The Office of Management and Budget wants to shift a half dozen more federal health programs into the four new giant medical block grants and then cut the total for all the blocks to about $1.8 billion in fiscal 1983, or at least $1 billion below the fiscal 1981 level.
The OMB also wants to phase out the elite 6,500-member Public Health Service Commissioned Corps by barring future enlistments and letting the corps melt away by attrition.
The health programs that would be merged into block grants under the OMB plan are the feeding program for women, infants and children, the family planning program, health services for migrant workers and black lung victims, the developmental disabilities program and the special health screening program for low-income children.
The OMB proposals, which reportedly will be appealed by Health and Human Services Secretary Richard S. Schweiker, were revealed in charts obtained by The Washington Post.
The block grants proposals involve federal grants for special health programs, but not Medicaid.
The new proposal, if endorsed by President Reagan, is certain to meet fierce opposition from states and localities because it would shrivel further the amount of money the federal government would give them, without reducing their responsibilities.
"We told the White House last Friday that further cuts in block grants in fiscal 1983 will risk discrediting the whole approach," said a spokesman for the National Governors Association.
The fight over creating the original four block grants last summer was one of the toughest battles over the budget bill. The president proposed melding about 30 health grant programs into a handful of blocks.
With Rep. Henry A. Waxman (D-Calif.), chairman of the House Commerce subcommittee on health and the environment, leading the opposition, Congress kept 10 of the programs separate, although appropriations were cut, and put the other 20 into four blocks: maternal and child health, preventive health, primary care and alcohol, drug abuse and mental health.
In fiscal 1981, before Reagan took office, the appropriations for the 20 programs put into the blocks last summer, plus the six in the OMB plan, totaled $2.8 billion to $3 billion. The exact figure was not available yesterday because officials didn't have precise numbers for the child health screening programs.
For fiscal 1982, Congress appears likely to vote about $2.3 billion to $2.5 billion for these programs, compared with OMB's fiscal 1983 figure of $1.8 billion.
Waxman said he opposes the block grant plan as well as the big cuts the OMB is planning for the Food and Drug Administration, the Centers for Disease Control and other parts of HHS.
"I will certainly fight against this kind of budget proposal for 1983," he said.
The Children's Defense Fund called the plans to cut the health screening program for low-income children "long-term folly" and "absolutely unacceptable."
The phasing out of the PHS Commissioned Corps, which provides medical staff for national emergencies such as the Mount St. Helen's eruption and underserved medical areas such as Indian reservations, is also likely to meet opposition.
The OMB says it believes it can save money because these PHS personnel get higher pay and allowances than most other government doctors, but corps backers say it is necessary to compensate the staff for being moved around rapidly to meet any emergency.
Overall, the OMB wants to allow HHS $282.5 billion in new budget authority (about $600 million under Schweiker's request) and $269 billion in outlays in fiscal 1983, about what Schweiker asked.
Among key OMB health proposals: deep cuts in the National Health Service Corps; no new money at all for the health planning agencies, which the OMB wants to kill; big cuts in mental health training and nurse training; abolition of the office that campaigns against smoking and a 15 percent cut in Schweiker's request for the Indian Health Service.
But one thing did well: Sen. Jeremiah Denton (R-Ala.) would get $11 million in 1982 and $16 million in 1983 (OMB increased Schweiker's figure for this) for Denton's new program to finance local centers to promote teen-age chastity.