Washington Highlights: April 8,
2005
Progress on Budget
Resolution Slowed
Contents
Prior Issues
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Progress on the FY 2006 budget resolution has been slowed as Congress
is coming off a two-week recess and an abbreviated workweek due
to the Pope's funeral. The Senate named conferees to the budget
resolution conference committee on April 4; the House is expected
to name conferees the week of April 11. Legislators face an April
15 statutory deadline to pass a budget resolution; however, there
are no penalties for not meeting the deadline.
The House and Senate approved differing versions of the budget
on March 17. The House bill (H.
Con. Res. 95) directs the House Energy and Commerce Committee
and the House Ways and Means Committee to find savings of $20 billion
and $18.7 billion, respectively, over five years. The bill does
not specify where the cuts must come from, but the Committees must
find savings in programs within their jurisdiction. Programmatic
jurisdictions of the House Energy and Commerce Committee include
Medicaid, Medicare outpatient services and the drug benefit, the
environment and others. The House Ways and Means Committee has jurisdiction
over Medicare, the Earned Income Tax Credit, welfare, child care
and unemployment insurance. Given the size of both the Medicare
and Medicaid program, it is likely that the savings could be achieved
through these programs. The Senate struck language from its version
of the budget resolution (S.
Con. Res. 18) that would have required the Finance Committee,
which has jurisdiction over the Medicaid program, to identify $15
billion in savings over 5 years. Senators also approved amendments
providing additional funds for the National Institutes of Health
(NIH) and higher education programs.
Senate conferees include Senators Judd Gregg (R-N.H.), Charles
Grassley (R-Iowa), Wayne Allard (R-Colo.), Kent Conrad (N.D.), Paul
Sarbanes (D-Md.) and Patty Murray (D-Wash.).
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Survey Finds Medicare Beneficiary Access to Care
Will Be Compromised As a Result of Medicare Physician Payment Reductions
An American Medical Association (AMA) survey
released April 4 indicates that steep Medicare payment cuts to physicians,
nurses and other health professionals will hurt access to care for
America's seniors and disabled. Designed to examine how the projected
Medicare physician payment cuts could affect physicians' practices,
the survey topics include: potential changes to accepting/treating
Medicare patients, potential changes to practice and likelihood
of participation in Medicare Advantage.
According to the survey results, more than one third (38 percent)
of physicians reported that they will decrease the number of new
Medicare patients they will accept if Medicare payment rates are
cut by 5 percent on January 1, 2006. Eighteen percent reported that
they would decrease the number of established Medicare patients
that they treat. Further, 61 percent of physicians reported that
a 5 percent cut would lead them to defer purchase of new equipment;
57 percent said they will reduce time spent with Medicare patients;
54 percent will defer purchase of information technology; 52 percent
will begin referring complex cases; 49 percent will stop providing
certain services; and 24 percent will shift services from the office
to the hospital.
Currently, 20 percent of survey participants reported that they
accept some or no new Medicare patients who contact them. Of the
80 percent who do accept all new Medicare patients, 42 percent reported
that they are contractually obligated to do so by a hospital, group
practice or other entity. AMA's President-Elect, J. Edward Hill,
M.D., stated, "[physicians] simply cannot afford to accept
an unlimited number of new Medicare patients into their practices
if Medicare payments do not keep up with the cost of providing care."
Senate Panel Addresses FY 2006 NIH Funding
The Senate Appropriations Subcommittee on Labor, HHS, Education
and Related Agencies held an April 6 hearing to hear testimony
from National Institutes of Health (NIH) Director Elias A. Zerhouni,
M.D., on the FY 2006 NIH budget. Chairman Arlen Specter (R-Pa.)
presided over the hearing; Ranking Member Tom Harkin (D-Iowa) and
full Appropriations Committee Chairman Thad Cochran (R-Miss.) were
also in attendance.
Chairman Specter expressed the shared concerns of the Senate over
President Bush's proposed flat funding of the NIH and reaffirmed
his commitment to his amendment to the Senate version of the budget
resolution (S. Con. Res. 18), which would provide the NIH an additional
$1.5 billion in funds for FY 2006.
Dr. Zerhouni began his testimony by outlining recent NIH progress
against disease challenges, including a 60 percent decrease in mortality
of heart disease, an increased cancer survival rate while incidence
and mortality declined, an Ebola vaccine, and the swift identification
of SARS thanks in part to recent advances in human genome research.
