Washington Highlights: December 21, 2007

Congress Completes 2008 Funding

Contents Congress Completes 2008 Funding Medicare/SCHIP Package Awaits President's Signature Omnibus Increases VA Medical Care Funding Omnibus Bill Includes Increase for NSF Omnibus Provides Increase for FDA Senate Letter Urges One-Year Extension of Medicaid Moratorium President Swears in New VA Secretary House, Senate Approve Bill to Rename NICHD On the Hill Prior Issues December 14, 2007 December 7, 2007 Novebmer 30, 2007 November 16, 2007 Archive

Congress completed action Dec. 19 on a $555 billion omnibus FY 2008 spending package when the House approved the measure 272-142, sending it to the President. The House initially passed the "Consolidated Appropriations Act for FY 2008" Dec. 17 as an amendment to the State-Foreign Operations appropriations bill (H.R. 2764). This was done so that the Senate could further amend the omnibus bill to provide additional Iraq funding. The Senate passed the measure 76-17 on Dec. 18, sending it back to the House for final approval of the additional war spending.

Congress also passed another continuing resolution (H.J.Res 72) to fund the federal government mostly at FY 2007 levels through Dec. 31 to give the Administration time to review the omnibus bill. The current continuing resolution expires Dec. 21.

The omnibus bill includes $473.5 billion funding for the 11 regular appropriations bills that have not been signed into law, including those bills that provide funding for the Department of Health and Human Services and the Department of Veterans Affairs (see related story). When combined with the Defense spending bill, which has already been enacted (P.L. 110-116), the total meets the President's overall discretionary spending limit of $932.8 billion. This total does not include $70 billion in funding for military operations in Afghanistan and Iraq and $11.2 billion in emergency spending for items such as veterans' programs, border security, and drought relief that is included in the omnibus.

For programs funded under the Labor-HHS-Education bill (Division G), the omnibus provides $144.8 billion in discretionary spending for FY 2008, an increase of $316 million (0.2 percent) over the FY 2007 funding level, but $5.8 billion less than in the Labor-HHS conference agreement the President vetoed Nov. 13 [see Washington Highlights, Nov. 16]. Most of the programs in the Labor-HHS portion of the omnibus were subject to a 1.747 percent across-the-board cut to meet the President's spending limit.

For NIH, the omnibus provides an appropriation of $29.229 billion, an increase of $329 million (1.1 percent) over FY 2007. The omnibus also includes a $196 million increase from 2007 to 2008 in the transfer from NIH to the Global HIV/AIDS Fund, which results in a program level for NIH of $28.942 billion, an increase of $133 million (0.46 percent) over FY 2007.

In a Dec. 18 statement, AAMC President Darrell G. Kirch, M.D., noted "The AAMC is particularly frustrated with this outcome for the NIH, given that members from both sides of the aisle in the House and Senate approved a conference agreement in early November that provided a $900 million (3.1 percent) increase for the NIH. Despite this strong bipartisan support, the White House's insistence on an unrealistic spending cap has resulted in what is essentially a freeze on all domestic spending."

After adjusting for the 1.747 percent across-the-board rescission, the bill provides $194 million for the Title VII health professions training programs, a $9.2 million (5 percent) increase over FY 2007. Within that total, the Health Careers Opportunity Program (HCOP) receives $9.8 million, a $5.9 million (148 percent) increase, and the Centers of Excellence (COE) receive $12.8 million, an $893,000 (7.5 percent) increase over FY 2007. As a result of the across-the-board rescission, the bill reduces funding for the primary care training programs by $853,000 (1.7 percent) for a total of $48 million.

The vetoed conference agreement had provided $212 million for Title VII, including $16.2 million for HCOP and $20.2 million for COE.

A $15 million rescission is applied to the Title VII health professions student loan programs. This rescission was not included in the vetoed conference report.

The omnibus provides $123.5 million for the National Health Service Corps (NHSC), a 2.2 million decrease from FY 2007 as a result of the 1.747 percent across-the-board rescission. The House had approved $131.5 million, a $5.8 million (4.6 percent) increase over FY 2007. The new funds increase the NHSC recruitment appropriation, which funds the NHSC scholarship and loan repayment awards, to $91 million. The Senate bill had level funded the NHSC at the FY 2007 level ($125.6 million), rejecting the proposed $9 million (7.2 percent) cut in the President's budget.

The bill provides $334.6 million for the Agency for Healthcare Research and Quality (AHRQ), a $15.6 million increase (4.9 percent), as provided in the vetoed conference agreement. The AHRQ total includes $30 million for clinical effectiveness research, double the $15 million designated for such research in FY 2007. Unlike both the House and the Senate bills, which funded AHRQ through a direct appropriation, the omnibus provides AHRQ funding through Evaluation Tap funding, as in years past.

