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  • Trump Budget Cuts to Medicaid, Research, Food Programs Cause Concern, But Will They Survive?

    With plans that include significant cuts to Medicaid, health research, and anti-poverty programs, the 2018 federal budget proposal from the Trump administration is being met with concern by APTA and most other health care and consumer organizations. However, like nearly every other budget submitted by a US President, the chances of the $4.1 trillion proposal surviving Congress intact is unlikely.

    The proposal, released May 23, combines cuts in health care, education, and anti-poverty spending with significant increases in spending on defense and border security. The President’s plan would boost 2018 discretionary spending for defense to $607 billion, with nondiscretionary defense spending set at $560 billion—an overall increase of 10% for military spending. The $2.6 billion for border security would include $1.6 billion for the construction of a border wall with Mexico.

    The budget also proposes 2% cuts across-the-board for all nondefense spending for the next 10 years, as well as significant cuts to nearly every other facet of government, including the departments of labor, interior, education, and state, which would all be cut by double-digit percentages ranging from 10.9% (interior) to 31.2% (Environmental Protection Agency). Besides defense and homeland security, the only other department slated for an increase is the Department of Veterans Affairs, with a proposed 5.8% increase.

    Cuts and other changes that may be of specific interest to physical therapists, physical therapist assistants, and students include:

    • $1.4 trillion in cuts to Medicaid—$800 billion achieved if the American Health Care Act is passed, and an additional $600 billion in reductions realized through a switch to a per capita or block grant system at the state level
    • 0.6% cut to Medicare, a cut that the Congressional Budget Office/Office of Management and Budget says would amount to an $8.7 trillion reduction over 10 years if no policies are changed
    • $5.8 billion in cuts to the National Institutes of Health, including cuts to agencies involved in research on cancer, aging, infectious disease, and child health and development (the arm of NIH that also includes the National Center for Medical Rehabilitation Research)
    • Elimination of the Agency for Healthcare Research and Quality
    • More than $10 billion in cuts to education programs, with $9 billion tied directly to cuts in the Department of Education
    • Phase-out of the public service loan forgiveness program for any student loans originating after June 30, 2018, as well as elimination of subsidized student loans
    • A 5% cut to the Office of National Drug Control Policy, which coordinates federal efforts to combat the opioid epidemic (rumors were that cuts could be as high as 95%)

    "The budget proposal we're seeing represents a dramatic shift in spending, but it is consistent with what we anticipated, given the stated priorities of the administration," said Justin Elliott, APTA vice president of government affairs. "It is important to remember that Presidential budgets are almost always viewed more as a wish list from the administration. They are very rarely enacted as presented."

    But APTA isn't making any assumptions about the fate of Trump's budget.

    "Many of the proposed cuts would have a direct detrimental impact on our patients, and are in opposition to the core values of APTA and the physical therapy profession," said APTA President Sharon Dunn, PT, PhD. "We will join with many other health care and patient advocacy organizations to work with Congress toward a budget that supports wide access to affordable health care, strengthens research capabilities, and helps to improve the overall health of society."

    Comments

    • What's the latest on passing the PIMA bill? It has been said that the bill would save Medicare $3 billion over the next 10 yrs. The amendment of or abolishment of Stark law combined with the actual enforcement of existing regulations on the AMA would save millions/billions more.

      Posted by Darrin Brooks on 5/24/2017 3:44 PM

    • Regardless of its relative chances of being enacted, the agenda as demonstrated by this proposed budget is anathema to the pro health care and pro wellness values of our profession. We should object loudly to this and object to all legislative initiatives that might mirror or move towards these budget based values that place so little value on humans and so much value on numbers and more tax cuts for the wealthy.

      Posted by Jonathan Holtz, PT on 5/24/2017 4:47 PM

    • I am a recent graduate and I would love to participate in making a difference to support those in need of health care and are in need of sufficient insurance for proper care. Please let me know how I can particpate

      Posted by Debbie jones on 5/24/2017 7:17 PM

    • I am currently a physical therapist for 5 years with annual certification for 5 years in the public service loan foregiveness program. One has to hope these changes do not happen due to the improper cuts and harm they will do to children, veterans and people relying on need or medical assistance from federal funds. For our profession, the loan foregivness program is a majorly utilized program by graduates to be able to afford housing and to start a family. With over 500,000 public servants in the program currently, the removal of this program either for current enrolles or for future loan borrowers will cut the amount of Physical therapists and other health professionals who join the modest paying public sector where mission is valued most. Simply speaking....the public health care system will be decimated where post grad students will run to private paying organizations and companies. This is a scary time. But we will see who stands up to this injustice and who has the strength to fight to serve those in need and stay current with our Core Values and Ethical mission

