Washington Highlights: April 3,
2009
House, Senate Approve FY 2010 Budget Resolutions
Contents
Prior Issues
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The House April 2 and Senate later that night adopted their respective
fiscal year (FY) 2010 budget resolutions, a blueprint that establishes
budget totals for the fiscal year.
The House adopted its budget (H.Con.Res.
85) 233-196 with no Republicans voting for the proposal and
20 Democrats voting against it. The Senate vote on the budget (S.Con.Res.13)
was 55-43, with no Republicans supporting the plan and two Democrats
- Evan Bayh (Ind.) and Ben Nelson (Neb.) - voting against the measure.
Totaling $3.55 trillion, the House package largely tracks President
Obama's plan [see Washington
Highlights, Feb. 27]. The House bill allows $543 billion
for non-defense discretionary spending, $7 billion less than the
President's $540 billion request. The Senate budget totals $3.53
trillion and permits $475 billion for non-defense discretionary
spending in FY 2010. Unlike the Senate version, the House budget
also includes provisions that would allow health care reform to
move through the filibuster proof reconciliation process.
The Senate approved the following amendments of interest to medical
schools and teaching hospitals:
- S.AMDT.742 offered by Sens. James Inhofe (R-Okla.), Daniel Akaka
(D-Hawaii), Richard Burr (R-N.C.), John Thune (R-S.D.), and Lisa
Murkowski (R-Alaska) to "provide for advance appropriations
for medical care for veterans through the Department of Veterans
Affairs;"
- S.AMDT.799 offered by Sens. Michael Bennet (D-Colo.), Pat Roberts
(R-Kansas), Blanche Lincoln (D-Ark.), Mike Johanns (R-Neb.) and
Jon Tester (D-Mont.) to "establish a deficit-neutral reserve
fund to address the systemic inequities of Medicare and Medicaid
reimbursement that lead to access problems in rural areas, including
access to primary care and outpatient services, hospitals, and
an adequate supply of providers in the workforce;"
- S.AMDT.802 offered by Sen. Mark Pryor (D-Ark.) to "provide
a deficit-neutral reserve fund for the Veterans Health Administration
to ensure that the supply of appropriately prepared health care
professionals is available to meet the needs of the Veterans Health
Administration;"
- S.AMDT.841 offered by Sens. Murkowski, Patty Murray (D-Wash.),
Bennet, Tester, Thune, Jeff Bingaman (D-N.M.), and Amy Klobuchar
(D-Minn.) to "increase funding for the National Health Service
Corps;"
- S.AMDT.887 offered by Sen. Klobuchar to "establish a deficit-neutral
reserve fund to promote payment policies under the Medicare program
that reward quality and efficient care and address geographic
variations in spending;" and
- S.AMDT.970 offered by Sens. Orrin Hatch (R-Utah) and Edward
Kennedy (D-Mass.) to "establish a deficit-neutral reserve
fund to support the National Health Service Corps."
Conference negotiations will focus on reconciliation instructions
and discretionary spending levels provided to the appropriations
committees for the 12 annual spending bills.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Senate Panel Approves Patent Reform Legislation
The Senate Judiciary Committee April 2 approved
(15-4) a compromise version of "Patent Reform Act of 2009"
(S.515),
readying the bill for consideration on the Senate floor. During
mark up, the committee adopted a compromise amendment
by voice vote, addessing issues that had stalled the bill in the
110th Congress and early this year including how to award damages
in infringement cases and the scope of post-grant review of patents.
Committee Chair Patrick Leahy (D-Vt.), Ranking Member Arlen Specter
(R-Pa.), and Sen. Dianne Feinstein (D-Calif.) crafted the compromise
amendment. Joining the amendment as co-sponsors were Sens. John
Cornyn (R-Texas), Sheldon Whitehouse (R-R.I.), and Ted Kaufman (D-Del.).
At the mark up, Sen. Orrin Hatch (R-Utah) announced his opposition
to the amendment because of the inequitable conduct provisions.
The final language defines judges as the gatekeepers in deciding
what evidence juries can hear in determining how to apportion damages.
The amendment removes the problematic "in public use or on
sale" language from the inter partes reexamination procedure,
thereby limiting evidence to patents and printed publications. The
amendment also addresses venue rules for patent infringement cases.
The committee rejected (4-13) an amendment offered by Sen. Jon
Kyl (R-Ariz.) that would have raised the threshold before patents
could be challenged in a post-grant review process.
