In letter, Sullivan protests proposed cuts in U.S. health budget


WASHINGTON -- Dr. Louis W. Sullivan, the secretary of health and human services, has complained that cuts in his budget request demanded by Richard G. Darman, the White House budget director, would harm services to 50 million Americans who benefit from Social Security, Medicare and other federal health programs.

In a confidential letter, Dr. Sullivan also complained that Mr. Darman was interfering too much in the operation and management of the giant Department of Health and Human Services, which accounts for 35 percent of all federal spending.

Dr. Sullivan asserted that Mr. Darman's budget proposals would cause delays in the payment of Medicare benefits to the elderly and in the payment of Social Security benefits for disabled people, that it would provide too little money for prenatal care and that it would restrict health care for members of minority groups and for low-income people.

He also said that the Darman proposals would cut Medicare payments to teaching hospitals in inner-city neighborhoods and make it more difficult for elderly people to get information about Social Security over the telephone.

Dr. Sullivan's comments came in response to Mr. Darman's preliminary decisions on the 1992 budget, which President Bush will submit to Congress in early February.

A copy of Dr. Sullivan's letter, sent last Friday to Mr. Darman, was obtained yesterday from a budget expert who said he regards many of the proposals as misguided.

Mr. Darman's decisions for each agency are contained in a document known as a "passback," called that because they are passed back from the Office of Management and Budget to the agency.

In a personal declaration of independence, Dr. Sullivan wrote, "We intend to treat any detailed directions and requirements in the passback as advisory" only. To underline his point, Dr. Sullivan said that "specific staffing levels and management arrangements must be left to responsible policy officials and program administrations" in the department and must not be dictated by Mr. Darman's office.

Some similar decisions by Mr. Darman have been appealed by other Cabinet officers, but the Sullivan protest is the strongest so far and has proved the most difficult to resolve, administration officials said.

Aides to Mr. Darman declined to discuss details of Dr. Sullivan's letter but said they believed that disagreements could be resolved amicably.

Mr. Darman and John H. Sununu, the White House chief of staff, have said that many executive agency officials do not understand the severity of the limits on domestic spending imposed by Congress in the budget bill passed in October.

Dr. Sullivan's letter did not specify the total amount of money at stake in his disputes with Mr. Darman. But he did request particular amounts for certain programs, and the requests taken together would cost several billion dollars.

In the fiscal year that ended Sept. 30, the department spent $439 billion, while the federal government as a whole spent $1.25 trillion.

Dr. Sullivan said the Social Security and Medicare trust funds were "solvent and serving their clients daily." But he said, "The means of providing those benefits are seriously threatened by the level of resources for their administration which OMB has suggested."

He further warned, "Our ability to respond to the needs of 50 million aged and disabled beneficiaries will be seriously eroded. Social Security Administration will experience systemwide backlogs which will be especially apparent in such high-visibility areas as disability claims, where processing times will grow by one-third and appeals will take a month longer to review. Medicare providers and beneficiaries will soon notice the deterioration in service delivery, as fiscal year 1991 Medicare claims processing times grow to 50 days, well in excess of statutory payment deadlines."

Dr. Sullivan said, "The outlook for fiscal year 1992 is even more bleak. At the level of resources provided" by Mr. Darman, "Social Security Administration will see the backlogs of disability claims double, increasing from three to six months," and more than half of all callers to the agency's toll-free telephone number will get a busy signal on some days.

Mr. Darman's budget allowance would force the Health Care Financing Administration, which operates Medicare, to reduce its 3,000-member staff by 22 percent, Dr. Sullivan said, and the average time for handling Medicare claims "would increase to 80 days."

Mr. Darman's preliminary decisions on the budget for fiscal 1992, which begins Oct. 1, 1991, were distributed last week to all agencies.

In his letter, Dr. Sullivan also pleaded with Mr. Darman for more money to combat "disgracefully high rates" of infant mortality.

In addition, the secretary said, "We are deeply concerned about the scope and content of the proposed reductions in spending for Medicare benefits," especially Mr. Darman's proposal to cut Medicare payments to teaching hospitals, many of which are in inner-city neighborhoods.

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