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Group Project 

Please review the first 60 minutes of at least one of the recordings of these three budget discussions (or more if you can handle it).  Also you can look at the stars on the page below the videos that give you some key comments on important issues. These are the Health and Human Services Department Fiscal Year 2021, 2022, and 2023 Budget Requests. Each group member must review one of the three recordings and write a one page reaction paper (single spaced) to what you observed on the budget hearing. 

· What was the theme and what were identified as the President's priorities for that year?

· Do the priorities discussed in debate match with the priorities outlined in the Fiscal Year Budget in Brief?

· How did the two political sides differ or agree in their approaches to the budget in their prepared responses and in what they identified as the priorities of the American people.  

· In your opinion, what was most striking about these testimonies and responses from the representatives? 

· Please share files so that you can combine the three responses.

· Read each of your team member's review's and together write a brief introduction 

. Include data on budgeted amounts for each fiscal year

. What areas account for the majority of spending in US Federal budget for health, etc.

. Other relevant information

· Write a summary/conclusion of the three budget requests to tie the paper together.

· Each team member will submit as a single document. Feel free to add any important points.

· Make sure all team member names are on the document.

· The first three links are for the CSpan Videos of the budget requests; second three are the PDF documents.

 

Intro

(David’s part of Intro):

The main goal of the Health and Human Services Fiscal Year 2023 Budget is navigating the preparation and planning for post COVID-19 public health emergency. The president’s plans for preparing and planning for post COVID-19 is providing healthcare providers at least a 60-day notice of when the HHS will eliminate the Public Health and continue to fund COVID-19 aid to mitigate the spread of COVID-19 and prepare for future pandemics. The president’s budget request is proposing a $1.6 trillion budget. The budget request is proposing to allocate $975 million for the Strategic National Stock Pile and $82 billion for over five years to prepare for future pandemics and health threats. The majority of the spending accounts for Medicare and Medicaid services. 

(my part)...

From the 2022 video, the budget proposes $131.8 billion for the discretionary budget authority and $1.5 trillion for the mandatory funding. The priority areas for this budget include; ensuring equitable distribution of HHS programs across the diverse population, help in maternal help, fund data and research, help in early child care and learning. In addition, the funds help to avert the opioid and substance use crisis, increasing numbers of unaccompanied Migrant children and help in fighting Covid-19 pandemic.

My part.

 

C-SPAN, 2021 Health and Human Services Fiscal Year 2022 Budget Request (video) https://www.c-span.org/video/?512389-1/health-human-services-fiscal-year-2022-budget-request

Question One

The budget theme is to improve the quality of life among Americans based on the health and employment domain. The unemployment rate is rising, and the budget has set half a trillion USA dollars to create employment opportunities through job stimulus. The decision is premised on the fact that an unemployed population cannot attain high levels of health. The budget further stated the increasing number of unaccompanied immigrant students and required to allocate funding for the children to ensure they are given a quality of life. Covid-19 is a significant setback to the economy, and a stimulus package has been set aside to ensure that the impacts of covid-19 have been cushioned. Another priority is climate change and substance abuse. Climate change has affected agriculture and the production sector. The funds set aside are meant to give farmers an economic boost while giving enough funding to rehabilitation centers to ensure that children and youths suffer from substance addiction.

Question Two

The priorities discussed in the debate do not match those outlined in the fiscal year budget brief. The discussion emphasizes Obama care, which was installed to cushion the health needs of the vast population. The budget, however, devolved from the health sector and did not offer substantive funding for health insurance. The ignoring of the Obama care policy in the budget is likely to cause a challenge in the discourse as the unemployed people unable to pay the health insurance premiums may not be able to access the quality care as President Bidden brought forth in his manifesto. The unemployment crisis, accelerated by the covid-19 pandemic, is a priority in the debate but has not been addressed in the fiscal year budget brief. More priority has been put on social services such as mental health and immigration to offer children immigrants with safe places to live. The budget focused more on social life and paid less attention to the economic side.

Question Three

Both the democrats and the republicans agreed on the problem of unemployment. They wanted more resources to be set aside to create employment opportunities for the Americans as they argued that a working population would help overcome the health and drug challenge. The two parties agreed on increasing the budget for the defense to enable the army to handle Ukraine vs. Russia conflict amicably. The medical budget, however, raised debate with the republicans complaining of the little resources allocated to the health docket. Although too many resources were allocated to handle the covid-19 challenge, the funding for health insurance was reduced, and therefore people could not afford the healthcare insurance. Whenever the government makes a budget, the debate in the senate must be considered because all the representatives speak on behalf of their people. All the senators were, however, in agreement that employment is an important aspect, and the bottom middle out approach must be funded to ensure all the people are empowered.