The AAMC joined the Association of American Universities, the American
Council on Education, the Association of Public and Land-grant Universities,
and the Council on Governmental Relations in an April 1 letter
supporting the compromise amendment. The university group had previously
submitted a March 25 position statement
to members of the committee.
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
House Committee Holds Hearing on Health Care
Associated Infections
The House Appropriations Subcommittee on Labor, Health and Human
Services, and Education April 1 held a hearing
entitled, "National Strategy to Reduce Healthcare-Associated
Infections (HAI)". The hearing addressed a Department of Health
and Human Services (HHS) "Action
Plan" based on a recent Government Accountability Office
(GAO) report that encouraged HHS and inter-related agencies to take
a more proactive role in addressing the issue of HAIs.
Don Wright, M.D., M.P.H., Principal Deputy Assistant Secretary
for Health in the Office of Public Health and Science (OPHS) at
HHS, testified the department is in the process of synthesizing
the public comments and revising the Action Plan [see Washington
Highlights,
Jan. 9].
Acting Director of the Centers for Disease Control and Prevention
(CDC) Richard E. Besser, M.D., discussed how the $50 million for
HAI prevention included in the "American Recovery and Reinvestment
Act of 2009" (P.L.
111-5) would be used and distributed. He indicated $40 million
would be distributed to all states to create or expand state-based
HAI prevention collaboratives; enhance states' abilities to assess
where HAIs are occurring and evaluate the impact of hospital-based
interventions in other healthcare settings; and build a public workforce
in health departments who can lead state-wide initiatives. The remaining
$10 million will be left to the discretion of the Centers for Medicare
and Medicaid Services (CMS). Dr. Besser also stated, "Based
on the success that CDC and AHRQ [the Agency for Healthcare Research
and Quality] have seen in local, regional and national initiatives,
we anticipate 10-20 percent reductions in HAIs within two years."
Other witnesses included:
- Peter Pronovost, M.D., Ph.D., F.C.C.M., Professor and Director
at Johns Hopkins School of Medicine;
- Rachel Stricof, Director of Hospital-Acquired Infection Reporting
Program at New York Department of Health;
- Robert Hyzy, M.D., Associate Professor of Internal Medicine
at the University of Michigan Health System, on behalf of the
American Hospital Association; and
- Carolyn M. Clancy, M.D., Director of AHRQ, who spoke about successful
efforts to reduce HAIs including the Keystone ICU Project.
All witnesses expressed the need for increased financial incentives
on all levels to help reduce HAIs. Witnesses also noted the need
to enhance medical school and residency curriculum to include public
safety training. The witnesses disagreed on whether public reporting
for HAIs should be mandatory, voluntary, or a combination.
Information:
Jennifer Faerberg, Director, Health Care Affairs
AAMC Health Care Affairs
jfaerberg@aamc.org
(202) 862-6221
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
House Panel Holds Fourth Hearing on Health Care
Reform
The House Energy and Commerce Health Subcommittee held a March
31 hearing titled "Making Health Care Work for American Families:
The Role of Public Health." At this fourth session in a series
of five hearings (see related story), the committee
explored the role public health programs will play in making health
reform sustainable, preventing chronic diseases, and improving health
outcomes. Additionally, the hearing addressed clinical and preventative
services available at the childhood level, access to care in rural
communities, the role of the medical home, and care coordination
between primary care physicians and public health professionals.
During the hearing, Rep. Chris Murphy (D-Conn.) asked what role
primary care providers and the medical home concept play in the
success of public health. Acting Director of the Centers for Disease
Control (CDC) Richard E. Besser, M.D., said major gaps exist, especially
in rural communities, making care coordination more difficult. He
suggested a greater emphasis on reimbursement and additional community
services that will connect the providers (as in the medical home
model). Chair of the Task Force on Community Preventative Services
and Director of Los Angeles County Department of Public Health Jonathan
E. Fielding, M.D., M.P.H., echoed Dr. Besser's suggestions, stating
there needs to be a greater connection between primary care physicians
and public health professionals and an increased focus on the reimbursement
issues.
Other witnesses included:
- Heather Howard, J.D., Commissioner, New Jersey Department of
Health and Senior Services;
- David Satcher, M.D., Ph.D., Former U.S. Surgeon General, Director,
Satcher Health Leadership Institute, Morehouse School of Medicine;
- Barbara Spivak, M.D., President, Mt. Auburn Cambridge Independent
Practice Association, Inc.;
- Devon Herrick, Ph.D., Senior Fellow, National Center for Policy
Analysis; and
- Jeffrey Levi, Ph.D., Executive Director, Trust for America's
Health.
