The Bill Finally Comes Due
While the potential for a government shutdown looms due to the inability of
Congress and the President to reach agreement on spending levels for the
federal agencies for the remainder of Fiscal Year 2011, House Budget
Committee Chairman Paul Ryan (R-WI) yesterday released details of his
proposed fiscal year 2012 federal budget.
The House proposal for FY 2012 makes it perfectly clear that the key set of
issues that will define the political agenda going into the 2012 elections
will center around fiscal policy. The current stalemate between the House
and Senate over spending mere billions of dollars for the next six months
pales in comparison to the budget blueprint released today, which calls for
multiple trillions of dollars in spending reductions over the next ten
Regardless of where one stands on the political spectrum, there is no
question that the policies proposed in the FY 2012 House budget are
breathtaking in scope and will impact all Americans, but in particular,
people with significant health care conditions and disabilities, including
people in need of orthotic and prosthetic care. To be fair, it should be
noted that these proposals are not entirely a surprise. Chairman Ryan has
been signaling for months his intention to follow many of the
recommendations made by two bipartisan fiscal commissions that produced
similar recommendations late last year.
Highlights of the proposed House budget that impact healthcare include for
1. It cuts massive amounts of funding from Medicare and Medicaid over the
2. It converts the Medicare program (which covers 42 million seniors and 6
million people with disabilities below 65) from an entitlement into a
“premium support” program and relies on the private market to cover
beneficiaries. The federal contributions to premiums are not designed to
keep pace with medical inflation, however, so beneficiaries will have to pay
more for Medicare coverage out of their own pocket with each consecutive
year or find plans with more modest benefit packages.
3. It converts the Medicaid program from an entitlement into a “block grant”
program to the states that will significantly increase the financial burden
on states (and on Medicaid beneficiaries) to pay for healthcare. This will
undoubtedly have a major impact on access to benefits such as
rehabilitation, orthotics, prosthetics and durable medical equipment, to
name only a few of the categories of benefits to be affected.
4. It repeals and defunds the Affordable Care Act and would reverse any
increases in coverage under Medicaid and in the private insurance market set
to take place in 2014. This would mean that pre-existing condition
exclusions and other insurance practices that segregate the private market
into good risks and bad risks would continue to be in effect.
5. It rolls back funding for health care and other discretionary spending
programs to FY 2006 levels and then freezes those levels for five years.
These dramatic spending reductions will have a major impact on the ability
of agencies such as the NIH, National Institute on Disability and
Rehabilitation Research (NIDRR), the National Science Foundation and the
Health Resources and Services Administration (HRSA) to continue programs
that impact O&P and many other areas of healthcare.
Some observers of the spending negotiations this week between Congress and
the President anticipate that the Ryan budget proposal may enable Congress
to avoid a shutdown simply by putting into perspective the enormity of the
next budget debate and taking emphasis off the current spending stalemate.
However, the spending agreement deadline is fast approaching and if an
agreement is not reached by Friday, April 8, the shutdown will take place-at
President Obama held a meeting with House and Senate leaders yesterday in an
attempt to reach a last minute compromise but a deal was not struck. In
addition, this past Monday night, House Appropriations Chairman Hal Rogers
(R-KY) introduced a seventh continuing resolution (“CR”) that would extend
the spending deadline by one week, to give the parties one more chance to
reach agreement, but it is unclear whether this new CR can pass.
Specifically, the House Budget proposal for FY 2012 would cut $6.2 trillion
in spending over the next decade compared to Obama’s budget for 2012. The
plan also projects that it would eventually bring government spending to
below 20 percent of the gross domestic product or “GDP.” The budget is
expected to be “marked up” in committee on Wednesday, April 6, and could be
ready for a vote on the House floor as early as Friday-the same day the
current CR for FY 2011 expires.
At the same time, a bipartisan group of senators, including Budget Chairman
Kent Conrad (D-N.D.) and Senator Tom Coburn (R-OK), are holding negotiations
on legislation that could reflect President Obama’s deficit reduction
commission’s report, which was released last year. Many of those
recommendations were similar to the Ryan budget proposal and quite
controversial at the time of their release.
Conclusion: The stalemate over spending and the proposals to cut trillions
of dollars out of the federal budget over the next decade are issues that
are not easy to resolve, especially in a charged political climate. NAAOP
will continue to keep its members and friends informed of developments as
To make your voice heard, go to www.naaop.org to access NAAOP’s
Congressional Legislative Action Center and communicate with your
Congressman or Senator quickly and easily.
Please visit our website at: www.naaop.org
1501 M Street, NW
Washington, DC 20005-1700
e-mail: [email protected]
(202) 624-0064 Phone
(202) 785-1756 Fax