Mapping Obama's shifting health care priorities

New budget shows cuts to some health spending

Dan Diamond Dan Diamond, Managing Editor  

Today's big story: President Obama's latest budget calls for $360 billion in cuts to Medicare, Medicaid, and other health services.

But as The Hill's Sam Baker points out, those proposed budget cuts are largely familiar and were pushed by the Obama administration during last year's deficit talks; they don't really tell us anything new about the White House's health care strategy. 

Medicare and Medicaid spending also may be less a barometer of a president's priorities than you might think. Those budget requests are largely mandatory and can be shaped by years of congressional legislation, broad deficit-cutting decisions, or demographic trends.

What's getting less coverage, but bears watching for health wonks: The president's proposals on discretionary spending, and how they've changed over time.


On that front, here's what the latest budget tells us:

  • Even in a year where overall HHS funding is getting tighter, the president is making a larger request to fund CMS, given its role in implementing his health reform law. 
  • Government efforts to fight health care fraud, which picked up steam under the Bush administration, remain aggressive compared to previous years. As a result, they've also produced record takebacks in recent years—but funding has been shifted or scaled back since the FY 2012 request.
  • The Obama administration has significantly ramped up funding for the FDA, after several high-profile outbreaks and recalls during the Bush administration. However, this year's request comes in a bit below last year's. (Although as Politico Pro reports, FDA is getting an overall increase compared to last year's actual spending.)

Of course, a president's budget always relies a bit on hocus-pocus—a recent exposé revealed how White House officials tweaked the impact of the Affordable Care Act to show better long-term savings—and an election-year budget is naturally in flux. A program's actual spending may be significantly different than the budget document's figures, too.

But if you're trying to quantify a president's influence beyond the big budget numbers in the headlines, here's one place to look.

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