Politics of the federal budget process.

THE FEDERAL GOVERNMENT provided funding for allied health education programs from 1967 to 1979 in the amount of $276,495,000, which equates to approximately $1.2 billion as measured in 2007 dollars. The spigot was turned off during the decade of the 1980s and was not turned on again until 1990, beginning with $737,000 provided that year under section 764 of Title VII of the Public Health Service Act (PL 100-607). When the law was reauthorized as PL 102-408 in 1992, funding came under Section 767. With the reauthorization of PL 105-392 in 1998, Section 755 Allied Health & Other Programs was created for the same purpose. Over the years, funding gradually increased to approximately $5 million specifically for allied health. Total funding eventually reached a total of $11.9 million under section 755. Then in fiscal year 2006, Title VII programs were cut by more than 50%. Although Section 755 remained on the books, the allied health portion was one of 10 programs that lost all of its funding. An objective in November 2007 (when this essay was submitted for publication) was to have funding restored specifically for allied health. The task is no different than it was in previous years, when the objective back then was to increase funding. Despite efforts to restore money for allied health, the bill scheduled to be sent to the president once again will not include funds for that purpose. The Senate made an 11th hour addition in the form of an amendment in October, which would have added back $2 million, but the amendment was removed in conference when representatives from the two chambers met to resolve differences. The Federal Budget and Appropriations The budget and appropriations rituals begin in earnest at the start of each new congressional session every January. Viewed in the context of providing funds for health professions education, this essay will describe major steps involved in the process. Factors that affect the outcome include the level of belief on the part of legislators and executive branch personnel that health professions education programs are effective, a corollary belief that having an adequate supply of competently prepared health professionals is a responsibility of the federal government, an overall budget deficit, and the inability to sustain large entitlement programs such as Medicare and Social security unless substantial changes are made. The federal government's 2008 fiscal year began on October 1, 2007, but not a single one of 12 annual spending bills had been sent to the president for his signature by that date. A temporary funding measure known as a continuing resolution (CR) went into effect with an expiration date of November 16. Moreover, final spending measures for fiscal year 2007 never were completed and the government had to rely on a series of CRs to enable agencies to continue in operation. The final CR was a huge one encompassing unfinished spending bills that was signed into law (PL 110-5) on February 15, 2007, to keep the government operating through the rest of the fiscal year. The spending level for fiscal year 2006 was used as a baseline. The situation was similar in several previous years, except that spending bills eventually were signed into law, albeit several months late. What is it about the whole process that makes the most essential aspect of congressional responsibilities so difficult to achieve? No matter which political party is in control of either one or both chambers in Congress, every year at the beginning of a new session the same predictions are made to the effect that all spending bills will be completed by early summer. Yet, every year the same problems arise and the entire matter tends to go awry. Typically, the dilemma starts to unfold with the task of producing a budget. Federal Budget The following 2007 calendar shows the dates associated with the production of a budget for fiscal year 2008. …