Question Four

The testimonies and suggestions offered by the senators prove that a working economy is an antidote to a country's challenges. Although the covid-19 pandemic is a setback to the country's economy, a labor-intensive industry must be developed to offer people employment opportunities so they can take care of their health needs. The testimonies show that the representation debate was not about what the people wanted, but most senators were debating to defend the party ideologies. Senators must debate the real issues affecting the people because they have a divine responsibility to make laws that will improve people's lives.

Alex part, 

Health and Human Services Fiscal Year 2021 Budget

Qn. 1; According to Chuck Grassley, one of President Trump’s themes for 2021 was the need to reduce the cost of prescription drugs and propose policy changes for the Medicare and Medicaid programs. Grassley believes that the long-standing high cost of prescription drugs is one of the most important challenges faced by HHS. The theme in the 2021 budget emphasized the proposals of cutting or reducing future spending on these programs and other key safety programs. The goal was to initiate massive cuts for core public services that assist struggling households in affording basic access to crucial services. Also, the budget bolsters the efforts to improve health care in rural America. Even though Grassley felt that there were many contentious issues in the budget, the issues mentioned above were some of the areas the house needed to cooperate to find the most effective solutions.

 

Qn. 2; The priorities discussed in the debate match those outlined in the Fiscal Years Budget in Brief. For instance, as highlighted in Qn.1, Grassley states that President Trump’s 2021 budget proposals bolstered efforts such as reducing the cost of prescription drugs. This priority is described in p.2 of the 2021 Fiscal Year Budget in Brief. The Brief highlights President Trump’s pledge to lower the high cost of drugs and reduce out-of-pocket costs for American consumers. The administration sought to achieve this by advocating for policies aligning with the four pillars of the President’s American Patients First Blueprint. P.7 also highlights the need to prioritize health care accessibility for rural America. It discusses “HHS’s 4-point Strategy to Transform Rural Health,” which includes areas such as building sustainable health care models for rural communities and leveraging technology and innovation. Another priority in the debate was the discussion on vaping and e-cigarettes. According to the debate, some proposals introduced new taxation frameworks that impose excise duties on vaping products. P.25 and 26 of the 2021 Brief reinforce this debate stating that President Trump’s administration was committed to preventing youth from using all tobacco products, including e-cigarettes.

 

Qn.3: The sides agreed on the need to reduce the cost of drug prescriptions. It is crucial to note that Chuck Grassley, a democrat, largely supported the need to lower the cost of prescription drugs as proposed by the 2021 budget. According to him, this area is one of those that the members needed to set aside their political differences to find common ground to meet specific patient needs and ensure everyone benefits from essential health care services. Senator Rob Portman of Ohio, a Republican, agreed with him. He says he was one of the people who rooted and voted for the bipartisan pact regarding prescription drugs and the need to reduce its costs. He also supported Grassley’s proposals regarding opioid expenditure and addiction and urged Democrats to support such initiatives for mutual benefit. However, Senator Ron Wyden of Oregon, a Democrat, disagreed that the proposal made things easier for the elderly.

 

Qn.4; Senator Ron Wyden’s disagreement with some of the budget proposals was more striking for me. For example, Wyden believes President Trump’s administration was trying to force proposals that had failed in 2017. He calls the Healthy Adult Opportunity a “horrible policy” that would hurt people. He believes that its inclusion in the 2021 budget was meant to push the dirty work of Medicaid Block Grants to the states. The pushing of the Medicaid Block Grants by CMS VERMA would signal the beginning of the end for health care safety. It is striking that although Wyden agrees with some of the proposals, he believes there has been significant dishonesty from Trump’s administration regarding the 2021 budget. 

David part..

Human and Health Services Fiscal Year 2023 Request

Theme and Priorities

The theme of the U.S. Fiscal Year 2023 Budget Request is to work with Congress to prepare for ending the public health emergency from COVID-19. The president's priorities for 2023 are to prepare for possible future pandemics and health threats, mitigate the spread of COVID-19, and address the challenges caused by the pandemic. The president wants to end the public health emergency while still keeping costs low and increasing access to healthcare. The budget request proposes investments for keeping Telehealth as a permanent health service, reducing healthcare costs, expanding access to healthcare, reducing disparities, transforming the mental health system’s infrastructure, reducing prescription drug costs, and preparing for future pandemics and health threats. The U.S. Fiscal Budget 2023 Request addresses how the U.S. can address the challenges from COVID-19, expand healthcare access, reduce health disparities, improve the behavioral health system, and improve the overall health of the public. 

