document_title: History of health care reform in the United States

question_text: when did health care reform began in the united states

question_tokens: when did health care reform began in the united states

text: History of health care reform in the United States

text: Federal health care proposals[edit]

text: 19th century[edit]

text: One of the earliest health care proposals at the federal level was the 1854 Bill for the Benefit of the Indigent Insane, which would have established asylums for the indigent insane, as well as the blind and deaf, via federal land grants to the states. This bill was proposed by activist Dorothea Dix and passed both houses of Congress, but was vetoed by president Franklin Pierce. Pierce argued that the federal government should not commit itself to social welfare, which he stated was the responsibility of the states.[1][2]

text: After the Civil War, the federal government established the first system of medical care in the South, known as the Freedmen's Bureau. The government constructed 40 hospitals, employed over 120 physicians, and treated well over one million sick and dying former slaves. The hospitals were short lived, lasting from 1865 to 1870. Freedmen's Hospital in Washington, D.C. remained in operation until the late nineteenth century, when it became part of Howard University.[3]

text: The next major initiative came in the New Deal legislation of the 1930s, in the context of the Great Depression.[4]

text: In the first 10–15 years of the 20th century Progressivism was influencing both Europe and the United States.[5] Many European countries were passing the first social welfare acts and forming the basis for compulsory government-run or voluntary subsidized health care programs.[6] The United Kingdom passed the National Insurance Act of 1911 that provided medical care and replacement of some lost wages if a worker became ill. It did not, however, cover spouses or dependents. U.S. efforts to achieve universal coverage began with progressive health care reformers who supported Theodore Roosevelt for President in 1912, though he was defeated.[7] Progressives campaigned unsuccessfully for sickness insurance guaranteed by the states.[8] A unique American history of decentralization in government, limited government, and a tradition of classical liberalism are all possible explanations for the suspicion around the idea of compulsory government-run insurance.[6] The American Medical Association (AMA) was also deeply and vocally opposed to the idea,[8] which it labeled "socialized medicine". In addition, many urban US workers already had access to sickness insurance through employer-based sickness funds.

text: Early industrial sickness insurance purchased through employers was one influential economic origin of the current American health care system.[9] These late-19th-century and early-20th-century sickness insurance schemes were generally inexpensive for workers: their small scale and local administration kept overhead low, and because the people who purchased insurance were all employees of the same company, that prevented people who were already ill from buying in.[9] The presence of employer-based sickness funds may have contributed to why the idea of government-based insurance did not take hold in the United States at the same time that the United Kingdom and the rest of Europe was moving toward socialized schemes like the UK National Insurance Act of 1911.[9] Thus, at the beginning of the 20th century, Americans were used to associating insurance with employers, which paved the way for the beginning of third-party health insurance in the 1930s.

text: With the Great Depression, more and more people could not afford medical services. In 1933, Franklin D. Roosevelt asked Isidore Falk and Edgar Sydenstricter to help draft provisions to Roosevelt's pending Social Security legislation to include publicly funded health care programs. These reforms were attacked by the American Medical Association as well as state and local affiliates of the AMA as "compulsory health insurance." Roosevelt ended up removing the health care provisions from the bill in 1935. Fear of organized medicine's opposition to universal health care became standard for decades after the 1930s.[11]

text: During this time, individual hospitals began offering their own insurance programs, the first of which became Blue Cross.[12] Groups of hospitals as well as physician groups (i.e. Blue Shield) soon began selling group health insurance policies to employers, who then offered them to their employees and collected premiums. In the 1940s Congress passed legislation that supported the new third-party insurers. During World War II, Henry Kaiser used an arrangement in which doctors bypassed traditional fee-for-care and were contracted to meet all the medical needs for his employees on construction projects up and down the West coast.[13] After the war ended, he opened the plan up to the public as a non-profit organization under the name Kaiser Permanente.

text: During World War II, the federal government introduced wages and price controls. In an effort to continue attracting and retaining employees without violating those controls, employers offered and sponsored health insurance to employees in lieu of gross pay. This was a beginning of the third-party paying system that began to replace direct out-of-pocket payments.

text: Following the world war, President Harry Truman called for universal health care as a part of his Fair Deal in 1949 but strong opposition stopped that part of the Fair Deal.[14][15] However, in 1946 the National Mental Health Act was passed, as was the Hospital Survey and Construction Act, or Hill-Burton Act. In 1951 the IRS declared group premiums paid by employers as a tax-deductible business expense,[6] which solidified the third-party insurance companies' place as primary providers of access to health care in the United States.

text: In the Civil Rights era of the 1960s and early 1970s, public opinion shifted towards the problem of the uninsured, especially the elderly. Since care for the elderly would someday affect everyone, supporters of health care reform were able to avoid the worst fears of "socialized medicine," which was considered a dirty word for its association with communism.[6] After Lyndon B. Johnson was elected president in 1964, the stage was set for the passage of Medicare and Medicaid in 1965.[16] Johnson's plan was not without opposition, however. "Opponents, especially the AMA and insurance companies, opposed the Johnson administration's proposal on the grounds that it was compulsory, it represented socialized medicine, it would reduce the quality of care, and it was 'un-American.'"[6] These views notwithstanding, the Medicare program was established by legislation signed into law on July 30, 1965, by President Lyndon B. Johnson. Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are either age 65 and over, or who meet other special criteria.

text: In 1970, three proposals for single-payer universal national health insurance financed by payroll taxes and general federal revenues were introduced in the U.S. Congress.[17] In February 1970, Representative Martha Griffiths (D-MI) introduced a national health insurance bill—without any cost sharing—developed with the AFL–CIO.[18] In April 1970, Senator Jacob Javits (R-NY) introduced a bill to extend Medicare to all—retaining existing Medicare cost sharing and coverage limits—developed after consultation with Governor Nelson Rockefeller (R-NY) and former Johnson administration HEW Secretary Wilbur Cohen.[19] In August 1970, Senator Ted Kennedy (D-MA) introduced a bipartisan national health insurance bill—without any cost sharing—developed with the Committee for National Health Insurance founded by United Auto Workers (UAW) president Walter Reuther, with a corresponding bill introduced in the House the following month by Representative James Corman (D-CA).[20] In September 1970, the Senate Labor and Public Welfare Committee held the first congressional hearings in twenty years on national health insurance.[21]

text: In January 1971, Kennedy began a decade as chairman of the Health subcommittee of the Senate Labor and Public Welfare Committee, and introduced a reconciled bipartisan Kennedy–Griffiths bill proposing universal national health insurance.[22] In February 1971, President Richard Nixon proposed more limited health insurance reform—an employer mandate to offer private health insurance if employees volunteered to pay 25 percent of premiums, federalization of Medicaid for the poor with dependent minor children, and support for health maintenance organizations (HMOs).[22] Hearings on national health insurance were held by the House Ways and Means Committee and the Senate Finance Committee in 1971, but no bill had the support of committee chairmen Representative Wilbur Mills (D-AR) or Senator Russell Long (D-LA).[22]

text: In October 1972, Nixon signed the Social Security Amendments of 1972 extending Medicare to those under 65 who have been severely disabled for over two years or have end stage renal disease (ESRD), and gradually raising the Medicare Part A payroll tax from 1.1% to 1.45% in 1986.[23] In November 1972, Nixon won re-election in a landslide over the only Democratic presidential nominee ever not endorsed by the AFL–CIO, Senator George McGovern (D-SD),[24] who was a cosponsor of the Kennedy-Griffiths bill, but did not make national health insurance a major issue in his campaign.[25]

text: In October 1973, Long and Senator Abraham Ribicoff (D-CT) introduced a bipartisan bill for catastrophic health insurance coverage for workers financed by payroll taxes and for Medicare beneficiaries, and federalization of Medicaid with extension to the poor without dependent minor children.[26] In February 1974, Nixon proposed more comprehensive health insurance reform—an employer mandate to offer private health insurance if employees volunteered to pay 25 percent of premiums, replacement of Medicaid by state-run health insurance plans available to all with income-based premiums and cost sharing, and replacement of Medicare with a new federal program that eliminated the limit on hospital days, added income-based out-of-pocket limits, and added outpatient prescription drug coverage.[27] In April 1974, Kennedy and Mills introduced a bill for near-universal national health insurance with benefits identical to the expanded Nixon plan—but with mandatory participation by employers and employees through payroll taxes and with lower cost sharing—both plans were criticized by labor, consumer, and senior citizens organizations because of their substantial cost sharing.[27]

