The Office of Management and Budget has proposed consolidating all federal AIDS programs in the surgeon general's office, an idea that is expected to raise questions among public health officials because Surgeon General C. Everett Koop has not been actively involved in administering health policy.
The OMB's fiscal 1987 budget proposals for the Health and Human Services Department also include cuts in Medicare, Medicaid and National Institutes of Health grants, according to OMB budget documents made available to the Los Angeles Times.
According to the documents, the OMB granted the department its full $213 million request for AIDS-related activities for fiscal 1987, which begins next Oct. 1. That is $17 million more than the Reagan administration requested for the current year but $17 million less than Congress appropriated to combat AIDS, or acquired immune deficiency syndrome, a fatal disease that attacks the body's immune system.
It is not clear from the budget documents whether the surgeon general would have a voice in formulating AIDS policy or allocating funds to the agencies within HHS that administer AIDS-related programs. The documents say only: "The surgeon general and a small staff will be designated to coordinate the department's activities."
The surgeon general's office could not be reached for comment, and an OMB official said only, "There are several unresolved issues with HHS, and AIDS is one of them."
Rep. Henry A. Waxman (D-Calif.), chairman of the House Energy and Commerce subcommittee on health and leader of the House fight for increased AIDS funding, said he was puzzled by the proposal.
"Suddenly OMB has gotten involved and is managing health programs in budget documents," he said. "For some reason, OMB wants to transfer these complex research and public health programs to an office of very little direct experience with the epidemic. We'll have to monitor this plan very carefully."
Another source speculated that the proposal may be tied to a suggestion circulating earlier in the White House that the surgeon general "calm public alarm" by issuing a public report on AIDS. The source said the idea "now seems to have been dropped."
This same source speculated that the proposed transfer of authority may also be tied to the fact that the job of assistant secretary for health has been vacant and filled on a temporary basis for more than a year.
During the administration of President Jimmy Carter, the assistant secretary's job and the surgeon general's job had been held by the same person. Now, however, the surgeon general reports to the assistant secretary.
"It may well be that someone at OMB is just confused about who is in charge," said the source, who did not wish to be identified.
While the OMB left the HHS request for AIDS funds untouched, it proposed significant cuts in other health programs. Otis R. Bowen, the new HHS secretary, is reported to have protested these proposals to the White House, which can reject them before President Reagan submits his fiscal 1987 budget to Congress in February.
Many of the health-care financing proposals have been suggested in previous years, only to be rejected by Congress. The OMB proposed, for example, that Medicare beneficiaries pay higher premiums for their coverage and that Medicare reimbursement rates for hospitals be increased next year by only 2 percent, not enough to offset inflation. According to the documents, the OMB is also studying a new formula for computing payments to physicians who treat Medicare patients.
The OMB also repeated a previously unsuccessful proposal to limit the costs of the Medicaid program for the poor, in part by reimbursing states only for "medically necessary services." Also among the Medicaid proposals are a limit to the federal payment for educational and vocational services for the mentally retarded and a requirement for a mandatory second opinion on surgery.
In the NIH budget, the OMB proposed a reduction from the administration's requested $5.01 billion in fiscal 1986 to $4.9 billion in fiscal 1987. Congress appropriated $5.5 billion in fiscal 1986.
For the Centers for Disease Control, the OMB would reduce the chronic and environmental health program from $30.6 million to $15.7 million in 1987.