Health Care and the American Recovery and Reinvestment Act (New Eng Jour Med)

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Health Care and the American Recovery and Reinvestment Act
Robert Steinbrook, M.D.

http://content.nejm.org/cgi/content/full/360/11/1057?query=TOC

On February 17, 2009, four weeks after his inauguration, President Barack Obama signed into law a $787 billion economic stimulus package.1,2 The economic impact of the American Recovery and Reinvestment Act of 2009, as the measure is officially known, will not be apparent for months. Nonetheless, the bill's approval — even before any new senior officials of the Department of Health and Human Services (DHHS) were in place — has jump-started the Obama administration's plans for health care.

By launching broad federal initiatives for biomedical and comparative effectiveness research, the adoption of health information technology, and the protection of the privacy and security of medical records, the stimulus law should have major and immediate effects. It directs to health care about $150 billion in new funds (see table), most of which will be spent within 2 years. The spending includes $87 billion for Medicaid, $24.7 billion to subsidize private health insurance for people who lose or have lost their jobs, $19.2 billion for health information technology, and $10 billion for the National Institutes of Health (NIH). The new NIH funding, equivalent to a third of the institutes' $29.5 billion annual budget, was added at the insistence of Senator Arlen Specter (R-PA), a strong supporter of the agency. Specter, who has survived a brain tumor and two episodes of Hodgkin's disease, was one of the three Republicans in Congress who voted for the legislation.

The act also provides $650 million to support prevention and wellness activities targeting obesity, smoking, and other risk factors for chronic diseases and $500 million for health professions training programs, including $300 million to revitalize the National Health Service Corps (NHSC). The NHSC provides loan repayment, salary support, and scholarships for physicians and other providers who practice in underserved areas. Under the Bush administration, its budget decreased to about $125 million per year, and it could award only 84 scholarships in fiscal 2008, less than 1 per medical school. The package increases by 50% the overall support for the NHSC and other workforce programs run by the Health Resources and Services Administration.

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After he was named the White House chief of staff in November, Rahm Emanuel remarked, "You never want a serious crisis to go to waste." Clearly, the economic crisis has allowed the Obama administration to undertake far-reaching health care initiatives that it could not otherwise have launched quickly, if at all. The government will now have to determine how to spend the money promptly — and wisely.

Source Information
Dr. Steinbrook ([e-mail]) is a national correspondent for the Journal.

The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved.

http://content.nejm.org/cgi/content/full/360/11/1057?query=TOC