text: In August 1974, after Nixon's resignation and President Gerald Ford's call for health insurance reform, Mills tried to advance a compromise based on Nixon's plan—but with mandatory participation by employers and employees through premiums to private health insurance companies and catastrophic health insurance coverage financed by payroll taxes—but gave up when unable to get more than a 13–12 majority of his committee to support his compromise plan.[27][28][29][30] In December 1974, Mills resigned as chairman of the Ways and Means Committee and was succeeded by Representative Al Ullman (D-OR), who opposed payroll tax and general federal revenue financing of national health insurance.[31]

text: In January 1975, in the midst of the worst recession in the four decades since the Great Depression, Ford said he would veto any health insurance reform,[32] and Kennedy returned to sponsoring his original universal national health insurance bill.[33] In April 1975, with one third of its sponsors gone after the November 1974 election,[34] the AMA replaced its "Medicredit" plan with an employer mandate proposal similar to Nixon's 1974 plan.[35] In January 1976, Ford proposed adding catastrophic coverage to Medicare, offset by increased cost sharing.[36] In April 1976, Democratic presidential candidate Jimmy Carter proposed health care reform that included key features of Kennedy's universal national health insurance bill.[37]

text: In December 1977, President Carter told Kennedy his bill must be changed to preserve a large role for private insurance companies, minimize federal spending (precluding payroll tax financing), and be phased-in so not to interfere with balancing the federal budget.[37][38] Kennedy and organized labor compromised and made the requested changes, but broke with Carter in July 1978 when he would not commit to pursuing a single bill with a fixed schedule for phasing-in comprehensive coverage.[37][38]

text: In May 1979, Kennedy proposed a new bipartisan universal national health insurance bill—choice of competing federally-regulated private health insurance plans with no cost sharing financed by income-based premiums via an employer mandate and individual mandate, replacement of Medicaid by government payment of premiums to private insurers, and enhancement of Medicare by adding prescription drug coverage and eliminating premiums and cost sharing.[39][40] In June 1979, Carter proposed more limited health insurance reform—an employer mandate to provide catastrophic private health insurance plus coverage without cost sharing for pregnant women and infants, federalization of Medicaid with extension to the very poor without dependent minor children, and enhancement of Medicare by adding catastrophic coverage.[39] In November 1979, Long led a bipartisan conservative majority of his Senate Finance Committee to support an employer mandate to provide catastrophic-only private health insurance and enhancement of Medicare by adding catastrophic coverage, but abandoned efforts in May 1980 due to budget constraints in the face of a deteriorating economy.[37][39][41][42]

text: The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) amended the Employee Retirement Income Security Act of 1974 (ERISA) to give some employees the ability to continue health insurance coverage after leaving employment.

text: Clinton initiative[edit]

text: Health care reform was a major concern of the Bill Clinton administration headed up by First Lady Hillary Clinton. The 1993 Clinton health care plan included mandatory enrollment in a health insurance plan, subsidies to guarantee affordability across all income ranges, and the establishment of health alliances in each state. Every citizen or permanent resident would thus be guaranteed medical care. The bill faced withering criticism by Republicans, led by William Kristol, who communicated his concern that a Democratic health care bill would "revive the reputation of... Democrats as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government." [43] The bill was not enacted into law.

text: The "Health Security Express," a cross-country tour by multiple buses carrying supporters of President Clinton's national health care reform, started at the end of July 1994. During each stop, the bus riders would talk about their personal experiences, health care disasters and why they felt it was important for all Americans to have health insurance.[44]

text: Bush era debates[edit]

text: In 2000 the Health Insurance Association of America (HIAA) partnered with Families USA and the American Hospital Association (AHA) on a "strange bedfellows" proposal intended to seek common ground in expanding coverage for the uninsured.[45][46][47]

text: In 2001, a Patients' Bill of Rights was debated in Congress, which would have provided patients with an explicit list of rights concerning their health care. This initiative was essentially taking some of ideas found in the Consumers' Bill of Rights and applying it to the field of health care. It was undertaken in an effort to ensure the quality of care of all patients by preserving the integrity of the processes that occur in the health care industry.[48] Standardizing the nature of health care institutions in this manner proved rather provocative. In fact, many interest groups, including the American Medical Association (AMA) and the pharmaceutical industry came out vehemently against the congressional bill. Basically, providing emergency medical care to anyone, regardless of health insurance status, as well as the right of a patient to hold their health plan accountable for any and all harm done proved to be the biggest stumbling blocks for this bill.[48] As a result of this intense opposition, the Patients' Bill of Rights initiative eventually failed to pass Congress in 2002.

text: As president, Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act which included a prescription drug plan for elderly and disabled Americans.[49]

text: During the 2004 presidential election, both the George Bush and John Kerry campaigns offered health care proposals. Bush's proposals for expanding health care coverage were more modest than those advanced by Senator Kerry.[50][51][52] Several estimates were made comparing the cost and impact of the Bush and Kerry proposals. While the estimates varied, they all indicated that the increase in coverage and the funding requirements of the Bush plan would both be lower than those of the more comprehensive Kerry plan.[53][54]

text: In 2006 the HIAA's successor organization, America's Health Insurance Plans (AHIP), issued another set of reform proposals.[55]

text: In January 2007 Rep. John Conyers, Jr. (D-MI) has introduced The United States National Health Care Act (HR 676) in the House of Representatives. As of October 2008, HR 676 has 93 co-sponsors.[56] Also in January 2007, Senator Ron Wyden introduced the Healthy Americans Act (S. 334) in the Senate. As of October 2008, S. 334 had 17 cosponsors.[57]

text: Also in 2007, AHIP issued a proposal for guaranteeing access to coverage in the individual health insurance market and a proposal for improving the quality and safety of the U.S. health care system.[58][59]

text: "Economic Survey of the United States 2008: Health Care Reform" by the Organisation for Economic Co-operation and Development, published in December 2008, said that:[60]

text:
Tax benefits of employer-based insurances should be abolished.
The resulting tax revenues should be used to subsidize the purchase of insurance by individuals.
These subsidies, "which could take many forms, such as direct subsidies or refundable tax credits, would improve the current situation in at least two ways: they would reach those who do not now receive the benefit of the tax exclusion; and they would encourage more cost-conscious purchase of health insurance plans and health care services as, in contrast to the uncapped tax exclusion, such subsidies would reduce the incentive to purchase health plans with little cost sharing."

text: In December 2008, the Institute for America's Future, together with the chairman of the Ways and Means Health Subcommittee, Pete Stark, launched a proposal from Jacob Hacker, co-director of the U.C. Berkeley School of Law Center on Health, that in essence said that the government should offer a public health insurance plan to compete on a level playing field with private insurance plans.[61] This was said to be the basis of the Obama/Biden plan. The argument is based on three basic points. Firstly, public plans success at managing cost control (Medicare medical spending rose 4.6% p.a. compared 7.3% for private health insurance on a like-for-like basis in the 10 years from 1997 to 2006). Secondly, public insurance has better payment and quality-improvement methods because of its large databases, new payment approaches, and care-coordination strategies. Thirdly, it can set a standard against which private plans must compete, which would help unite the public around the principle of broadly shared risk while building greater confidence in government in the long term.[62]

text: Also in December 2008, America's Health Insurance Plans (AHIP) announced a set of proposals which included setting a national goal to reduce the projected growth in health care spending by 30%. AHIP said that if this goal were achieved, it would result in cumulative five-year savings of $500 billion. Among the proposals was the establishment of an independent comparative effectiveness entity that compares and evaluates the benefits, risks, and incremental costs of new drugs, devices, and biologics.[63] An earlier "Technical Memo" published by AHIP in June 2008 had estimated that a package of reforms involving comparative effectiveness research, health information technology (HIT), medical liability reform, "pay-for-performance" and disease management and prevention could reduce U.S. national health expenditures "by as much as 9 percent by the year 2025, compared with current baseline trends."[64]