Written statements and audio of the hearing are available on the
committee's website.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
House Committee Concludes Hearings on Health Care
Reform
The House Energy and Commerce Health Subcommittee April 2 concluded
a series of five hearings on health reform issues with a hearing
titled "Making Health Care Work for American Families: Saving
Money, Saving Lives" (see related story).
The final hearing focused on how to get more value out of health
care spending by improving quality and lowering costs. The hearing
also examined the role of transparency in the delivery and purchasing
of health care services.
In his opening statement, Subcommittee Chair Frank Pallone (D-N.J.)
stated, "The challenges we face with costs and quality aren't
endemic to just public programs. Private insurers and employers
must also begin to rethink the way they pay for health care services.
Changes to Medicare payment policies can help drive that change."
Jonathan Skinner, Ph.D., Professor of Economics, The Dartmouth
Institute for Health Policy and Clinical Practice, suggested, "What
is lacking in the U.S. health care system is accountability for
the cascade of treatments and services in local systems, each of
which might appear rational at the micro-level, but in the aggregate
results in considerable inefficiency and waste." He supported
the development of Accountable Care Organizations (ACOs) as one
way to help health care providers deliver better quality at a lower
cost. The ACOs are similar to a medical home in that it is a local
network of providers that manage the full spectrum of care for all
patients within the network. Other panelists agreed on the need
for greater coordination of care and an integrated delivery system.
There was also a consensus on the need for greater transparency
in health care costs suggesting higher prices do not always equal
greater quality.
Other witnesses included:
- Christine K. Cassel, M.D., President and CEO, American Board
of Internal Medicine and ABIM Foundation;
- Bruce Sigsbee, M.D., M.S., President Elect, American Academy
of Neurology Medical Director, Pen Bay Physicians and Associates;
- Dennis Smith, M.P.A., Senior Research Fellow in Health Care
Reform, The Heritage Foundation;
- Jerry Avorn, M.D., Professor of Medicine, Harvard Medical School;
- Paul Ginsburg, Ph.D., President, Center for Studying Health
System Change;
- Regina Herzlinger, Ph.D., Professor of Business Administration,
Harvard Business School;
- Ronald Bachman, F.S.A., M.A.A.A., Senior Fellow, Center for
Health Transformation; and
- Diane Archer, J.D., Director, Health Care Project, Institute
for America's Future.
Written statements and audio of the hearing are available on the
committee's website.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
HELP and Finance Committees Hold Confirmation
Hearings for Gov. Sebelius
The Senate Committee on Health, Education, Labor and Pensions (HELP)
March 31 and the Senate Committee on Finance
April 2 held confirmation hearings for President Obama's nominee
for Secretary of Heath and Human Services, Kansas Governor Kathleen
Sebelius (D). Much of both hearings focused on health reform, and
the different directions that possible reform could take. In both
hearings, Gov. Sebelius remarked that health care reform is something
that cannot wait and, if confirmed, she will make every effort to
ensure it happens as quickly as possible.
In the HELP Committee hearing, Gov. Sebelius stressed that states
alone cannot make health care reform happen, although they will
play a large part in the process. There was concern from a number
of the Republican members that if healthcare reform were to happen
as part of budget reconciliation, they would be left out. Gov. Sebelius
stated that she is not prepared to take any options off the table,
but she will ensure that both sides of the aisle are included in
the process.
The HELP panel also discussed the shortage of health care providers,
especially in rural areas. Sen. Patty Murray (D-Wash.) and Sen.
Bernie Sanders (I-Vt.) both indicated that although increased funding
for National Health Service Corps (NHSC) and Title VII and VIII
health professions programs in the economic recovery package (P.L.
111-5) was a huge step in the right direction, there is still
much work to be done. Sen. Jack Reed (D-R.I.) mentioned the importance
of investing in Title VII and VIII and the GME programs, to help
increase availability of primary care providers and nurses. Sen.
Richard Burr (R-N.C.) also mentioned the disparity in reimbursement
as a major cause of the current primary care provider shortage.
Throughout both hearings, there was a lot of conversation about
health care insurance. Gov. Sebelius talked about a program in Kansas,
and many other states, where state government employees are given
a choice as to whether they would like to participate in a government
plan or a private plan. She believes that a similar model, with
side by side options of public or private insurance will likely
be the way forward for health reform.
Medicare and Medicaid were the central topic of the Finance Committee
hearing. Specifically, many members brought up Medicare part D.
