On May 23, 2017, President Trump released his fiscal year 2018 budget proposal titled “A New Foundation for American Greatness,” which seeks $1.5 trillion in nondefense discretionary cuts and $1.4 trillion in Medicaid cuts over the course of a decade.
After carefully reading and reviewing of the proposed budget, the National Association of Free and Charitable Clinics (NAFC) cannot support the budget as written because it does not align with the NAFC 2017 policy priorities, mission statement or organizational beliefs with respect to health care reform.
With respect to the NAFC 2017 public policy priorities, the proposed budget does the following:
- Decreases funding for the Free Clinic Federal Tort Claims Act (FTCA) program from the approved FY2017 Omnibus funding level of $1 million to $100,000. The $100,000 amount takes us back to the FY2016 appropriated level, does not allow for the expansion of the program to include the Free Clinic entity, and does not allow for the expansion of the program to include Charitable Clinics and Pharmacies.
- Eliminates the Corp oration for National and Community Service, the federal agency that administers national service programs including AmeriCorps and Senior Corps programs which place volunteers in Free and Charitable Clinics, State Associations and Charitable Pharmacies around the country.
- Eliminates the Community Services Block Grant (CSBG) program, which helps provide funding to many clinics to continue providing health care to their patients.
- While the budget does include a 2-year extension of the Children’s Health Insurance Program (CHIP), funding for this program would be cut by eliminating the 23 percent increased federal funding match added by the ACA and by no longer providing federal CHIP dollars for children from families with incomes above 250 percent of the federal poverty level. States would also be allowed to transfer children from families with incomes below 133 percent of FPL, who had been transferred from CHIP to Medicaid, back to CHIP.
- Reduces telehealth funding programs available to Free and Charitable Clinics from $17 million to $10 million.
- Decreases funding for the Ryan White HIV/AIDS program by $59 million.
- Decreases Medicaid spending by $610 billion over 10 years. This decrease is on top of the more than $800 billion in cuts called for under the House-passed American Health Care Act (AHCA).
General areas of concern:
- Assumes the Senate passage of the American Health Care Act (AHCA) as it is currently written with no changes, which the Senate has stated it will not do.
- Eliminates the Medicaid expansion in 2020 and allows states to decide if they would like to utilize a block grant or a per capita allotment for Medicaid payment. There would be no full federal funding for Medicaid after 2020.
- Decreases funding for the National Institutes of Health by $5.8 billion.
- Decreased funding for the National Cancer Institute by $1 billion.
- Decreases funding for both the National Heart, Lung and Blood Institute by $575 million.
- Decreases the National Institute of Allergy and Infectious Diseases by $838 million.
- Decreases funding to the both the Centers for Disease Control and Prevention and the Food and Drug Administration (FDA) by $1 billion each.
While the President’s budget is just one piece of a larger funding puzzle in Washington, DC and many say that the proposed budget will not reflect what is actually passed by the House and Senate, it does indicate priorities for this Administration.
“We urge Members of Congress to work across the aisle to ensure that important spending decisions put people over politics,” said Nicole Lamoureux, NAFC CEO. “It is our expectation that policy makers understand that people should not have to make the hard choice between putting food on the table and paying for their medication nor should they be expected to rely on emergency rooms as their primary care doctor’s office. People should not have to declare bankruptcy to pay for their medical bills and/or insurance premiums.”
The NAFC remains ready to work with lawmakers to address the needs of the medically underserved throughout the country and to ensure that health care becomes more affordable and accessible for all Americans.