text: Debate in the 2008 presidential election[edit]

text: Although both candidates had a health care system that revolved around private insurance markets with help from public insurance programs, both had different opinions on how this system should operate when put in place.[65]

text: Senator John McCain proposed a plan that focused on making health care more affordable. The senator proposed to replace special tax breaks for persons with employer-based health care coverage with a universal system of tax credits. These credits, $2,500 for an individual and $5,000 for a family would be available to Americans regardless of income, employment or tax liability. In his plan, Senator McCain proposed the Guaranteed Access Plan which would provide federal assistance to the states to secure health insurance coverage through high-risk areas.[66]

text: Senator McCain also proposed the idea of an open-market competition system. This would give families the opportunity to go across state lines and buy health plans, expanding personal options for affordable coverage and force the health insurance companies to compete over the consumers’ money on an unprecedented scale.[67]

text: Barack Obama called for universal health care. His health care plan called for the creation of a National Health Insurance Exchange that would include both private insurance plans and a Medicare-like government run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. It would have required parents to cover their children, but did not require adults to buy insurance.

text: The Philadelphia Inquirer reported that the two plans had different philosophical focuses. They described the purpose of the McCain plan as to "make insurance more affordable," while the purpose of the Obama plan was for "more people to have health insurance."[68] The Des Moines Register characterized the plans similarly.[69]

text: A poll released in early November, 2008, found that voters supporting Obama listed health care as their second priority; voters supporting McCain listed it as fourth, tied with the war in Iraq. Affordability was the primary health care priority among both sets of voters. Obama voters were more likely than McCain voters to believe government can do much about health care costs.[70]

text: 2009 reform debate[edit]

text: In March 2009 AHIP proposed a set of reforms intended to address waste and unsustainable growth in the current health care market. These reforms included:

text:
An individual insurance mandate with a financial penalty as a quid pro quo for guaranteed issue
Updates to the Medicare physician fee schedule;
Setting standards and expectations for safety and quality of diagnostics;
Promoting care coordination and patient-centered care by designating a "medical home" that would replace fragmented care with a coordinated approach to care. Physicians would receive a periodic payment for a set of defined services, such as care coordination that integrates all treatment received by a patient throughout an illness or an acute event. This would promote ongoing comprehensive care management, optimizes patients’ health status and assist patients in navigating the health care system
Linking payment to quality, adherence to guidelines, achieving better clinical outcomes, giving better patient experience and lowering the total cost of care.
Bundled payments (instead of individual billing) for the management of chronic conditions in which providers would have shared accountability and responsibility for the management of chronic conditions such as coronary artery disease, diabetes, chronic obstructive pulmonary disease and asthma, and similarly
A fixed rate all-inclusive average payment for acute care episodes which tend to follow a pattern (even though some acute care episodes may cost more or less than this).[71]

text: On May 5, 2009, US Senate Finance Committee held hearings on Health care reform. On the panel of the "invited stakeholder", no supporter of the Single-payer health care system was invited.[72] The panel featured Republican senators and industry panelists who argued against any kind of expanded health care coverage.[73] The preclusion of the single payer option from the discussion caused significant protest by doctors in the audience.[73]

text: There is one bill currently before Congress but others are expected to be presented soon. A merged single bill is the likely outcome.[citation needed] The Affordable Health Choices Act is currently before the House of Representatives and the main sticking points at the markup stage of the bill have been in two areas; should the government provide a public insurance plan option to compete head to head with the private insurance sector, and secondly should comparative effectiveness research be used to contain costs met by the public providers of health care.[citation needed] Some Republicans have expressed opposition to the public insurance option believing that the government will not compete fairly with the private insurers. Republicans have also expressed opposition to the use of comparative effectiveness research to limit coverage in any public sector plan (including any public insurance scheme or any existing government scheme such as Medicare), which they regard as rationing by the back door.[citation needed] Democrats have claimed that the bill will not do this but are reluctant to introduce a clause that will prevent, arguing that it would limit the right of the DHHS to prevent payments for services that clearly do not work.[citation needed] America's Health Insurance Plans, the umbrella organization of the private health insurance providers in the United States has recently urged the use of CER to cut costs by restricting access to ineffective treatments and cost/benefit ineffective ones. Republican amendments to the bill would not prevent the private insurance sectors from citing CER to restrict coverage and apply rationing of their funds, a situation which would create a competition imbalance between the public and private sector insurers.[citation needed] A proposed but not yet enacted short bill with the same effect is the Republican sponsored Patients Act 2009.[citation needed]

text: On June 15, 2009, the U.S. Congressional Budget Office (CBO) issued a preliminary analysis of the major provisions of the Affordable Health Choices Act.[74] The CBO estimated the ten-year cost to the federal government of the major insurance-related provisions of the bill at approximately $1.0 trillion.[74] Over the same ten-year period from 2010 to 2019, the CBO estimated that the bill would reduce the number of uninsured Americans by approximately 16 million.[74] At about the same time, the Associated Press reported that the CBO had given Congressional officials an estimate of $1.6 trillion for the cost of a companion measure being developed by the Senate Finance Committee.[75] In response to these estimates, the Senate Finance Committee delayed action on its bill and began work on reducing the cost of the proposal to $1.0 trillion, and the debate over the Affordable Health Choices act became more acrimonious.[76][77] Congressional Democrats were surprised by the magnitude of the estimates, and the uncertainty created by the estimates has increased the confidence of Republicans who are critical of the Obama Administration's approach to health care.[78][79]

text: However, in a June New York Times editorial, economist Paul Krugman argued that despite these estimates universal health coverage is still affordable. "The fundamental fact is that we can afford universal health insurance—even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts."[80]

text: In contrast to earlier advocacy of a publicly funded health care program, in August 2009 Obama administration officials announced they would support a health insurance cooperative in response to deep political unrest amongst Congressional Republicans and amongst citizens in town hall meetings held across America.[81][82][83] However, in a June 2009 NBC News/Wall Street Journal survey, 76% said it was either "extremely" or "quite" important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance."[84]

text: During the summer of 2009, members of the "Tea Party" protested against proposed health care reforms.[85][86][87] Former insurance PR executive Wendell Potter of the Center for Media and Democracy- whose funding comes from groups such as the Tides Foundation-[88] argue that the hyperbole generated by this phenomenon is a form of corporate astroturfing, which he says that he used to write for CIGNA.[89] Opponents of more government involvement, such as Phil Kerpen of Americans for Prosperity- whose funding comes mainly from the Koch Industries corporation[90] counter-argue that those corporations oppose a public-plan, but some try to push for government actions that will unfairly benefit them, like employer mandates forcing private companies to buy health insurance.[91] Journalist Ben Smith has referred to mid-2009 as "The Summer of Astroturf" given the organizing and coordinating efforts made by various groups on both pro- and anti-reform sides.[87]

text: Healthcare debate, 2008–2010[edit]

text: Healthcare reform was a major topic of discussion during the 2008 Democratic presidential primaries. As the race narrowed, attention focused on the plans presented by the two leading candidates, New York Senator Hillary Clinton and the eventual nominee, Illinois Senator Barack Obama. Each candidate proposed a plan to cover the approximately 45 million Americans estimated to not have health insurance at some point each year. Clinton's plan would have required all Americans obtain coverage (in effect, an individual health insurance mandate), while Obama's provided a subsidy but did not include a mandate. During the general election, Obama said that fixing healthcare would be one of his top four priorities if he won the presidency.[92]

text: After his inauguration, Obama announced to a joint session of Congress in February 2009 his intent to work with Congress to construct a plan for healthcare reform.[93][94] By July, a series of bills were approved by committees within the House of Representatives.[95] On the Senate side, from June through to September, the Senate Finance Committee held a series of 31 meetings to develop of a healthcare reform bill. This group – in particular, Senators Max Baucus (D-MT), Chuck Grassley (R-IA), Kent Conrad (D-ND), Olympia Snowe (R-ME), Jeff Bingaman (D-NM), and Mike Enzi (R-WY) – met for more than 60 hours, and the principles that they discussed, in conjunction with the other Committees, became the foundation of the Senate's healthcare reform bill.[96][97][98]

