Washington Highlights: June 26,
2009
House Releases Draft Health Care Reform Legislation
Contents
Prior Issues
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The House June 19 issued an initial "discussion
draft" of its health care reform legislation. The draft
"tri-committee" document is a joint product of the three
committees of jurisdiction (Ways and Means, Energy and Commerce,
and Education and Labor). The committees conducted a series of hearings
on the legislation during the week of June 22 (see
related story), with tentative plans to mark-up the same broadly
based bill shortly after the July 4 recess. The Congressional Budget
Office (CBO) has not yet released the estimated cost of the health
reform package.
The committees have invited a variety of stakeholders (including
the AAMC) to submit comments on the draft bill language. The AAMC
is expected to submit comments shortly. The discussion draft includes
several provisions of particular interest to medical schools and
teaching hospitals, including:
- A redistribution of unused graduate medical education (GME)
training slots, the preservation and redistribution of Medicare-funded
GME training slots when teaching hospitals close, and the elimination
of regulatory barriers to placing residents in non-hospital settings
for portions of their training;
- Medicare physician payment reform that fully eliminates the
scheduled 21 percent cut, establishes a one-year inflationary
update in CY 2010, and implements in CY 2011 newly rebased target
growth rates for two distinct service categories. The first category
includes evaluation and management (E&M) and Medicare preventative
services, while the second category includes all other services.
The annual target growth rates for the first and second service
categories are set at 2 percent and 1 percent, respectively;
- The issuance of recommendations (no later than July 1, 2016)
on the "appropriate amount, targeting, and distribution of"
Medicare and Medicaid disproportionate share hospital (DSH) payments
that "take into account the impact of ... health care reforms;"
- An initiative to reduce "potentially preventable"
hospital readmissions, starting in FY 2011;
- The extension of the Physician Quality Reporting Initiative
(PQRI) through 2012, along with the creation of incentive payments
for counties with low rates of Medicare per capita spending on
physician services;
- Legislative language establishing that GME costs would qualify
for federal Medicaid "matching" payments. The language
also establishes greater accountability for "how such payments
are being used;"
- Limits on the creation and expansion of physician-owned hospitals;
- Reauthorization of the Health Resources and Services Administration's
Title VII health professions and Title VIII nursing education
programs (see related story);
- Allows practitioners to practice part-time in the National Health
Service Corps (NHSC);
- A new funding mechanism for certain Public Health Service programs,
authorizing appropriators to provide funds from a mandatory Public
Health Investment Fund for Title VII, Title VIII, NHSC, and other
health programs; and
- A new program providing scholarship and loan repayment for physicians
providing "primary health services" and other health
professionals that agree to serve in shortage areas designated
by the Secretary of Health and Human Services.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
House Tri-Committee Addresses Title VII Reauthorization
The discussion draft
released June 19 by the House Committees on Energy and Commerce,
Ways and Means, and Education and Labor (see related
story) includes provisions to reauthorize the Health Resources
and Services Administration (HRSA)'s Title VII health professions
and Title VIII nursing education programs.
Like the draft bill being considered by the Senate Health, Education,
Labor, and Pensions (HELP) Committee [see Washington
Highlights,
June 12], the bill:
- Udates the Title VII Primary Care Loan program;
- Establishes a National Center for Health Workforce Analysis;
- Authorizes funding and activities for the Title VII primary
care medicine programs distinctly from the Title VII primary care
dentistry programs; and,
- Allows Title VII primary care medicine grantees to use funds
to train physicians teaching in community-based settings.
The House "tri-committee" bill strikes the individual
funding authorizations for the Title VII programs, and authorizes
funding for groups of programs through the bill's proposed Public
Health Investment Fund, a mandatory funding stream for designated
programs in the Public Health Service. The bill deposits in the
fund $4.7 billion for FY 2010 up to $8.8 billion in FY 2014, and
authorizes appropriators "to increase funding, over the fiscal
year 2008 level" for the selected Title VII, Title VIII, and
several other health programs.
Additionally, the House bill adds eligibility for geriatric medicine
to the Title VII primary care medicine programs, but does not address
the Title VII geriatric education training programs. The House bill
also reauthorizes the Title VII diversity programs, with some changes
to the Centers of Excellence and the Faculty Loan Repayment program.
New programs in the House draft include a grant program promoting
training in interdisciplinary and team-based care as well as a grant
program to address health disparities by promoting interdisciplinary
cultural and linguistic competency.