It was noted that Medicare part D has been far less costly than
it was initially thought to be, but there is still a problem with
the "donut hole" that exists in coverage. Additionally
the panel discussed physician reimbursement, especially as it relates
to Medicare and Medicaid. Gov. Sebelius discussed the need to shift
the focus of the repayment system from one that favors the number
of contacts with patients, to one that favors positive outcomes.
The Finance hearing also addressed the problems of fraud and abuse
in the current health care system. Sen. Thomas Carper (D-Del.) pointed
out that over $70 billion in improper payments have been discovered
with new reporting measures. He suggested that if fraud and abuse
were minimized, the savings could help pay the costs of health care
reform. Gov. Sebelius noted that in Kansas, they have developed
a smartcard system for Medicare and Medicaid, which have helped
lower the incidents of fraud in their state.
Republican and Democrat members alike displayed full support for
Gov. Sebelius as HHS Secretary.
Information:
Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
House Panel Examines Fraud Prevention and False
Claims Reform
The House Judiciary Committee April 1 held a hearing
on legislative "proposals to fight fraud and protect taxpayers."
While much of the hearing focused on mortgage, securities, and investment
fraud, members also questioned panelists about proposed amendments
to the False Claims Act (FCA).
The "False Claims Corrections Act" (H.R.
1788), introduced March 30 by Rep. Howard Berman (D-Calif.),
was among the bills discussed. In his opening statement, Ranking
Member Lamar Smith (R-Texas) noted "As currently drafted, this
bill does not properly strike the balance between providing the
government the tools it needs to fight fraud and ensuring that innocent
recipients of federal funds are not hauled into court to defend
against lawsuits based on an overly broad law. I suspect that the
provisions of this legislation will subject non-fraudulent conduct
of too many organizations —including hospitals, universities
and non-profits— to costly False Claims Act litigation while
at the same time taking away defenses against frivolous cases."
Reps. Berman and Daniel Lungren (R-Calif.), as co-sponsors of H.R.
1788, spoke in favor of the legislation.
Marcia Madsen, Senior Partner at Mayer Brown, LLP, testified on
behalf of the U.S. Institute of Legal Reform and the U.S. Chamber
of Commerce. In her written statement, Ms. Madsen notes "The
Chamber agrees that the False Claims Act is an important tool to
fight fraud involving Federal contracts and programs … The
Chamber believes, however, that the proposed amendments to the statute
are not needed." She concludes, "Although the stated objective
of the legislation is to enhance the FCA as a tool in the fight
against fraud, waste, and abuse, the amendments are not focused
on how the Government's abilities to fight fraud, waste, and abuse
can be improved, but rather appear directed toward the questionable
objective of making it easier for qui tam relators to bring and
maintain FCA actions to enrich themselves and their lawyers."
Jeb White, President and CEO of the Tax Payers Against Fraud, testified
in support of the legislation.
The AAMC has been working with a coalition of interested stakeholders
coordinated by the Chamber of Commerce and opposed similar legislation
in the 110th Congress because of the demonstrated effectiveness
of the current law.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
NIH Updates NRSA Stipend Levels
The National Institutes of Health (NIH) March 27 issued
the FY 2009 stipend levels for trainees and fellows receiving Ruth
L. Kirschstein National Research Service Awards (NRSA). The published
stipend levels have increased about one percent over the FY 2007
level, the last year there was an increase in the stipend levels
for postdoctoral trainees and fellows with zero or one year of experience.
Other stipend levels have not increased since FY 2004. The FY 2009
stipend levels are retroactive for all Kirschstein-NRSA awards made
on or after Oct. 1, 2008.
The following table compares the FY 2009, FY 2007, and FY 2004
stipend levels.
|
|
FY2009
|
FY2007
|
FY2004
|
|
Predoctoral
|
$20,976
|
$20,772
|
$20,772
|
|
Postdoctoral
|
|
|
|
|
0
|
$37,368
|
$36,996
|
$35,568
|
|
1
|
$39,360
|
$38,976
|
$37,476
|
|
2
|
$42,204
|
$41,796
|
$41,796
|
|
3
|
$43,860
|
$43,428
|
$43,428
|
|
4
|
$45,504
|
$45,048
|
$45,048
|
|
5
|
$47,460
|
$46,992
|
$46,992
|
|
6
|
$49,344
|
$48,852
|
$48,852
|
|
7
|
$51,522
|
$51,036
|
$51,036
|
Information:
Jodi Lubetsky, Manager, Science Policy
AAMC Biomedical Health Sciences Research
jlubetsky@aamc.org
(202) 828-0485
|