text: With universal healthcare as one of the stated goals of the Obama Administration, Congressional Democrats and health policy experts like Jonathan Gruber and David Cutler argued that guaranteed issue would require both a community rating and an individual mandate to prevent either adverse selection and/or free riding from creating an insurance death spiral;[99] they convinced Obama that this was necessary, persuading him to accept Congressional proposals that included a mandate.[100] This approach was preferred because the President and Congressional leaders concluded that more liberal plans, such as Medicare-for-all, could not win filibuster-proof support in the Senate. By deliberately drawing on bipartisan ideas – the same basic outline was supported by former Senate Majority Leaders Howard Baker (R-TN), Bob Dole (R-KS), Tom Daschle (D-SD) and George Mitchell (D-ME) – the bill's drafters hoped to increase the chances of getting the necessary votes for passage.[101][102]

text: However, following the adoption of an individual mandate as a central component of the proposed reforms by Democrats, Republicans began to oppose the mandate and threaten to filibuster any bills that contained it.[103] Senate Minority Leader Mitch McConnell (R-KY), who lead the Republican Congressional strategy in responding to the bill, calculated that Republicans should not support the bill, and worked to keep party discipline and prevent defections:[104]

text:
“
It was absolutely critical that everybody be together because if the proponents of the bill were able to say it was bipartisan, it tended to convey to the public that this is O.K., they must have figured it out.[105]
”

text: Republican Senators, including those who had supported previous bills with a similar mandate, began to describe the mandate as "unconstitutional". Writing in The New Yorker, Ezra Klein stated that "the end result was... a policy that once enjoyed broad support within the Republican Party suddenly faced unified opposition."[106] The New York Times subsequently noted: "It can be difficult to remember now, given the ferocity with which many Republicans assail it as an attack on freedom, but the provision in President Obama's healthcare law requiring all Americans to buy health insurance has its roots in conservative thinking."[107][108]

text: The reform negotiations also attracted a great deal of attention from lobbyists,[109] including deals among certain lobbies and the advocates of the law to win the support of groups who had opposed past reform efforts, such as in 1993.[110][111] The Sunlight Foundation documented many of the reported ties between "the healthcare lobbyist complex" and politicians in both major parties.[112]

text: During the August 2009 summer congressional recess, many members went back to their districts and entertained town hall meetings to solicit public opinion on the proposals. Over the recess, the Tea Party movement organized protests and many conservative groups and individuals targeted congressional town hall meetings to voice their opposition to the proposed reform bills.[94] There were also many threats made against members of Congress over the course of the Congressional debate, and many were assigned extra protection.[113]

text: To maintain the progress of the legislative process, when Congress returned from recess, in September 2009 President Obama delivered a speech to a joint session of Congress supporting the ongoing Congressional negotiations, to re-emphasize his commitment to reform and again outline his proposals.[114] In it he acknowledged the polarization of the debate, and quoted a letter from the late-Senator Ted Kennedy urging on reform: "what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."[115] On November 7, the House of Representatives passed the Affordable Health Care for America Act on a 220–215 vote and forwarded it to the Senate for passage.[94]

text: Senate[edit]

text: The Senate began work on its own proposals while the House was still working on the Affordable Health Care for America Act. Instead, the Senate took up H.R. 3590, a bill regarding housing tax breaks for service members.[116] As the United States Constitution requires all revenue-related bills to originate in the House,[117] the Senate took up this bill since it was first passed by the House as a revenue-related modification to the Internal Revenue Code. The bill was then used as the Senate's vehicle for their healthcare reform proposal, completely revising the content of the bill.[118] The bill as amended would ultimately incorporate elements of proposals that were reported favorably by the Senate Health and Finance committees.

text: With the Republican minority in the Senate vowing to filibuster any bill that they did not support, requiring a cloture vote to end debate, 60 votes would be necessary to get passage in the Senate.[119] At the start of the 111th Congress, Democrats had only 58 votes; the Senate seat in Minnesota that would be won by Al Franken was still undergoing a recount, and Arlen Specter was still a Republican.

text: To reach 60 votes, negotiations were undertaken to satisfy the demands of moderate Democrats, and to try to bring aboard several Republican Senators; particular attention was given to Bob Bennett (R-UT), Chuck Grassley (R-IA), Mike Enzi (R-WY), and Olympia Snowe (R-ME). Negotiations continued even after July 7—when Al Franken was sworn into office, and by which time Arlen Specter had switched parties—because of disagreements over the substance of the bill, which was still being drafted in committee, and because moderate Democrats hoped to win bipartisan support. However, on August 25, before the bill could come up for a vote, Ted Kennedy—a long-time advocate for healthcare reform—died, depriving Democrats of their 60th vote. Before the seat was filled, attention was drawn to Senator Snowe because of her vote in favor of the draft bill in the Finance Committee on October 15, however she explicitly stated that this did not mean she would support the final bill.[99] Paul Kirk was appointed as Senator Kennedy's temporary replacement on September 24.

text: Following the Finance Committee vote, negotiations turned to the demands of moderate Democrats to finalize their support, whose votes would be necessary to break the Republican filibuster. Majority Leader Harry Reid focused on satisfying the centrist members of the Democratic caucus until the hold-outs narrowed down to Connecticut's Joe Lieberman, an independent who caucused with Democrats, and Nebraska's Ben Nelson. Lieberman, despite intense negotiations in search of a compromise by Reid, refused to support a public option; a concession granted only after Lieberman agreed to commit to voting for the bill if the provision was not included,[99][120] even though it had majority support in Congress.[121] There was debate among supporters of the bill about the importance of the public option,[122] although the vast majority of supporters concluded that it was a minor part of the reform overall,[120] and that Congressional Democrats' fight for it won various concessions; this included conditional waivers allowing states to set up state-based public options,[121] for example Vermont's Green Mountain Care.[123]

text: With every other Democrat now in favor and every other Republican now overtly opposed, the White House and Reid moved on to addressing Senator Nelson's concerns in order to win filibuster-proof support for the bill;[124] they had by this point concluded that "it was a waste of time dealing with [Snowe]"[125] because, after her vote for the draft bill in the Finance Committee, Snowe had come under intense pressure from the Republican Senate Leadership who opposed reform.[126] (Snowe retired at the end of her term, citing partisanship and polarization).[127] After a final 13-hour negotiation, Nelson's support for the bill was won after two concessions: a compromise on abortion, modifying the language of the bill "to give states the right to prohibit coverage of abortion within their own insurance exchanges," which would require consumers to pay for the procedure out-of-pocket if the state so decided; and an amendment to offer a higher rate of Medicaid reimbursement for Nebraska.[94][128] The latter half of the compromise was derisively referred to as the "Cornhusker Kickback"[129] and was later repealed by the subsequent reconciliation amendment bill.