The House committees also propose establishing under Title VII
a new HRSA Advisory Committee on Health Workforce Evaluation and
Assessment. Similar to the Senate HELP Committee's proposed National
Health Care Workforce Commission, the advisory committee is tasked
with collecting, reviewing, and reporting information on projected
health workforce needs.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Senate Panel Continues Deliberating Health Care
Reform Draft
The Senate Health, Education, Labor, and Pensions (HELP) Committee
continued marking up its draft health care reform legislation
before adjourning June 25 for Congress's week-long Independence
Day recess [see Washington
Highlights,
June 19]. In its daily meetings since June 17, the committee
has adopted more than 250 amendments on Title II (quality provisions),
Title III (prevention provisions) and Title IV (workforce provisions)
of the bill.
Many of the amendments make technical changes to the draft legislative
text or modify proposed programs to expand eligibility for additional
health professionals, populations, or geographic areas. Other approved
provisions include:
- An amendment sponsored by Sen. Richard Burr (R-N.C.) to reinstate
the "20/220 pathway" of the Economic Hardship Deferment;
- An amendment sponsored by Sen. Orrin Hatch (R-Utah) directing
the Institute of Medicine to make recommendations on reducing
unnecessary hospital readmissions; and
- An amendment sponsored by Sen. Tom Coburn (R-Okla.) to address
legal and regulatory barriers that prevent hospitals, group practices,
and other entities from providing hardware, software, and technology
support to other providers in the community.
In her opening remarks, Sen. Patty Murray (D-Wash) - who led the
committee's consideration of Title IV - stressed the importance
of addressing health workforce issues in the context of health reform.
She noted that improving the affordability of health care without
addressing its accessibility is "like building schools and
not hiring any teachers."
In response to Republican concerns about incomplete information
on the bill's projected cost, HELP Committee Acting Chair Chris
Dodd (D-Conn.) pledged to withhold consideration of portions of
the bill until cost estimates from the Congressional Budget Office
(CBO) become available. Provisions on coverage, follow-on biologics,
and long term care remain outstanding. The committee is expected
to begin addressing those provisions July 7.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
House Committees Hold Hearings on Health Reform
Discussion Draft
The House Committees on Energy and Commerce, Ways and Means, and
Education and Labor held a series of hearings the week of June 22
to discuss a discussion draft
of their joint health care reform bill (see related
story). These hearings were held in preparation of the bill's
mark up in the three committees when Congress returns from the week-long
July 4 recess.
The House Energy and Commerce Subcommittee on Health held a series
of three hearings starting on June 23. The first hearing
focused on consumer views of the discussion draft. The second hearing
June 24 focused on single-payer health care options; state, local,
and tribal issues; as well as drug and device manufacturer issues.
Former Secretary of Health and Human Services (HHS) Michael Levitt
commended the draft for addressing the payment system for Medicare,
but cautioned that adding large populations to Medicaid will burden
state budgets.
A third hearing
June 25 focused on Medicare payment; employer and employee views;
as well as provider and insurer issues. When asked by Rep. Jane
Harmon (D-Cali.) about Disproportionate Share Hospital (DSH) payments,
Patricia Gabow, M.D., CEO of Denver Health and Hospital Authority,
representing the National Association of Public Hospitals, emphasized
the importance of maintaining the DSH payments during the time of
enrolling the uninsured under any health reform legislation that
may pass.
Additionally, the Full House Energy and Commerce Committee met
June
24 to hear testimony from HHS Secretary Kathleen Sebelius. Secretary
Sebelius reiterated the Administration's commitment to achieving
health care reform this year and working with the committees in
both the House and Senate in accomplishing bipartisan comprehensive
health reform.
The House Committee on Education and Labor June 23 held a hearing
with a diverse group of small business owners, economists, consumers,
patient advocates and other stakeholders. The hearing mostly focused
on the proposed public health insurance option. Fitzhugh Mullan,
M.D., Murdock Head Professor of Medicine and Health Policy, George
Washington University, praised the National Health Service Corps
and the Title VII health professions programs as an integral part
of health care reform.
The House Committee on Ways and Means also held a hearing
June 24 to discuss the draft proposal. The hearing included three
groups of panelists representing policy analysts, consumer groups,
and providers. Chip Kahn, President and CEO of the Federation of
American Hospitals (FAH) stated, "Despite the enforcement of
the individual and employer mandates in the draft…DSH payments
are absolutely vital to maintaining the fragile health care safety
net, especially considering well-documented Medicare and Medicaid
payment shortfalls." Rep. Shelley Berkley (D-Nev.) and Rep.
Allyson Schwartz (D-Pa.) both emphasized the need for more doctors,
incentives for primary care doctors, increased graduate medical
education (GME) funding, and medical student loan repayments.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
House Approves Advanced VA Funding, Panel Approves
FY 2010 VA Appropriations
The House June 23 passed (409-1) the Veterans Health Care Budget
Reform and Transparency Act of 2009 (H.R. 1016) to provide advanced
funding for VA medical care, as well as the Medical and Prosthetic
Research and Information Technology accounts. The bill would allow
Congress to provide appropriations for these accounts 1-year ahead
of the standard appropriations cycle. House Committee on Veterans
Affairs Ranking Member Steve Buyer (R-Ind.) was the only nay vote.
