Washington Highlights: September 10, 2004

House Approves Labor-HHS Spending Bill

Contents House Considers Labor-HHS Spending Bill Stevens Concerned Senate Cannot Complete FY05 Spending Bills NIH Issues Proposed Public Access Policy CBO Revises Deficit Estimate Prior Issues September 3, 2004 August 27, 2004 August 6, 2004 July 30, 2004 July 23, 2004 Archive

The House Sept. 10 approved its version of the FY 2005 Labor-HHS-Education appropriations bill (H.R. 5006; H. Rept. 108- 636).

The House agreed to an amendment by Reps. Frank LoBiondo (R-N.J.), Nita Lowey (D-N.Y.), and Zach Wamp (R-Tenn) that prohibits the Centers for Medicare and Medicaid Services (CMS) from implementing the so-called "75 percent Rule" that would reduce Medicare payments for some rehabilitation hospitals until an General Accountability Office (GAO) study is completed on the issue. The amendment was supported by the AAMC and 29 other provider and patient advocacy organizations. Additionally, the House rejected by voice vote an amendment sponsored by Rep. Tom Tancredo (R-Colo.) that would have prevented the distribution of Medicare Modernization Act (MMA) funds to hospitals, physicians, and ambulance services that treat large numbers of undocumented immigrants. The funds are made available under section 1011 of the MMA and total $250 million per year in FYs 2005 - 2008. In a Sept. 9 letter, the AAMC, along with the American Hospital Association, National Association of Public Hospitals, National Association of Children's Hospitals, Federation of American Hospitals, Catholic Health Association, Premier Inc., and VHA Inc., expressed strong opposition to the amendment.

The House adopted by voice vote an amendment by Rep. Randy Neugebauer (R-Texas) to prohibit further funding for two specific grants supported by the National Institute of Mental Health. Reps. Kenny Hulsof (R-Mo.) and Lamar Smith (R-Texas) spoke against the amendment. House Labor-HHS Appropriations Subcommittee Chairman Ralph Regula (R-Ohio) spoke against Congress intervening in individual grant funding decisions but ultimately did not oppose the amendment since funding for the grants has already ended.

Subcommittee Chairman Regula and Rep. Ernest Istook (R-Okla.) engaged in a colloquy on the House floor regarding public access to research publications. Rep. Istook, who added language on this issue to the committee report on the bill, praised NIH for its quick response (see related article). He noted NIH Director Elias Zerhouni, M.D., sought "comment from publishers, for-profit and nonprofit groups, from scientists, and from advocates for curing different diseases…. [He] has produced a draft proposal from NIH that carefully balances the interests of these groups…." Chairman Regula replied that he was "very pleased to see that NIH has responded so quickly and thoughtfully to the House report language," and encouraged NIH "to move expeditiously to finalize its proposal after considering the comments it receives on its policy."

The House rejected by a vote of 79 to 333 an amendment offered by Rep. Joel Hefley (R-Colo.) that sought to reduce the overall funding level of the bill by 1 percent. The House also defeated amendments by Rep. Sheila Jackson-Lee (D-Texas) to add funds to the National Center for Health Statistics and the NIH National Center on Minority Health and Health Disparities to increase activities related to lupus and to add funds to the Centers for Disease Control and Prevention to increase hepatitis C research.

Several amendments were offered and subsequently withdrawn, including those to provide an additional $25 million to the Office of the Secretary of Health and Human Services to advance health information technology; to provide $104 million for the Community Access Program; to appropriate $50 million for the Agency For Health Care Research and Quality to conduct outcomes research on prescription drugs and other treatments as authorized by section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003; and to prohibit the use of funds to carry out the Medicare coverage decision regarding obesity until the Secretary submits a report to Congress containing the estimate of the increased costs to the Medicare program.

Several members of Congress, including Michael Castle (R-Del.) and Randy "Duke" Cunningham (R-Calif.) made statements in support of expanding the Administration's policy on federal funding for research using embryonic stem cells.