text: On December 23, the Senate voted 60–39 to end debate on the bill: a cloture vote to end the filibuster by opponents. The bill then passed by a vote of 60–39 on December 24, 2009, with all Democrats and two independents voting for, and all Republicans voting against except one (Jim Bunning (R-KY), not voting).[130] The bill was endorsed by the AMA and AARP.[131]

text: Several weeks after the vote, on January 19, 2010, Massachusetts Republican Scott Brown was elected to the Senate in a special election to replace the late Ted Kennedy, having campaigned on giving the Republican minority the 41st vote needed to sustain filibusters, even signing autographs as "Scott 41."[94][132][133] The special election had become significant to the reform debate because of its effects on the legislative process. The first was a psychological one: the symbolic importance of losing the traditionally Democratic (‘blue’) Massachusetts seat formerly held by Ted Kennedy, a staunch support of reform, made many Congressional Democrats concerned about the political cost of passing a bill.[134][135] The second effect was more practical: the loss of the Democrat's supermajority complicated the legislative strategy of reform proponents.[135]

text: House[edit]

text: The election of Scott Brown meant Democrats could no longer break a filibuster in the Senate. In response, White House Chief of Staff Rahm Emanuel argued the Democrats should scale-back for a less ambitious bill; House Speaker Nancy Pelosi pushed back, dismissing Emanuel's scaled-down approach as "Kiddie Care."[136][137] Obama also remained insistent on comprehensive reform, and the news that Anthem Blue Cross in California intended to raise premium rates for its patients by as much as 39% gave him a new line of argument to reassure nervous Democrats after Scott Brown's win.[136][137] On February 22 Obama laid out a "Senate-leaning" proposal to consolidate the bills.[138] He also held a meeting, on February 25, with leaders of both parties urging passage of a reform bill.[94] The summit proved successful in shifting the political narrative away from the Massachusetts loss back to healthcare policy.[137]

text: With Democrats having lost a filibuster-proof supermajority in the Senate, but having already passed the Senate bill with 60 votes on December 24, the most viable option for the proponents of comprehensive reform was for the House to abandon its own health reform bill, the Affordable Health Care for America Act, and pass the Senate's bill, The Patient Protection and Affordable Care Act, instead. Various health policy experts encouraged the House to pass the Senate version of the bill.[139] However, House Democrats were not happy with the content of the Senate bill, and had expected to be able to negotiate changes in a House–Senate Conference before passing a final bill.[135] With that option off the table, as any bill that emerged from Conference that differed from the Senate bill would have to be passed in the Senate over another Republican filibuster; most House Democrats agreed to pass the Senate bill on condition that it be amended by a subsequent bill.[135] They drafted the Health Care and Education Reconciliation Act, which could be passed via the reconciliation process.[136][140][141] Unlike rules under regular order, as per the Congressional Budget Act of 1974 reconciliation cannot be subject to a filibuster, which requires 60 votes to break, but the process is limited to budget changes; this is why the procedure was never able to be used to pass a comprehensive reform bill in the first place, such as the ACA, due to inherently non-budgetary regulations.[142][143] Whereas the already passed Senate bill could not have been put through reconciliation, most of House Democrats' demands were budgetary: "these changes – higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal – mainly involve taxes and spending. In other words, they're exactly the kinds of policies that are well-suited for reconciliation."[140]

text: The remaining obstacle was a pivotal group of pro-life Democrats, initially reluctant to support the bill, led by Congressman Bart Stupak. The group found the possibility of federal funding for abortion would be substantive enough to warrant opposition. The Senate bill had not included language that satisfied their abortion concerns, but they could not include additional such language in the reconciliation bill, as it would be outside the scope of the process with its budgetary limits. Instead, President Obama issued Executive Order 13535, reaffirming the principles in the Hyde Amendment.[144] This concession won the support of Stupak and members of his group and assured passage of the bill.[141][145] The House passed the Senate bill with a vote of 219 to 212 on March 21, 2010, with 34 Democrats and all 178 Republicans voting against it.[146] The following day, Republicans introduced legislation to repeal the bill.[147] Obama signed the ACA into law on March 23, 2010.[148] The amendment bill, The Health Care and Education Reconciliation Act, was also passed by the House on March 21, then by the Senate via reconciliation on March 25, and finally signed by President Obama on March 30.

text: State and city reform efforts[edit]

text: A few states have taken steps toward universal health care coverage, most notably Minnesota, Massachusetts and Connecticut. Examples include the Massachusetts 2006 Health Reform Statute[149] and Connecticut's SustiNet plan to provide health care to state residents.[150] The influx of more than a quarter of a million newly insured residents has led to overcrowded waiting rooms and overworked primary-care physicians who were already in short supply in Massachusetts.[151] Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health care providers using what is generally characterized as a charity care scheme; New Jersey is an example of a state that employs the latter strategy.[citation needed]

text: Several single payer referendums have been proposed at the state level, but so far all have failed to pass: California in 1994,[152] Massachusetts in 2000, and Oregon in 2002.[153] The state legislature of California twice passed SB 840, The Health Care for All Californians Act, a single-payer health care system. Both times, Governor Arnold Schwarzenegger (R) vetoed the bill, once in 2006 and again in 2008.[154][155][156]

text: The percentage of residents that are uninsured varies from state to state. In 2008 Texas had the highest percentage of residents without health insurance, 24%.[157] New Mexico had the second highest percentage of uninsured that year at 22%.[157]

text: States play a variety of roles in the health care system including purchasers of health care and regulators of providers and health plans,[158] which give them multiple opportunities to try to improve how it functions. While states are actively working to improve the system in a variety of ways, there remains room for them to do more.[159]

text: One municipality, San Francisco, California, has established a program to provide health care to all uninsured residents (Healthy San Francisco).[citation needed]

text: In July 2009, Connecticut passed into law a plan called SustiNet, with the goal of achieving health care coverage of 98% of its residents by 2014.[150] The SustiNet law establishes a nine-member board to recommend to the legislature, by January 1, 2011, the details of and implementation process for a self-insured health care plan called SustiNet. The recommendations must address (1) the phased-in offering of the SustiNet plan to state employees and retirees, HUSKY A and B beneficiaries, people without employer-sponsored insurance (ESI) or with unaffordable ESI, small and large employers, and others; (2) establishing an entity that can contract with insurers and health care providers, set reimbursement rates, develop medical homes for patients, and encourage the use of health information technology; (3) a model benefits package; and (4) public outreach and ways to identify uninsured citizens.[160] The board must establish committees to make recommendations to it about health information technology, medical homes, clinical care and safety guidelines, and preventive care and improved health outcomes. The act also establishes an independent information clearinghouse to inform employers, consumers, and the public about SustiNet and private health care plans and creates task forces to address obesity, tobacco usage, and health care workforce issues. The effective date of the SustiNet law was July 1, 2009, for most provisions.[160]

text: In May 2011, the state of Vermont became the first state to pass legislation establishing a single-payer health care system. The legislation, known as Act 48, establishes health care in the state as a "human right" and lays the responsibility on the state to provide a health care system which best meets the needs of the citizens of Vermont. In December 2014, the governor of the state of Vermont suspended plans to implement this single-payer system because of its cost.[citation needed]


document_title: Military budget of the United States

question_text: what is the percentage of military spending in the us budget

question_tokens: what is the percentage of military spending in the us budget

root

text: Military budget of the United States

text: Budget by Year[edit]

text: The following is historical spending on defense from 1996-2015, spending for 2014-15 is estimated.[1] The Defense Budget is shown in billions of dollars and total budget in trillions of dollars. The percentage of the total U.S. budget spent on defense is indicated in the third row, and change in defense spending from the previous year in the final row.

tag: p

text:
1990s
2000s
2010s

96
97
98
99
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15

Defense Budget (Billions)
266
270
271
292
304
335
362
456
491
506
556
625
696
698
721
717
681
610
614
637

Total Budget (Trillions)
1.58
1.64
1.69
1.78
1.82
1.96
2.09
2.27
2.41
2.58
2.78
2.86
3.32
4.08
3.48
3.51
3.58
3.48
3.64
3.97

Defense Budget %
16.8
16.5
16.0
16.4
16.7
17.1
17.3
20.1
20.4
19.6
20.0
21.9
20.9
17.1
20.7
20.4
19.1
17.5
16.8
16.0

