The $787 billion American Recovery and Reinvestment Act of 2009, signed by President Obama on February 17, gives a huge monetary boost to the country and pushes forward an abundance of health care provisions. More than $140 billion will be spent on health care, including funding to revamp the country’s health information infrastructure, stimulate medical research, and provide medical coverage for the thousands of Americans who recently found themselves out of work and, consequently, without health insurance.

"We have done more in 30 days to advance the cause of health care reform than this country has done in an entire decade," President Obama said in a Washington Post article.

There are four major categories of government spending on health care, which include:

Health Care Coverage for Low-Income and Out of Work Americans
According to the Center on Budget and Policy Priorities (CBPP), $87 billion will be spent as a temporary increase in the share of Medicaid that the Federal government will pay over nine calendar quarters (October 2008-December 2010). As a state’s unemployment rises, the more people qualify for Medicaid and the less revenue a state has to pay for the increase in its Medicaid rolls, the CBPP report says. With this in mind, the legislation targets assistance based on a state’s unemployment rate.

Additionally, $25 billion will be spent to fund the Consolidated Omnibus Budget Reconciliation Act (COBRA), which provides a right to temporary continuation of health coverage at group rates to those employees who involuntarily become jobless.

While these increases in coverage for the low-income and unemployed will provide access to necessary health care, it is not yet clear whether these provisions will directly impact the sleep market. Those who gain access to coverage through these provisions could potentially impact sleep lab patient volumes.

Comparative-Effectiveness Studies
The stimulus package marks the first time that the federal government will spend sizeable amounts of money comparing the cost and effectiveness of different available medical treatments. According to WebMD $1.1 billion will be spent on these cost-effectiveness studies.

"By signing the economic stimulus package into law, President Obama has made a major investment in America’s future. The $1.1 billion for comparative effectiveness research also is a major investment in ensuring quality, patient-centered health care in this country,” said Dan Leonard, president of the National Pharmaceutical Council. "However, as Congress moves forward with the framework for comparative effectiveness research (CER), it is critically important that funding be targeted to improve the overall quality of patient care and that the research conducted examines all aspects of health care, including drugs, devices, and other medical treatments. Establishing an open and transparent process for the prioritization of comparative effectiveness research topics will be the next critical step toward ensuring that sound evidence leads to quality care."

Sleep medicine could eventually find its place in comparative-effectiveness studies, but it is up to the US Department of Health and Human Services to allocate this funding over several years.

Health Information Technology
For those medical practices that have been hesitant to adopt electronic medical filing because of the hefty cost associated with the change, the stimulus includes $19 billion in grants and incentives to switch from paper to electronic records, according to an article posted on WebMD.

"The creation and support of legislation as well as regulation that advances health care IT adoption and interoperability is something we wholeheartedly support," said Tee Green, president of Greenway Medical Technologies. "The creation of an interoperable health care system will benefit America by improving care quality, increasing patient safety, eliminating waste, and reducing fraud."

This switch to electronic medical records would improve the ability for sleep physicians to access patients’ medical history. It also appears that sleep labs and clinics should be able to take advantage of the incentives and grants to adopt the electronic health information.

Ten billion dollars will be utilized to increase the research budget of the National Institutes of Health (NIH), labeled by President Obama as “the biggest increase in basic research funding” for the NIH in a USA Today article.

How the NIH will use the funding is still unclear, but the National Heart, Lung, and Blood Institute, including the National Center on Sleep Disorders Research, could certainly benefit.

Complete information on HR 1 is available through Govtrack.