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

Stevens Concerned Senate Cannot Complete FY05 Spending Bills

Even as his committee approved its 302(b) allocations, permitting the subcommittees to begin marking up their respective FY 2005 spending bills, Senate Appropriations Chairman Ted Stevens (R-Alaska) expressed concern that the Senate will be unable to finish the appropriations bills before the election.

The defense appropriations bill is the only one of the 13 regular spending bills that has been signed into law. Chairman Stevens cited the time the Senate will devote to debating implementation of the recommendations of the 9/11 commission report as a major obstacle to completing work on the spending bills. He worried that work on the commission report might even carry over into a lame-duck session in November, pushing the appropriations bills into 2005.

The allocations, approved Sept. 8, give the Labor-HHS-Education subcommittee $142.317 billion, about $200 million less than the House allocation. The VA-HUD-Independent Agencies subcommittee received $92.930 billion, the same as allocated in the House.

NIH Issues Proposed Public Access Policy

The National Institutes of Health (NIH) Sept. 3 published a notice seeking public comments on a proposed policy "to facilitate enhanced public access to NIH health related research information." According to the notice, "NIH intends to request that its grantees and supported Principal Investigators provide the NIH with electronic copies of all final version manuscripts upon acceptance for publication if the research was supported in whole or in part by NIH funding." NIH says it "will archive these manuscripts and any appropriate supplementary information in PubMed Central (PMC), NIH's digital repository for biomedical research."

NIH further proposes that, "Six months after an NIH supported research study's publication - or sooner if the publisher agrees - the manuscript will be made available freely to the public through PMC. If the publisher requests, the author's final version of the publication will be replaced in the PMC archive by the final publisher's copy with an appropriate link to the publisher's electronic database." NIH is accepting comments on the proposal until Nov. 3.

The NIH action follows the release in July of House Appropriations Committee report language that called on NIH develop a policy requiring that a "complete electronic copy of any manuscript" reporting work supported by NIH grants or contracts be provided to NIH's PubMed Central upon acceptance and be made "freely and continuously available no later than six months after publication, or immediately in cases in which some or all of the publication costs are paid with NIH grant funds." The Washington Post Sept. 6 reported that Senator Arlen Specter (R-Pa.), chair of the Senate Labor-HHS-Education Appropriations Subcommittee, would not add similar language to the Senate report, "But he said that he generally likes the open-access principle and that he hopes a reasonable policy will emerge with public input in the next two months."

CBO Revises Deficit Estimate

The Congressional Budget Office (CBO) Sept. 7 projected the federal budget deficit in FY 2004 will total $422 billion, $56 billion less than CBO's previous budget baseline released in March. At the same time, CBO increased its deficit projections for FY 2006 and beyond, estimating the cumulative deficit will total $2.294 trillion for FY's 2005-2014, $281 billion higher that the March baseline projection.

CBO noted that although the deficit estimate for FY 2004 is a record in terms of dollars, it represents 3.6 percent of the nation's gross domestic product, less than the deficits of the mid-1980s and early 1990s, which frequently exceeded 4 percent of GDP.

CBO's budget deficit estimate is $22 billion less than the deficit estimate of $444 billion deficit published by the Office of Management and Budget in its Mid-Session Review of the President's budget on July 30 [see Washington Highlights, Aug. 6]. For each of the following five years, CBO projects a higher deficit than OMB. CBO projects a cumulative deficit of nearly $1.6 trillion for the FYs 2005-2009 period, as compared with OMB's projection of a $1.1 trillion deficit.

The CBO report states, "Even if the economy grows more rapidly than projected, significant long-term strains on the budget will start to intensify within the next decade as the baby-boom generation begins to reach retirement age." CBO estimates "a growing elderly population and rapidly rising health care costs will cause total federal spending for Social Security, Medicare, and Medicaid to increase from more than 8 percent of GDP in 2004 to between 12 percent and 17 percent in 2030 and to between 13 percent and 28 percent in 2050 (depending on assumptions about federal spending and revenues in the future)."

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