The Senate Committee on Veterans Affairs May 21 reported its version
of the advanced appropriations bill (S. 423), which and does not
include VA research or information technology.
The full House Appropriations Committee June 23 approved
the FY 2010 Military Construction and Veterans Affairs appropriations
bill, including FY 2011 funding for VA medical care. The bill includes
$44.5 million for FY 2010 VA medical care, a 4.1 billion (10 percent)
increase over FY 2009; and $48.2 million for FY 2011 VA medical
care, a 3.7 billion (8 percent) increase over FY 2010. The committee
approved $580 million for VA research, a $70 million (13.7 percent)
increase over FY 2009. It is unclear if the House FY 2010 appropriations
bill includes advanced funding for research or information technology.
The committee also directs the VA Under Secretary for Health to
provide a report to the House and Senate appropriations committees
on the VA Blue Ribbon Panel on VA-Medical School Affiliations' recommendations.The
Blue Ribbon Panel
is chaired by former AAMC President Jordan Cohen, M.D., and was
created in 2006 to advice the VA "on issues related to a comprehensive
philosophical framework to enhance VA's partnerships with medical
schools and affiliated institutions."
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Groups Object to Proposed Increase of SBIR Set-Aside
The AAMC joined nearly 100 organizations on a June 23 letter
to Congress opposing a provision to increase the Small Business
Innovation Research (SBIR) set-aside for federal research agencies.
The letter, coordinated by the Federation of American Societies
for Experimental Biology (FASEB), objects to a provision in the
SBIR/STTR Reauthorization Act of 2009 (S.
1233) that would increase the allocation for the SBIR program
from 2.5 percent to 3.5 percent of any federal agency budget that
provides more than $100 million for research [see Washington
Highlights,
June 19]. Signatories on the letter warn that the "mandatory
increase in the SBIR allocation across agencies will necessarily
result in funding cuts for the peer-reviewed research conducted
by other organizations" through the National Institutes of
Health, National Science Foundation, and others. Instead, the groups
urge Congress to "increase funding for all research, thereby
increasing the total investment in SBIR."
The Senate Committee on Small Business and Entrepreneurship approved
the bill June 18, and the full Senate is expected to approve the
legislation by unanimous consent. Meanwhile, the House Small Business
Committee June 25 and the House Committee on Science and Technology
June 24 approved an alternate bill (H.R.
2965) that does not increase the SBIR set-aside.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
HIT Standards Committee Holds Second Meeting,
Workgroup Proposes Taxonomy
The Office of the National Coordinator for Health Information Technology's
(ONC's) HIT Standards Committee
June 16 held its second meeting to hear reports from its three workgroups
and to discuss areas in which it believes there are "gaps"
in available standards. The Committee emphasized the preliminary
nature of its discussions and set itself a deadline of the next
meeting, July 21, for each workgroup to report recommendations to
the full committee.
In general, the three workgroups are mapping their work on standards
requirements to each goal set forth in the Meaningful Use Matrix
the HIT Policy Committee released June 16 [see Washington
Highlights, June 19]. The Clinical Operations Workgroup,
for example, developed a draft taxonomy for categorizing the maturity
of standards required for each measure in the matrix, ranging from
well-accepted and "deployable" standards (Category I)
to standards that are undeveloped and merely a "gleam in the
eye" (Category IV). The Clinical Quality and Privacy and Security
Workgroups are also working to map quality measures and privacy/security
best practices to the Policy Committee's meaningful use objectives.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
On the Agenda in Washington...
July 6: Senate HELP Committee to Mark Up Health Care
Reform Legislation
Time TBD, 325 Russell Senate Office Building
The Senate Health, Education, Labor, and Pensions (HELP) Committee
is scheduled to consider the "Affordable Health Choices Act."
July 6: Senate Military Construction and Veterans Affairs
Appropriations Subcommittee to Mark Up FY 2010 Bill
Time TBD, Location TBD
The Senate Military Construction and Veterans Affairs Appropriations
Subcommittee is tentatively scheduled to mark up draft FY 2010 appropriations
for the Department of Veterans Affairs (VA) with full committee
consideration scheduled for July 7.
July 8: House Labor-HHS-Education Appropriations Subcommittee
to Mark Up FY 2010 Bill
Time TBD, Location TBD
The House Labor-HHS-Education Appropriations Subcommittee is scheduled
to consider its FY 2010 appropriations bill.
July 14: House Committee on Appropriations to Mark Up FY
2010 Labor-HHS-Education Appropriations
Time TBD, Location TBD
The full House Committee on Appropriations is scheduled to mark
up its FY 2010 Labor-HHS-Education Appropriations.
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