Trump’s Budget and the Hospice Community

HAN is happy to be hosting Dr. Noam Stern, a Fellow in Pediatric Palliative Care at Akron Children’s Hospital in Akron, Ohio. During his time with us, Dr. Stern will be learning about the intersection of clinical practice and policy-making, with an eye towards improving advocacy for pediatric palliative care. As a part of his experience, he will be writing the occasional guest blog post:

President Trump released his budget proposal on Thursday and there have been lots of reports in the media of drastic changes to government programs, so let’s take a look at what this proposal would mean to us.

Importantly this proposal is only regarding discretionary spending, meaning that mandatory spending including Medicare, Medicaid, and Social Security are not addressed in this budget.  This is also a “skinny budget” of 62 pages so many details still remain to be seen, but here is what we do know.

There are two relevant increases for the health care community. The first is an increase of $4.4 billion dollars to Veteran Affairs which would increase their budget by 5.9% and could improve the services our patients receive. Second is a $500 million increase to opioid abuse prevention and treatment, an area very relevant to our practice. Beyond those increases which will affect us directly, big ticket items that would need to be balanced out with cuts include an increase of $54 billion (10%) to the department of defense, $2.6 billion to start work on boarder wall, and $1.4 billion for school choice programs.

So how would this all be paid for? In dollars the biggest cuts come to the Department of Health and Human Services,  which would lose $15.1 billion or 17.9%. A large part of this would come from the National institutes of Health (NIH) which provides for medical research funding. Also cut are $403 million to health professions and nursing training programs. The Community Development Block Grant program which provides Meals on Wheels would lose all $3 Billion of federal funding, although much of that program’s funding is from other sources.

While the President’s budget is an important part of the process, it is important to note that it is only the first step.  Congress will either adopt these recommendations or reject them as it moves through the annual budgeting and appropriations cycle.  Many Members of Congress, including some Republicans, have declared the budget “dead on arrival.”  So this is not the final word on federal spending, to be sure.

And as noted earlier, this budget does not affect the Medicare Hospice benefit, payment rates, or anything of the like – that is something that would need to be addressed separately.  If anything happens on that front, we’ll be sure to let you know.