National Cancer Institute (NCI) Director Andrew C. von Eschenbach,
M.D., provided additional testimony on advances in cancer research
at NCI, outlining the discovery of cancer subsets and its applications
for treating individual cancer patients.
Dr. Zerhouni summarized the NIH's top budgetary priorities for
FY 2006:
- Increasing research project grants by $56 million, raising
the number of new and competing research project grants by 247
grants to a total of 9,463;
- Increasing funding for the NIH Roadmap for Medical Research
by adding $98 million for a total of $333 million to keep this
multi-year initiative on track;
- Developing countermeasures against biological and chemical
threats by increasing biodefense research by a net $56 million
to $1.8 billion;
- Providing $26 million for the Neuroscience Blueprint that
supports NIH Institutes collaborating to use new tools to solve
pressing public health challenges; and
- Increasing funding for the development of a vaccine to combat
HIV/AIDS by $100 million to $607 million.
Dr. Zerhouni has also requested an additional $2 million for creating
an Office of Portfolio Analysis and Strategic Initiatives (OPASI)
to focus attention on creating better institutional tools to analyze,
assess, and manage the NIH-wide research portfolio and to provide
better information to support priority-setting decisions in areas
of common interest to all Institutes and Centers. The new office's
contributions will include an improved process for collecting data
on various diseases, conditions, and research fields, and improvements
in data about burden of disease.
In a response to recent ethical questions and public trust issues,
the hearing continued with questions regarding stem cell research
and conflict of interest challenges. National Institute on Deafness
and Other Communications Disorders (NIDCD) Director and NIH Stem
Cell Task Force Chairman James Battey, M.D. Ph.D., testified that
there is a scientific need for use of stem cell lines derived after
the current August 9, 2001 cut-off date, citing genetic changes
that are inevitably occurring each time these lines are cultured.
Dr. Zerhouni detailed the problems arising as a result of the new
divestment policies (set to be implemented in July) to prevent conflict
of interest difficulties. He has already requested a 90-day extension
from the Department of Health and Human Services (HHS) and hopes
refine the conflict of interest policy in order to prevent the reactive
exodus of NIH scientists to venues with less stringent guidelines.
The hearing concluded with a brief discussion on what Senator Harkin
referred to as "the plight of young scientists." He noted
that concern has grown over the length of training and increased
competition for grants that has resulted in a 23 percent decrease
in NIH scientists under 35 years old. With rising education debt
and increased competition for grants due to the flat funding of
the NIH in President's proposed budget, Senator Harkin the NIH will
lose talented young scientists to other organizations. Dr. Zerhouni
shared this concern and indicated a retreat of all the NIH Directors
has already been planned for later this year to discuss this specific
issue.
Information:
Matthew Shick, Legislative Analyst
AAMC Office of Governmental Relations
jmschick@aamc.org
(202) 828-0525
Senate VA Committee Considers Perlin Nomination
The Senate Committee on Veterans' Affairs held an April 7 confirmation
hearing on President Bush's nomination of Jonathan B. Perlin, M.D.
Ph.D., to be Under Secretary for Health of the Department of Veterans
Affairs. Dr. Perlin has served as Acting Under Secretary for Health
since April 2004 and before that as Deputy Under Secretary for Health
beginning in July 2002. In addition, he assumed the role of Acting
Chief Research and Development Officer from December 2003 to July
2004. The nomination is subject to ratification by the full Senate.
In his opening statement,
Dr Perlin noted that as a medical school student, he had the privilege
of receiving training at a VA medical center and, years later, when
given the opportunity, he gratefully returned to VA, eager to "meaningfully
and tangibly express our gratitude to the men and women of all generations
who successfully defended our freedom while in uniform."
Dr. Perlin answered brief questions from the Committee regarding
the VHA's Electronic Health Record system and increasing use of
technology, Medicare coverage of veterans who are qualified, and
a need for VHA expansion in rural areas. Chairman Larry Craig (R-Idaho)
concluded the hearing by stressing the need for a seamless relationship
between the Veterans Health Administration and medical institutions.
Information:
Matthew Shick, Legislative Analyst
AAMC Office of Governmental Relations
jmschick@aamc.org
(202) 828-0525
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