      Posted by Anthony Bujno PT,DPT on 5/25/2017 7:24 PM

    • Darrin - The Promoting Integrity in Medicare Act, or PIMA, was introduced by Rep. Jackie Speier (D-CA) in April of 2017. H.R. 2066 would remove physical therapists and other providers from the definition of designated health services within the Stark laws, effectively ending self-referral. APTA, in coordination with the Alliance for Integrity in Medicare (AIM) Coalition, has been pushing Congress to make this legislative change for several years. In 2016, the Congressional Budget Office estimated that this change would save the Medicare over $3 billion dollars over the 10 year budget window. APTA would like for this policy change to be implemented and save Medicare billions of dollars. The environment for passage is very difficult. The Republican Congress is not typically in favor of this policy. Combine this with the fact that former Rep. Price, an orthopedic surgeon, is the head of the Department of Health and Human Services, and it is very unlikely we’ll see congressional action on PIMA. We will keep pushing and fighting in hopes that Congress will finally come around and help end this abuse.

      Posted by APTA Government Affairs staff on 5/26/2017 7:19 AM

    • As a member, I'm very happy to support legislative efforts that further our profession. My main concern is the strong left-leaning tone of this article. This article could have been written by the Democratic national committee or appeared as an editorial in the New York Times. As an association meant to represent all of its members, the APTA needs to realize that wading into political arguments can be risky. Articles like this can easily alienate a lot of members and it certainly has begun to alienate me. I shouldn't have to address the contents of this article but I find it necessary. My main question is: since when can't the government do with less money? Really? Every year the government takes in record taxes. Many of us feel that the need to spend more and more every year needs to stop. Under Obamacare which it seems the APTA supported, my personal insurance rates have doubled. Maybe it would be wise to take a poll of the membership and find out how Obama's policies have negatively impacted your members and their families. Also, I didn't see any APTA articles addressing the fact that Obama took $600 billion out of the Medicare program to help fund Obama care. Also, how many articles have there been on the fact that almost every major insurance carrier is running away from Obamacare. Many states now have only one insurance option. Deductibles have increased to an average of somewhere between eight and $10,000. I work in home health now and it is extremely difficult to even get a wheelchair or a commode chair for a patient directly due to Medicare budget cuts. I don't have to tell you about the ongoing reimbursement issues. It seems like every year we hear from the APTA that they just could not prevent PT reimbursement cuts or didn't have enough sway to get them repealed. And by the way, what in the world does the APTA have to do with environmental protection agency. The last time I looked, the EPA has severely restricted business in this nation by designating wetlands on private property which leads to the confiscation of private property for example. Every year I have to make budget decisions my family, unfortunately with the doubling of my insurance premiums I have had to do with less and my family has had to do with less. So this begs the question, why can't our strong central government do with less money? By getting involved in these issues be APTA is taking a political stand against the desires of many of its members. I have tried to speak directly with Justin Moore PT the CEO of the American physical therapy Association but unfortunately he has not returned any of my phone calls. This is disturbing as I have been a long-term member and I mentioned to the person taking the message that I am on the brink of canceling my membership. The APTA Needs to look no further than the ESPN sports channel to find out what happens to an organization that starts taking left turns and alienating the base. Also, take a look at the NFL ratings since they stood with the player who refused to stand for the national anthem. Sports has no business in politics and you guys need to be very careful how you present political issues that are important to us as members. Stick with the issues that mean the most to us: reimbursement, practice patterns, research, education, and generally how to survive in a arena where reimbursement is getting killed.

      Posted by Brian Bibbee on 5/31/2017 4:51 PM

    • Since posting the above comments I did hear directly from both Justin Moore and Sharon Dunn. I appreciate them taking the time to discuss this matter and feel very satisfied that my concerns have been heard. Thank you to both!

      Posted by Brian Bibbee on 6/1/2017 9:16 AM

    • He should cut them, the fact that you people opposing this would happily sell your country out for some coin is despicable. You all know that factually over 50% of our budget is spent on entitlements like this and it will bleed us dry as a nation. The physicians lobbyists endorsed Obama Care for the reasons of filling their pockets and have paid the price of their folly, do not follow in their footsteps.

      Posted by Allen on 6/2/2017 12:51 AM

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