Children's Hospitals Graduate Medical Education (GME) receives $301.6 million, a $4.6 million (1.6 percent) increase over FY 2007. The conference agreement provided the House-recommended $307 million for Children's GME, while the Senate had proposed $200 million, a $97 million cut.

For the Centers for Disease Control and Prevention (CDC), the omnibus provides a program level of $6.5 billion, adding $110 million (1.8 percent) over FY 2007. The conference agreement had proposed $6.6 billion for CDC.

Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525

Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525

Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116

Medicare/SCHIP Package Awaits President's Signature

The House Dec. 19 accepted (411-3) the Senate-passed "Medicare, Medicaid, and SCHIP Extension of Act 2007" (S. 2499). The legislation, which the Senate passed by unanimous consent Dec. 18, includes several provisions of interest to medical school faculty and teaching hospitals, including a six-month Medicare physician fix and a short-term extension (until March 31, 2009) of the State Children's Health Insurance Program (SCHIP). According to a Dec. 18 estimate, the Congressional Budget Office (CBO) scores S. 2499 at a savings of $100 million over 5 years. President Bush is expected to sign the bill, which is cost-neutral over 10 years.

The bill establishes a 0.5 percent Medicare physician payment update for Jan. 1 through June 30, 2008. Without such relief, physicians faced a 10.1 percent cut in Medicare payments effective Jan. 1. The physician update will revert to the scheduled 10.1 percent cut on July 1, 2008.

S. 2499 extends the Physician Quality Reporting Initiative (PQRI) through 2009 and requires the Secretary of Health and Human Services to "establish alternative criteria" for quality reporting. It also "revises" certain components of the Physician Assistance and Quality Initiative (PAQI) Fund. According to a Dec. 18 estimate, the CBO scores the combined 6-month Medicare physician fix, along with changes to the PQRI/PAQI at a cost of $1.5 billion over 5 years.

The bill extends current SCHIP funding levels through March 31, 2009. As stated in a Finance Committee summary of S. 2499, it also provides "adequate funding to States for the purposes of maintaining their current enrollment through that date." CBO estimates a total SCHIP cost of $0.8 billion over 5 years.

Also of interest to medical school faculty and teaching hospitals are provisions that:

S. 2499 identifies program savings via a $1.5 billion cut over 5 years to the Medicare Advantage Stabilization Fund and improved identification of secondary payers for Medicare beneficiaries ($0.3 billion over 5 years).

The AAMC will be issuing a detailed bill summary in early 2008.

Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526

Omnibus Increases VA Medical Care Funding

The omnibus "Consolidated Appropriations Act for FY 2008" (H.R. 2764, Division I) provides $36.7 billion for VA medical care, a $3.3 billion (9.8 percent) increase over the FY 2007 comparable level (which includes FY 2007 emergency supplemental appropriations). Within VA medical care:

The omnibus bill includes $480 million for VA Medical and Prosthetics Research, a $33.8 million (7.58 percent) increase over the comparable FY 2007 level. As a result of the current continuing resolution, VA research has been operating at a funding level lower than its FY 2006 spending level [see Washington Highlights, Nov. 16].

The Senate Sept. 4 and the House June 15 had passed FY 2008 Military Construction and Veterans Affairs Appropriations bills (H.R. 2642, S. 1645), funding VA medical care at the same levels of the omnibus bill. The Senate measure provided $500 million for VA Medical and Prosthetic Research, while the House bill included $480 million for VA research, matching the Friends of VA Medical Care and Health Research recommendations for FY 2008.

Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116

Omnibus Bill Includes Increase for NSF

The omnibus "Consolidated Appropriations Act for FY 2008" (H.R. 2764, Division B) provides $6.065 billion for the National Science Foundation (NSF). The NSF funding level represents an increase of $147.8 million (2.4 percent) over FY 2007 and increases funding for Research and Related Activities by $156 million (3.4 percent) for a total of $4.754 billion. In a joint explanatory statement accompanying the bill, the Appropriations Committees express strong support for increases in the math and physical sciences, computer sciences, and engineering research directorates, but also emphasize the need to "maintain comparable growth in fiscal year 2008, to the extent possible, for the biological sciences and social, behavioral and economic sciences directorates," since "each of the science disciplines is valuable in maintaining U.S. competitiveness."

The House had passed a standalone FY 2008 Commerce-Justice-Science Appropriations bill (H.R. 3093) on July 26 with $6.509 billion for NSF [see Washington Highlights, Aug. 3], while the Senate provided $6.553 billion in its version of the bill, approved Oct. 16 [see Washington Highlights, Oct. 19]. The President's budget had requested $6.429 billion for NSF, commensurate with the Administration's American Competitiveness Initiative to bolster support for research and education in the physical sciences.

Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525

Omnibus Provides Increase for FDA

The omnibus "Consolidated Appropriations Act for FY 2008" (H.R. 2764, Division A) provides $1.717 billion for the Food and Drug Administration (FDA), a $142.6 million (9.1 percent) increase over FY 2007, after applying a 0.7 percent across-the-board rescission to nearly all programs under Division A. The FDA budget is supplemented by revenue generated by user fees, adding approximately $500 million to the appropriated levels.

The House had passed the FY 2008 Agriculture-Rural Development-Food and Drug Administration Appropriations bill (H.R. 3161) on Aug. 2, providing $1.702 billion for FDA [see Washington Highlights, Aug. 3]. The Senate version of the bill (S. 1859) was approved by the Senate Appropriations Committee on July 19, providing $1.760 billion for FDA [see Washington Highlights, July 27].

Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525

Senate Letter Urges One-Year Extension of Medicaid Moratorium

Sens. Jeff Bingaman (D-N.M.), Elizabeth Dole (R-N.C.), and 60 of their colleagues sent a Dec. 12 bipartisan sign-on letter to House and Senate leadership urging them to "include a one-year extension of the moratorium on the Medicaid public provider and graduate medical education (GME) rules...in any end-of-year legislation that you intend to pass" [see Washington Highlights, Dec. 14].

The 60 Senators signing the letter, which include 18 Republicans, were: Sens. Obama (D-Ill.); Landrieu (D-La.); Feingold (D-Wis.); Cornyn (R-Texas); Schumer (D-N.Y.); Menendez (D-N.J.); Coleman (R-Minn.); Lautenberg (D-N.J.); Kohl (D-Wis.); Durbin (D-Ill.); Feinstein (D-Calif.); McCaskill (D-Mo.); Lieberman (I-Conn.); Biden (D-Del.); Levin (D-Mich.); Bond (R-Mo.); Casey (D-Pa.); Kerry (D-Mass.); Sessions (R-Ala.); Leahy (D-Vt.); Brown (D-Ohio); Clinton (D-N.Y.); Hutchison (R-Texas); Bayh (D-Ind.); Isakson (R-Ga.); Cochran (R-Miss.); Burr (R-N.C.); Kennedy (D-Mass.); Sanders (I-Vt.); Bennett (R-Utah); Cantwell (D-Wash.); Cardin (D-Md.); Martinez (R-Fla.); Boxer (D-Calif.); Chambliss (R-Ga.); Klobuchar (D-Minn.); Johnson (D-S.D.); Salazar (D-Colo.); Lugar (R-Ind.); Collins (R-Me.); Nelson (D-Neb.); Specter (R-Pa.); Nelson (D-Fla.); Harkin (D-Iowa); Akaka (D-Hawaii); Stabenow (D-Mich.); Rockefeller (D-W.Va.); Tester (D-Mont.); Mikulski (D-Md.); Pryor (D-Ark.); Inouye (D-Hawaii); Domenici (R-N.M.); Wyden (D-Ore.); Snowe (R-Me.); Lincoln (D-Ark.); Shelby (R-Ala.); Dodd (D-Conn.); Reed (D-R.I.); Whitehouse (D-R.I.); Webb (D-Va.).

Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526

President Swears in New VA Secretary

President Bush Dec. 19 swore in James B. Peake, M.D., a former Army Surgeon General, as the nation's sixth Secretary of Veterans Affairs. The Senate Committee on Veterans Affairs Dec. 13 unanimously approved his nomination. Sen. Arlen Specter (R-Pa.) and House VA Committee Chair Chet Edwards (D-Texas) attended the swearing in ceremony.

According to a White House press release, President Bush stated at the ceremony, "Dr. Peake takes office at a critical moment in the history of this Department. Our nation is at war - and many new veterans are leaving the battlefield and entering the VA system. This system provides our veterans with the finest care - but the bureaucracy can be difficult to navigate."

Secretary Peake, who retired in 2004 as a three-star general, is a board-certified thoracic surgeon. Secretary Peake attended Cornell University's Weill Cornell Medical College after serving in Vietnam, where he earned the Silver Star and Purple Heart.

House, Senate Approve Bill to Rename NICHD

On the Hill

Rep. Julia Carson (D-Ind.) died Dec. 15, less than a month after disclosing that she had terminal lung cancer. Rep. Carson was serving her sixth term in Congress. Indiana Governor Mitch Daniels (R) will call a special election within 60 days after her death to fill the seat for the remainder of the 110th Congress.

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