Defense Spending % Change
-0.1
+1.6
+0.2
+7.8
+4.0
+10.1
+8.2
+26.0
+7.6
+3.1
+10.0
+12.5
+11.3
+0.2
+3.4
-0.6
-5.0
-10.5
+0.6
+3.8

tag: table

text: Budget for 2011[edit]

text: For the 2011 fiscal year, the president's base budget for the Department of Defense and spending on "overseas contingency operations" combine to bring the sum to US$664.84 billion.[2][3]

text: When the budget was signed into law on 28 October 2009, the final size of the Department of Defense's budget was $680 billion, $16 billion more than President Obama had requested.[4] An additional $37 billion supplemental bill to support the wars in Iraq and Afghanistan was expected to pass in the spring of 2010, but has been delayed by the House of Representatives after passing the Senate.[5][6]

text: Emergency and supplemental spending[edit]

text: The recent invasions of Iraq and Afghanistan were largely funded through supplementary spending bills outside the federal budget, which are not included in the military budget figures listed below.[7] However, the wars in Iraq and Afghanistan were categorized as "overseas contingency operations" in the starting of the fiscal year 2010, and the budget is included in the federal budget.[citation needed]

text: By the end of 2008, the U.S. had spent approximately $900 billion in direct costs on the wars in Iraq and Afghanistan. The government also incurred indirect costs, which include interests on additional debt and incremental costs, financed by the Veterans Administration, of caring for more than 33,000 wounded. Some experts estimate the indirect costs will eventually exceed the direct costs.[8] As of June 2011, the total cost of the wars was approximately $1.3 trillion.[9]

text: By title[edit]

text: The federally budgeted (see below) military expenditure of the United States Department of Defense for fiscal year 2013 are as follows. While data is provided from the 2015 budget, data for 2014 and 2015 is estimated, and thus data is shown for the last year for which definite data exists (2013).[1]

text:
Components
Funding
Change, 2012 to 2013

Operations and maintenance
$258.277 billion
-9.9%

Military Personnel
$153.531 billion
-3.0%

Procurement
$97.757 billion
-17.4%

Research, Development, Testing & Evaluation
$63.347 billion
-12.1%

Military Construction
$8.069 billion
-29.0%

Family Housing
$1.483 billion
-12.2%

Other Miscellaneous Costs
$2.775 billion
-59.5%

Atomic energy defense activities
$17.424 billion
-4.8%

Defense-related activities
$7.433 billion
-3.8%

Total Spending
$610.096 billion
-10.5%

text: By entity[edit]

text:
Entity
2010 Budget request[10]
Percentage of Total
Notes

Army
$244.8 billion
31.8%

Marine Corps
$40.6 billion
4%
Total Budget taken allotted from Department of Navy

Navy
$379.8 billion
43.4%
excluding Marine Corps

Air Force
$170.6 billion
22%

Defense Intelligence
$80.1 billion[11]
3.3%
Because of classified nature, budget is an estimate and may not be the actual figure

Defense Wide Joint Activities
$118.7 billion
15.5%

text: Programs spending more than $1.5 billion[edit]

text: The Department of Defense's FY 2011 $137.5 billion procurement and $77.2 billion RDT&E budget requests included several programs with more than $1.5 billion.

text:
Program
2011 Budget request[12]
Change, 2010 to 2011

F-35 Joint Strike Fighter
$11.4 billion
+2.1%

Ballistic Missile Defense (Aegis, THAAD, PAC-3)
$9.9 billion
+7.3%

Virginia class submarine
$5.4 billion
+28.0%

Brigade Combat Team Modernization
$3.2 billion
+21.8%

DDG 51 Burke-class Aegis Destroyer
$3.0 billion
+19.6%

P–8A Poseidon
$2.9 billion
−1.6%

V-22 Osprey
$2.8 billion
−6.5%

Carrier Replacement Program
$2.7 billion
+95.8%

F/A-18E/F Hornet
$2.0 billion
+17.4%

Predator and Reaper Unmanned Aerial System
$1.9 billion
+57.8%

Littoral combat ship
$1.8 billion
+12.5%

CVN Refueling and Complex Overhaul
$1.7 billion
−6.0%

Chemical Demilitarization
$1.6 billion
−7.0%

RQ-4 Global Hawk
$1.5 billion
+6.7%

Space-Based Infrared System
$1.5 billion
+54.0%

text: Other military-related expenditures[edit]

text: This does not include many military-related items that are outside of the Defense Department budget, such as nuclear weapons research, maintenance, cleanup, and production, which are in the Atomic Energy Defense Activities section,[15] Veterans Affairs, the Treasury Department's payments in pensions to military retirees and widows and their families, interest on debt incurred in past wars, or State Department financing of foreign arms sales and militarily-related development assistance. Neither does it include defense spending that is not military in nature, such as the Department of Homeland Security, counter-terrorism spending by the Federal Bureau of Investigation, and intelligence-gathering spending by NSA.

text: Audit of 2011 budget[edit]

text: Again in 2011, the GAO could not "render an opinion on the 2011 consolidated financial statements of the federal government", with a major obstacle again being "serious financial management problems at the Department of Defense (DOD) that made its financial statements unauditable".[16]

text: In December 2011, the GAO found that "neither the Navy nor the Marine Corps have implemented effective processes for reconciling their FBWT." According to the GAO, "An agency’s FBWT account is similar in concept to a corporate bank account. The difference is that instead of a cash balance, FBWT represents unexpended spending authority in appropriations." In addition, "As of April 2011, there were more than $22 billion unmatched disbursements and collections affecting more than 10,000 lines of accounting."[17]

text: Audit of implementation of budget for 2010[edit]

text: The US Government Accountability Office (GAO) was unable to provide an audit opinion on the 2010 financial statements of the US Government because of 'widespread material internal control weaknesses, significant uncertainties, and other limitations'.[18] The GAO cited as the principal obstacle to its provision of an audit opinion 'serious financial management problems at the Department of Defense that made its financial statements unauditable'.[18]

text: In FY 2010, six out of thirty-three DoD reporting entities received unqualified audit opinions.[19]

text: Chief financial officer and Under Secretary of Defense Robert F. Hale acknowledged enterprise-wide problems with systems and processes,[20] while the DoD's Inspector General reported 'material internal control weaknesses ... that affect the safeguarding of assets, proper use of funds, and impair the prevention and identification of fraud, waste, and abuse'.[21] Further management discussion in the FY 2010 DoD Financial Report states 'it is not feasible to deploy a vast number of accountants to manually reconcile our books' and concludes that 'although the financial statements are not auditable for FY 2010, the Department's financial managers are meeting warfighter needs'.[22]

text: Budget for 2016[edit]

text: On February 9, 2016, the US Department of Defense under President Obama released a statement outlining the proposed 2016 and 2017 defense spending budgets that "[reflect] the priorities necessary for our force today and in the future to best serve and protect our nation in a rapidly changing security environment."[23]

text:
Budget by Appropriation[23]

Components
Dollars In Billions

Military Personnel
138.6

Operation and Maintenance
244.4

Procurement
118.9

RDT&E
69.0

Revolving and Management Funds
1.3

Military Construction
6.9

Family Housing
1.3

Total
580.3

text:
Budget by Military Departments[23]

Departments
Dollars in Billions

Army
146.9

Navy
168.8

Air Force
161.8

Defense Wide
102.8

Total
580.3

text: Budget request for FY2018[edit]

text: On March 16, 2017 President Trump submitted his request to Congress for $639 billion in military spending—$54 billion—which represents a 10 percent increase—for FY 2018 as well as $30 billion for FY2017 which ends in September. With a total federal budget of $3.9 trillion for FY2018, the increase in military spending would result in deep cuts to many other federal agencies and domestic programs, as well as the State Department.[24][24][25][26][27][28] Trump had pledged to "rebuild" the military as part of his 2016 Presidential campaign.[29]

text: In April 2017, journalist Scot J. Paltrow raised concerns about the increase in spending with the Pentagon's history of "faulty accounting".[30]

text: On the 14th of July, H.R. 2810 the National Defense Authorization Act 2018 was passed by the U.S. House of Representatives 344 - 8, with 8 not voting. 60% of Democrats voted for this bill, which represented an 18% increase in defense spending. The Congress increased the budget to total 696 billion dollars.

text: Budget request for FY2017[edit]

text: The currently available budget request for 2017 was filed on February 9, 2016,[23][31] under now former-President Barack Obama.

text: The press release of the proposal specifies the structure and goals for the Fiscal Year (FY) 2017 budget:

text: The FY 2017 budget reflects recent strategic threats and changes that have taken place in Asia, the Middle East and Europe. Russian aggression, terrorism by the Islamic State of Iraq and the Levant (ISIL) and others, and China’s island building and claims of sovereignty in international waters all necessitate changes in our strategic outlook and in our operational commitments. Threats and actions originating in Iran and North Korea negatively affect our interests and our allies. These challenges have sharpened the focus of our planning and budgeting.[23]

text: The proposal also includes a comparison of the 2016 and the proposed 2017 request amounts, a summary of acquisitions requested for 2017 and enacted in 2016, and provides in detail a breakdown of specific programs to be funded.

