanding the business of healthcare is so important, even if you're in the technology of healthcare, and even if you're in the bowels of the technology of healthcare. Understanding the financials, understanding the policies that impact healthcare are so important in order to deliver the right solutions for your healthcare system.

That's why we covered it.

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