The Health and Human Services Department would spend $330.3 billion under President Reagan's proposed budget for fiscal 1986, almost $12 billion above fiscal 1985 estimates.
Virtually all the increases would come in Social Security, Medicare and Medicaid, and Supplemental Security Income for the aged, blind and disabled, but even the Medicare and Medicaid programs would grow more slowly than inflation is expected to. Nearly all other programs would be frozen at 1985 levels or cut further..
The increases in Social Security and SSI would cover new beneficiaries and a 4.1 percent cost-of-living increase next January.
For Medicare, the president wants to squeeze doctors, hospitals and other health care providers, but would force patients to pay more, too. The rates Medicare pays for hospital care, doctor services, home health and skilled nursing services, providers of durable medical equipment, clinical laboratory fees and the direct costs of training hospital interns and residents would be frozen at 1985 levels.
Rates for so-called "indirect" intern and resident costs of hospitals would be cut in half; patients would be charged $4.80 a visit for each home health visit after the first 20 in a year; Medicare monthly premiums, now about 25 percent of the cost of the doctor-insurance part of the program, would be raised to 35 percent by 1990; patients would not receive coverage until the month after they turned 65; the $75 annual deductible for doctors' charges would rise with inflation starting in 1987, and Medicare patients could receive a voucher worth the insurance cost of their coverage and be able to use it to purchase coverage under a private health plan instead of staying with Medicare.
These changes are estimated to reduce Medicare growth by $4.2 billion in 1986 and a total of $43 billion from 1986 to 1990.
In Medicaid, the proposals would "cap" the basic reimbursements to the states at $22.2 billion in fiscal 1986, then allow them to grow only to keep pace with the medical-care component of the Consumer Price Index. Another $1.2 billion would cover administrative costs. However, a special $300 million fund would be made available in 1986 to help states make the transition. Together, these provisions would provide $23.7 billion for the program in 1986, or $1 billion below the level of growth that is now anticipated. The changes would reduce the growth of the Medicaid program by $17 billion from 1986 to 1990.
New budget authority for the National Institutes of Health would be cut to $4.853 billion, or $287 million below the 1985 appropriation, and new research grants would be held to 5,000 instead of the 6,500 authorized by Congress for 1985. The administration also plans to distribute only 5,000 of this year's grants.
Budget authority for the Food and Drug Administration would be $409 million, $1 million below 1985. The National Health Service Corps would be cut by one-third. Funds for health-profession training and health planning would be wiped out. The Centers for Disease Control, which will get $408 million this year, would be cut to $392 million, with half the cut coming from occupational health and safety funds.
In Aid to Families with Dependent Children, outlays would be cut $180 million below what the program would otherwise receive by freezing administrative grants at $928 million, the same total as in 1985. The budget would then increase those grants only to keep pace with inflation, require all states to adopt "workfare" programs, bar unmarried teen-age mothers from leaving their parents' home in order to qualify for benefits and eliminate payments to employable parents whose youngest child is 16 or over.
The president would provide $2.1 billion for energy assistance for the poor, $2.7 billion for social services grants to the states, $1.075 billion for the Head Start program and bar a cost-of-living increase for disabled miners who receive black-lung benefits. He also would eliminate both the Work Incentive (WIN) program and the community services grant program, cut refugee program authority from $450 million to $362 million and shift some of the costs to voluntary refugee resettlement agencies.