text: Investments[edit]

text:
FY 2016 Enacted
FY 2017 Request
Change

Aircraft and Related Systems
50.6
45.3
-5.3

C4I Systems
7.1
7.4
0.3

Ground Systems
9.9
9.8
-0.1

Missile Defense Programs
9.1
8.5
-0.6

Missiles and Munitions
12.7
13.9
1.2

Mission Support
52.9
52.4
-0.5

Science & Technology (S&T)
13.0
12.5
-0.5

Shipbuilding and Maritime Systems
27.5
27.0
-0.5

Space-Based Systems
7.0
7.1
0.1

Rescissions
-1.8
-
+1.8

Total
188
183.9
-4.1

text: Amounts are in $ billions.

text: Major Acquisition Programs[edit]

text: These are the top 25 DoD weapon programs described in detail:

text:
FY 2016
FY 2017

Qty
$
Qty
$

Aircraft

F-35
Joint Strike Fighter
68
11.6
63
10.5

KC-46A
Tanker
12
3.0
15
3.3

P-8A
Poseidon
17
3.4
11
2.2

V-22
Osprey
20
1.6
16
1.5

E-2D AHE
Advanced Hawkeye
5
1.2
6
1.4

AH-64E
Apache Helicopter
64
1.4
52
1.1

C/HC/MC-130J
Hercules
29
2.4
14
1.3

UH-60
Black Hawk Helicopter
107
1.8
36
1.0

CH-53K
King Stallion Helicopter
--
0.6
2
0.8

MQ-4C
Triton
4
1.0
2
0.8

H-1 Upgrades
Bell Helicopter
29
0.9
24
0.8

NGJ
Next Generation Jammer Increment 1
--
0.4
--
0.6

CH-47F
Chinook Helicopter
39
1.1
22
0.7

Missile Defense/Missiles

BMDS
Ballistic Missile Defense
--
7.7
--
6.9

Trident II
Trident II Missile Modifications
--
1.2
--
1.2

AMRAAM
Advanced Medium Range Air to Air Missile
429
0.7
419
0.7

Ships

SSN 774
VIRGINIA Submarine
2
5.7
2
5.3

DDG 51
AEGIS Destroyer
2
4.4
2
3.5

CVN 78
FORD Aircraft Carrier
--
2.8
--
2.8

ORR
Ohio Replacement
--
1.4
--
1.9

LHA-6
Amphibious Assault Ship
--
0.5
1
1.6

LCS
Littoral Combat Ship
3
1.8
2
1.6

Space

AEHF
Advanced Extremely High Frequency Satellite
--
0.6
--
0.9

EELV
Evolved Expendable Launch Vehicle
4
1.5
5
1.8

Trucks

JLTV
Joint Light Tactical Vehicle
804
0.4
2,020
0.7

text: $ in billions, Qty being the number of items requested.

text: Science and Technology Program[edit]

text: This program's purpose is to "invest in and develop capabilities that advance the technical superiority of the U.S. Military to counter new and emerging threats.".[31] It has a budget of $12.5 billion, but is apart from the overall Research, Development, Test, and Evaluation (RDT&E) portfolio, which compromises $71.8 billion. Efforts funded apply to the Obama administration's refocusing of the US military to Asia, identifying investments to "sustain and advance [the] DoD's military dominance for the 21st century", counter the "technological advances of U.S. foes",[31] and support Manufacturing Initiative institutes. A breakdown of the amounts provided, by tier of research, is provided:

text:
Program
FY 2016 Request
FY 2016 Enacted
FY 2017 Request
Change (FY16 Enacted - FY17 Request)

Basic Research
2.1
2.3
2.1
-0.2

Applied Research
4.7
5.0
4.8
-0.2

Advanced Technology Development
5.5
5.7
5.6
-0.1

Total
12.3
13.0
12.5
0.5

text: Total Budget by Department[edit]

text:
Total Budget
FY 2016 Enacted
FY 2017 Request
Change

Army
146,928,044
148,033,950
+1,105,906

Navy
168,786,798
164,861,078
-3,925,720

Air Force
161,783,330
166,879,239
+5,095,909

Defense-Wide
102,801,512
102,927,320
+125,808

Total
580,299,684
582,701,587
+2,401,903

text: Amounts in Thousands of $USD

text: Total Budget of Military[edit]

text:
Total Budget
FY 2016 Enacted
FY 2017 Request
Change

Military Personnel
138,552,886
138,831,498
+278,612

Operation and Maintenance
244,434,932
250,894,310
+6,459,378

Procurement
118,866,320
112,081,088
-6,785,232

RDT&E*
69,009,764
71,765,940
+2,756,176

Revolving and Management Funds
1,264,782
1,512,246
+247,464

Military Construction
6,909,712
6,296,653
-613,059

Family Housing
1,261,288
1,319,852
+58,564

Total
580,299,684
582,701,587
+2,401,903

text: *Research, Development, Test and Evaluation

text: Amounts in thousands of $USD

text: Funding of payments and benefits[edit]

text: This portion of the military budget comprises roughly one third to one half of the total defense budget, considering only military personnel or additionally including civilian personnel, respectively. These expenditures "will likely always be, the single largest expense category for the Department." Since 2001, military pay and benefits have increased by 85%, but remained roughly one third of the total budget due to an overall increased budget. Military pay remains at about the 70th percentile compared to the private sector to attract sufficient amounts of qualified personnel.[32]

text:
Military Pay and Benefits Funding
FY 2016 Enacted
FY 2017 Request

Military Personnel Appropriations
128.7
128.9

Medicare-Eligible Retiree Health Care Accruals
6.6
6.4

Defense Health Program
32.9
33.8

DoD Education Activity
3.1
2.9

Family Housing
1.3
1.3

Commissary Subsidy
1.4
1.2

Other Benefit Programs
3.5
3.4

Military Pay and Benefits Funding
177.5
177.9

Civilian Pay and Benefits Funding
71.8
72.9

Total Pay and Benefits Funding
249.3
250.8

DoD Base Budget Authority
521.7
523.9

Military Pay and Benefits as % of Budget
34.0%
34.0%

Total Pay and Benefits as % of Budget
47.8%
47.9%

text: Funding the military health system[edit]

text: The request for 2017 amounts to $48.8 billion. The system has 9.4 million beneficiaries, including active, retired, and eligible Reserve Component military personnel and their families, and dependent survivors.[32]

text:
Program
FY 2017 Request

Defense Health (DHP)
33.5

Military Personnel
8.6

Military Construction
0.3

Health Care Accrual
6.4

Unified Medical Budget
48.8

text: Support service contractors[edit]

text: The role of support service contractors has increased since 2001 and in 2007 payments for contractor services exceeded investments in equipment for the armed forces for the first time.[33] In the 2010 budget, the support service contractors will be reduced from the current 39 percent of the workforce down to the pre-2001 level of 26 percent.[34] In a Pentagon review of January 2011, service contractors were found to be "increasingly unaffordable."[35]

text: Military budget and total US federal spending[edit]

text: The U.S. Department of Defense budget accounted in fiscal year 2010 for about 19% of the United States federal budgeted expenditures and 28% of estimated tax revenues. Including non-DOD expenditures, military spending was approximately 28–38% of budgeted expenditures and 42–57% of estimated tax revenues.[citation needed] According to the Congressional Budget Office, defense spending grew 9% annually on average from fiscal year 2000–2009.[36]

text: Because of constitutional limitations, military funding is appropriated in a discretionary spending account. (Such accounts permit government planners to have more flexibility to change spending each year, as opposed to mandatory spending accounts that mandate spending on programs in accordance with the law, outside of the budgetary process.) In recent years, discretionary spending as a whole has amounted to about one-third of total federal outlays.[37] Department of Defense spending's share of discretionary spending was 50.5% in 2003, and has risen to between 53% and 54% in recent years.[38]

text: For FY 2010, Department of Defense spending amounts to 4.7% of GDP.[39] Because the U.S. GDP has risen over time, the military budget can rise in absolute terms while shrinking as a percentage of the GDP. For example, the Department of Defense budget is slated to be $664 billion in 2010 (including the cost of operations in Iraq and Afghanistan previously funded through supplementary budget legislation[40][41]), higher than at any other point in American history, but still 1.1–1.4% lower as a percentage of GDP than the amount spent on military during the peak of Cold-War military spending in the late 1980s.[39] Admiral Mike Mullen, former Chairman of the Joint Chiefs of Staff, has called four percent an "absolute floor".[42] This calculation does not take into account some other military-related non-DOD spending, such as Veterans Affairs, Homeland Security, and interest paid on debt incurred in past wars, which has increased even as a percentage of the national GDP.

