This week, President Obama released his long-awaited fiscal year (FY) 2014 budget proposal. In it he proposes a $1.8 trillion balanced deficit-reduction strategy that replaces sequestration and cuts discretionary spending by $200 billion, which will be realized in FY 2017.
The president also highlights his goals for 2014, which include investments in electronic health records, replacement of the Sustainable Growth Rate (SGR) and increasing the number of health professionals in the system, specifically physician assistants.
The president’s FY 2014 proposal requests $211.8 million for the Public Health Service Act’s Title VII Health Professions Programs, a $589,000 cut below the estimated FY 2013 levels; Primary Care Training gets an increase of $12 million, which would bring total funding up to $50 million, an increase from $38 million in FY 2012. (Funding has not yet been finalized for FY 2013; however, it is estimated that this program will receive $36 million in FY 2013). The Primary Care Training program is the only federal program that directly supports PA education.
The administration has made increasing the number of primary care health professionals a high priority, and all funding is slated to go to programs that achieve that goal. Specifically, the Health Resources Services Administration (HRSA) has set a FY 2014 goal of securing 420 newly educated PAs to work in primary care through Title VII programs (an increase from last year’s 280). More broadly, HRSA has a clear goal of increasing the primary care workforce over the next five years, expressly growing the number of PAs in primary care (educated through Title VII programs) up to 1,400. The initiative will include grants to establish new clinical training sites while improving educational quality.
In addition, HRSA is refocusing its efforts on successful loan repayment and scholarship programs that help recruit health professionals in underserved areas. Programs like the National Health Service Corps (NHSC) are taking center stage in this budget process. HRSA has proposed $305 million to support NHSC, an increase of $10 million to help with 195 new awards for FY 2014.
But it is not all good news. Once again programs like Area Heath Education Centers (AHECs) and the Health Careers Opportunity Program (HCOP) are zeroed out. In addition, the Agency for Healthcare Research and Quality (AHRQ) took a major hit. The Patient-Centered Outcomes Research program was zeroed out and other AHRQ programs were significantly cut. House leadership is likely to recommend that this agency be terminated completely, as they did in FY 2013.
On a more positive note, the president’s budget allocates $135 million to the Substance Abuse and Mental Health Services Administration, to be administered jointly with HRSA, for a one-year program to expand the mental and behavioral health workforce by approximately 3,425 and would channel these professionals into high-need populations.
The president’s budget is normally a starting point for Congress to begin its own budget process, but this year Congress is already in full budget mode. Democrats will likely scramble to incorporate many of these recommendations into their broader plan.
Once a budget resolution is passed by Congress (likely later this summer), the FY 2014 appropriations and authorization process can begin, which are the legislation needed to fund specific programs within the set budget limits.
Jennifer Teters is AAPA director of congressional and political advocacy.
For more on the budget, see:
- The Department of Health and Human Services’ “budget in brief,” a more in-depth report on health programs than what the White House released
- The HRSA justification report (HRSA specifically works on health professions)