While the health care law has survived Republican efforts to repeal it, some of its individual initiatives are in limbo or limping along because of funding problems.
The law authorized the new efforts but didn’t provide appropriations for them. That has to occur separately – and given current deficit woes, as well as wrangling between Democrats and Republicans, the programs might never get off the ground, some experts say.
“Since the law was passed, the budgetary picture in Congress has changed dramatically," said Bruce Vladeck, former Medicare administrator in the Clinton administration and now a New York health care consultant. "So stuff (Obama administration officials) were interested in doing when health reform passed, they now have a realistic sense that …they are never going to get an appropriation to do it.”
One of the higher-profile initiatives that has not received any funding is a $50 million program to help states test alternatives to resolve medical malpractice disputes.
The American Medical Association, which backed the health law, is upset. “Congress should fully fund medical liability demonstration and pilot programs in the health reform law,” said Dr. Cecil Wilson, president of the AMA. “Everyone pays for the increasingly irrational medical liability system in this country.”
A separate program that is providing $25 million in grants to test malpractice reforms to improve patient safety hasn’t been affected. The White House approved those grants six months before the health care law was enacted.
Other initiatives in the health law slated for this year that haven't started or been fully funded include:
--A $24 million program to help test regional systems for delivering emergency care. The effort would help hospitals work together to assure adequate physician staffing in the ERs. No money has been proposed.
--A program to have health clinics run by nurse practitioners. The program has received $15 million instead of the $50 million called for in the law.
--A project to monitor for-profit nursing home chains and a program to increase use of information technology such as electronic health records in nursing homes. No money has been proposed.
Although these programs were authorized under the health law, funding was not mandated.
Administration officials say, given the budget squeeze, they’ve had to set priorities on funding.
“While recognizing the importance of restraining federal spending, the administration has proposed funding for some activities authorized by the Affordable Care Act, such as nurse-managed health centers and many workforce programs,” said Jessica Santillo, a spokeswoman for the Health and Human Services Department.
Some lobbying groups aren’t satisfied. For example, emergency room physicians worry they may lost an opportunity to improve care.
“We’ve been very disappointed at the lack of federal funding to implement the regionalized systems of emergency care pilot projects that were created under the Affordable Care Act,” said Dr. Sandra Schneider, president of the American College of Emergency Physicians. She said numerous studies have proven that “regionalized, coordinated and accountable emergency care systems would not only improve patient outcomes, but do so at less cost.”
Another program from the law that has not been funded is a $60 million program to test alternative dental providers such as hygienists or dental aides who would extract teeth and fill cavities in rural areas where dentists are scarce. The program, which is supposed to start by March 2012 was strongly supported by the Battle Creek, Mich.-based W.K. Kellogg Foundation which has been funding a similar program in Alaska. The federal money would be awarded to colleges, community health centers and Indian health clinics.
“We were excited to see the inclusion of the oral health provision in the bill,” said Alice Warner, program officer at the Kellogg Foundation. “We thought it was forward thinking.”
The American Dental Association, which opposes the idea of letting anyone but trained dentists extract teeth and fill cavities, applauded the lack of funding in Obama’s 2012 budget request. “We didn’t want this concept to get a foot in the door,” said an ADA spokesman.