text: In 2015, Pentagon and related spending totaled $598 billion. Military expenditures exceed the total amount of funds allocated to support social security, transportation, unemployment, labor, science, energy and the environment, international affairs, housing, veteran’s benefits, medicare, education.

text: In addition, the United States will spend at least $179 billion over the fiscal years of 2010-2018 on its nuclear arsenal, averaging $20 billion per year. Despite President Barack Obama’s attempts in the media to reduce the scope of the current nuclear arms race, the U.S. intends to spend an additional $1 trillion over the next 30 years modernizing its nuclear arsenal.

text: Federal waste[edit]

text: As of September 2014, the Department of Defense was estimated to have “$857 million in excess parts and supplies”.[43] This figure has risen over the past years and of the Pentagon waste that has been calculated, two figures that are especially worth mentioning is the expenditure of “$150 million on private villas for a handful of Pentagon employees in Afghanistan and the procurement of the JLENS air-defense balloon” which, throughout the program’s development over the past two decades, is estimated to have cost $2.7 billion.[43] Also, it is important to note that the JLENS air-balloon still does not function properly.

text: Comparison with other countries[edit]

text: The United States spends more on their defense budget than China, Saudi Arabia, Russia, the United Kingdom, India, France, and Japan combined.[45] The 2009 U.S. military budget accounts for approximately 40% of global arms spending. The 2012 budget is 6–7 times larger than the $106 billion military budget of China. The United States and its close allies are responsible for two-thirds to three-quarters of the world's military spending (of which, in turn, the U.S. is responsible for the majority).[46][47][48] The US also maintains the largest number of military bases on foreign soil across the world.[49] While there are no freestanding foreign bases permanently located in the United States, there are now around 800 U.S. bases in foreign countries. Military spending makes up nearly 16% percent of entire federal spending and approximately half of discretionary spending. In a general sense discretionary spending (defense and non-defense spending) makes up one-third of the annual federal budget.[50]

text: In 2015, out of its budget of 1.11 trillion, the United States spent $598 billion on military. U.S. defense spending is equivalent to the next seven largest military budgets—India, the United Kingdom, Japan, France, Saudi Arabia, Russia, and China—combined.

text: In 2017, the U.S. military budget is 773.5 billion and is estimated to increase in the upcoming years.

text: In 2005, the United States spent 4.06% of its GDP on its military (considering only basic Department of Defense budget spending), more than France's 2.6% and less than Saudi Arabia's 10%.[51]information 2006 This is historically low for the United States since it peaked in 1944 at 37.8% of GDP (it reached the lowest point of 3.0% in 1999–2001). Even during the peak of the Vietnam War the percentage reached a high of 9.4% in 1968.[52]

text: The US Military’s budget has plateaued in 2009, but is still considerably larger than any other military power.

text: Past commentary on military budget[edit]

text: In 2009, Secretary of Defense Robert Gates wrote that the U.S. should adjust its priorities and spending to address the changing nature of threats in the world: "What all these potential adversaries—from terrorist cells to rogue nations to rising powers—have in common is that they have learned that it is unwise to confront the United States directly on conventional military terms. The United States cannot take its current dominance for granted and needs to invest in the programs, platforms, and personnel that will ensure that dominance's persistence. But it is also important to keep some perspective. As much as the U.S. Navy has shrunk since the end of the Cold War, for example, in terms of tonnage, its battle fleet is still larger than the next 13 navies combined—and 11 of those 13 navies are U.S. allies or partners."[53] Secretary Gates announced some of his budget recommendations in April 2009.[54]

text: According to a 2009 Congressional Research Service there was a discrepancy between a budget that is declining as a percentage of GDP while the responsibilities of the DoD have not decreased and additional pressures on the military budget have arisen due to broader missions in the post-9/11 world, dramatic increases in personnel and operating costs, and new requirements resulting from wartime lessons in the Iraq War and Operation Enduring Freedom.[55]

text: In 2012, four billion dollars of the five billion dollars in budget cuts mandated by the Congress in the 2013 budget were achieved by declaring that nearly 65 thousand troops were now temporary and no longer part of the permanent forces and so their costs were shifted to the Afghanistan war budget.[56]

text: In May 2012, as part of Obama's East Asia "pivot", his 2013 national military request moved funding from the Army and Marines to favor the Navy, but the Congress has resisted this.[57]

text: Reports emerged in February 2014 that Secretary of Defense Chuck Hagel was planning to trim the defense budget by billions of dollars. The secretary in his first defense budget planned to limit pay rises, increase fees for healthcare benefits, freeze the pay of senior officers, and reduce military housing allowances. A reduction in the number of soldiers serving in the U.S. Army would reduce the size of the force to levels not seen since prior to the start of World War II.[58]

text: In July 2014, American Enterprise Institute scholar Michael Auslin opined in the National Review that the Air Force needs to be fully funded as a priority, due to the air superiority, global airlift, and long-range strike capabilities it provides.[59]

text: In January 2015 Defense Department published its internal study on how to save $125 billion on its military budget from 2016 to 2020 by renegotiating vendor contracts and pushing for stronger deals, and by offering workers early retirement and retraining.[60]

text: 2012 fiscal cliff[edit]

text: On 5 December 2012, the Department of Defense announced it was planning for automatic spending cuts, which include $500 billion and an additional $487 billion due to the 2011 Budget Control Act, due to the fiscal cliff.[61][62][63][64][65] According to Politico, the Department of Defense declined to explain to the House of Representatives Appropriations Committee, which controls federal spending, what its plans were regarding the fiscal cliff planning.[66]

text: This was after half a dozen defense experts either resigned from Congress or lost their reelection fights.[67]

text: Lawrence Korb has noted that given recent trends military entitlements and personnel costs will take up the entire defense budget by 2039.[68]

text: GAO audits[edit]

text: The Government Accountability Office was unable to provide an audit opinion on the 2010 financial statements of the U.S. government due to "widespread material internal control weaknesses, significant uncertainties, and other limitations."[69] The GAO cited as the principal obstacle to its provision of an audit opinion "serious financial management problems at the Department of Defense that made its financial statements unauditable."[70]

text: In Fiscal Year (FY) 2011, seven out of 33 DoD reporting entities received unqualified audit opinions.[71] Under Secretary of Defense Robert F. Hale acknowledged enterprise-wide weaknesses with controls and systems.[72] Further management discussion in the FY 2011 DoD Financial Report states "we are not able to deploy the vast numbers of accountants that would be required to reconcile our books manually".[71] Congress has established a deadline of FY 2017 for the DoD to achieve audit readiness.[73]

text: For FYs 1998-2010 the Department of Defense's financial statements were either unauditable or such that no audit opinion could be expressed.[74][75][76][77][78][79][80][81][82][83][84][85]

text: Reform[edit]

text: In a statement of 6 January 2011 Defense Secretary Robert M. Gates stated: "This department simply cannot risk continuing down the same path – where our investment priorities, bureaucratic habits and lax attitude towards costs are increasingly divorced from the real threats of today, the growing perils of tomorrow and the nation's grim financial outlook." Gates has proposed a budget that, if approved by Congress, would reduce the costs of many DOD programs and policies, including reports, the IT infrastructure, fuel, weapon programs, DOD bureaucracies, and personnel.[86]

text: The 2015 expenditure for Army research, development and acquisition changed from $32 billion projected in 2012 for FY15, to $21 billion for FY15 expected in 2014.[87]