Debate Priorities vs Budget Brief Priorities

After reviewing the debate and the Fiscal Budget 2023 Brief, the priorities discussed in both sources did match each other. Both sources state making major investments in priority areas such as maternal health, substance abuse, behavioral health, refugees, and reducing health disparities. However, the Fiscal Budget Brief discusses funding and addressing issues in more priority areas. The Fiscal Budget Brief discusses investments for family planning, ending the HIV epidemic, improving pediatric health, mitigating the opioid crisis, improving the nation’s Health Information technology, injury prevention and control, food safety, and improving the quality of care for Native American tribes. The debate especially focuses on improving the mental health system post COVID-19 public health emergency. While the debate focuses on the priority areas greatly affected by the COVID-19 pandemic, the brief addresses issues and proposes investments for all areas concerning public health. 

Differences and Agreements Between Republicans and Democrats

Republicans and democrats have similarities and differences in their approaches to addressing issues discussed in the budget and recognizing which areas are priority areas of Americans. Both political sides want to implement Telehealth permanently, decrease healthcare costs, improve the behavioral health system, improve maternal and postpartum care, ensure Medicare coverage for cancer screening tools, lower prescription costs, and address the prescription drug shortage. The two political parties want to improve the healthcare system, however, they have different approaches in achieving this. The first key difference is that republicans want to eliminate Medicare in five years and repeal the Affordable Care Act. Republicans want to accomplish this to reduce healthcare costs and allocate the funds to other public health sectors since the Medicare Trust Fund is expected to become insolvent in 2026. The President’s budget does not provide a plan to maintain Medicare’s solvency and instead promotes expansion coverages. Republicans fear that if Medicare and the Affordable Care Act aren’t eliminated, then the deficit and inflation will worsen. Democrats also want to implement price controls for healthcare services, however, the republicans do not want to. Republican Senator Mike Crapo argued that implementing price controls will lessen the development of cutting-edge treatments and cures, increase launch prices for new drugs, and cause a huge decline in innovative R&D. Both republicans and democrats also want to create bipartisan legislation to properly allocate the funds in the trust fund. However, Republicans do not agree with the long-term expansion of the Affordable Care Act because it would increase federal spending. Republicans argue that the long-term expansion will increase federal spending, force taxpayers with six-figure salaries to find health insurance coverage, and worsen the economic outlook for working class families. Democrats argued that instead of cutting out benefits, they will cut out costs to reduce federal spending. Another similarity in both parties’ approaches is to reduce the costs of prescription drugs and address the drug shortage by labeling the drugs with the longest possible expiration dates. A recent study conducted by the American Society of Health System Pharmacists reported there are over 200 brand-name prescription drugs in shortage. Both parties agreed to fund the resilient supply chain and shortages program and that drug shortages were an economic issue with pharmaceutical companies. The parties agree that bipartisan legislation needs to be passed to address these issues. However, the parties don’t agree on how to reduce prescription drug prices. 1 in 3 Americans reported they are not taking their medications due to being unable to pay the high prescription costs. Democrats want to lower prescription costs by putting a $35 cap on copays for insulin prescriptions and setting an out-of-pocket cap of $167 per month for senior prescriptions for Medicare Part D. Republicans on the other hand argue that implementing price controls for prescription drugs will instead cause prescription prices to increase and lessen the development of new drugs. Lastly, republicans and democrats do not agree on how to transition out of the COVID-19 public health emergency. Democrats want to continually fund COVID-19 aid in order to prepare for future pandemics and health threats. However, republicans want to discontinue funding COVID-19 aid because they feel it is unnecessary spending, should reflect the transition beyond the public health emergency, and is unpredictable. Republicans argue that instead of continuing the aid and living in a public health emergency, the public needs structured timelines and plans for exiting the continuous public health emergency. 

Striking Testimonies from the Representatives

One testimony from the representatives that was striking is that Medicare’s trust fund is expected to be depleted by the year of 2026. Republicans attribute the expected depletion of Medicare’s trust fund to the President’s Budget Request proposing for a long list of expansion coverages that can deepen the deficit and worsen inflation. Another testimony that was striking was the success of expanding health insurance coverage. Through the Affordable Care Act, 14.5 million Americans secured health insurance coverage. The rescue plan passed in March of 2021 provided better deals on health insurance to millions of Americans. The monthly premiums for individual health insurance decreased by more than 22% and six million Americans obtained health insurance coverage. The third testimony that was striking is the high costs accrued from COVID-19. So far, it has cost the United States $4.5 trillion dollars in direct support from the federal government. These costs include providing COVID-19 vaccines, shipping 325 million free at-home COVID-19 tests, providing 270 million N-95 masks, and dispensing 776,000 payments to over 400,000 healthcare providers.