Washington Highlights: July 21,
2006
Contents
Prior Issues
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Senate Panel Boosts NIH Funding by $220 Million
The Senate Appropriations Committee July 20 approved its FY 2007
Labor-HHS-Education spending bill (S.
3708). The bill provides $142.8 billion in discretionary funding
for FY 2007, an increase of nearly $1.27 billion (0.9 percent) over
the current year's funding level. For Public Health Service programs
within the bill, the Senate proposal provides $45.2 billion, an
increase of $936 million (2.1 percent) over the current year and
$235 million more than is included in the bill (H.R.
5647) the House Appropriations Committee approved June 13.
The Senate bill includes a program level of $28.459 billion for
NIH, an increase of $220 million (0.8 percent) over the FY 2006
comparable amount. The program level includes an appropriation of
$28.551 billion, minus $100 million transferred from NIH to the
Global AIDS/HIV Fund, plus the transfer of $8.2 million in evaluation
tap funds to the National Library of Medicine. The Senate bill is
$201 million over the program level of $28.258 billion in the House
bill. The Senate bill retains the salary cap on NIH extramural grants
at Executive Level I ($183,500 in 2006). The House bill adopted
the Administration's request to reduce the salary cap to Executive
Level II ($165,200).
The Senate bill includes $154.4 million for Title VII health professions
education programs, a $9.2 million (6.3 percent) increase over FY
2006 and $9.2 million less than the House bill provides. However,
neither bill restores the 52 percent cut below the FY 2005 level
enacted in the FY 2006 budget.
All Title VII programs are level funded with FY 2006, with the
exception of $50 million for primary care programs, a $9 million
(22.4 percent) increase. The Senate bill does not restore the geriatrics
training funds, which were eliminated in FY 2006, while the House
bill provides the FY 2005 level of $31.5 million. The Senate bill
also includes $8 million for public health, preventive medicine
and dental public health, which is level with FY 2006; the House
bill eliminates these funds.
Title VIII nursing is funded at $150 million, level with FY 2006
and the House bill.
The National Health Service Corps receives $125.5 million, the
same level of funding as FY 2006, but $6 million less than provided
in the House Committee bill.
The Senate bill designates $200 million for Children's Hospitals
Graduate Medical Education for FY 2007, $96.8 million (32.6 percent)
less than FY 2006 and $100 million less than the House bill.
The Agency for Healthcare Research and Quality (AHRQ) receives
$318.7 million, level funding relative to FY 2006 and the House
bill. Both the House and Senate bills provide the FY 2007 funds
through direct appropriations, as opposed to the evaluation tap
funds, which funded the agency in FY 2006.
The Senate bill includes $6.1 billion for the Centers for Disease
Control and Prevention (CDC), a $20.2 million decrease below FY
2006, but $21.4 million more than the House bill provides.
The Senate bill provides $106.7 million for the Department of Education's
National Institute on Disability and Rehabilitation Research, equal
to FY 2006 and the House bill.
During the markup, Sens. Sam Brownback (R-Kan.) and Richard Durbin
(D-Ill.) did not offer an expected amendment to prevent proposed
reductions in Medicaid's allowable provider tax rate. The President
has proposed regulatory changes that would reduce the allowable
rate from 6 percent to 3 percent. Estimated to save $2.1 billion,
the reduction would likely to have a direct and dramatic impact
on many Medicaid providers.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@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
President Vetoes Stem Cell Bill, House Fails in
Override Bid
Less than 24 hours after the Senate passed legislation to expand
the federal policy regarding funding for human embryonic stem cell
research, President Bush vetoed the bill and the House effort to
override fell 51 votes short.
The Senate July 18 passed "The Stem Cell Research Enhancement
Act" (H.R.
810) by a vote of 63 to 37. The bill would expand the number
of human embryonic stem cell lines eligible for federal research
funding. A total of 19 Republicans voted for H.R. 810: Alexander
(Tenn.), Bennett (Utah), Burr (N.C.), Chafee (R.I.), Cochran (Miss.),
Collins (Maine), Frist (Tenn.), Gregg (N.H.), Hatch (Utah), Hutchison
(Texas), Lott (Miss.), Lugar (Ind.), McCain (Ariz.), Murkowski (Alaska),
Smith (Ore.), Snowe (Maine), Specter (Pa.), Stevens (Alaska), and
Warner (Va.). Sen. Ben Nelson (D-Neb.) was the only Democrat to
vote against the measure.
The vote occurred following two days of debate on H.R. 810 and
two other stem cell-related bills: the "Alternative Pluripotent
Stem Cell Therapies Enhancement Act" (S.
2754) and the "Fetus Farming Prohibition Act of 2006"
(S.
3504). Under a unanimous consent agreement engineered by Senate
Majority Leader Bill Frist (R-Tenn.), amendments were not permitted
and each bill needed at least 60 votes to pass. The Senate passed
the other two bills unanimously.
Following the Senate action, the House moved quickly to pass S.
2754 and S. 3504 to allow all three bills to be sent to the President
at the same time. While the House voted 425 to 0 to suspend the
rules and pass the Fetus Farming Prohibition, a similar vote to
suspend the rules to allow passage of S. 2754 fell short of the
two-thirds majority required. Republicans had hoped to send all
three bills to the President at the same time so he could sign the
two alternatives while vetoing H.R. 810. The alternatives were intended
to provide a measure of political cover for conservative lawmakers
who wanted to oppose H.R. 810 and claim they voted in favor of stem
cell research.
Shortly after the Senate vote, AAMC President Darrell G. Kirch,
M.D., sent a letter
to the President urging him to sign the bill.
At a July 19 White House event attended by opponents of H.R. 810,
the President stated "This bill would support the taking of
innocent human life in the hope of finding medical benefits for
others. It crosses a moral boundary that our decent society needs
to respect, so I vetoed it." The President also announced he
was signing the Fetus Farming Prohibition Act (S. 3504).
Later the same day, the House voted on an effort to override the
veto of H.R. 810. The vote was 235-193, with 5 members not voting,
but supporters of H.R. 810 needed a two-thirds majority or 286 votes
to override the veto. The House passed H.R. 810 by a vote of 238-194
on May 24, 2005 [see Washington
Highlights, May
27, 2005].
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
AAMC Urges Extension of CMS Clinical Research
Policy Comment Period
The AAMC sent a July 20 letter
to the Centers for Medicare and Medicaid Services (CMS) Administrator
Mark McClellan, requesting a 15 day extension of the comment period
for the Clinical Trial Policy National Coverage Decision (NCD).
CMS July 10 issued a Tracking
Sheet for Clinical Trial Policy to reconsider the NCD issued
by CMS in 2000. The NCD provides Medicare payment for certain clinical
trials and for certain items and services for beneficiaries enrolled
in clinical trials. Under its new name, the "Clinical Research
Policy" will address the large number of issues raised concerning
the NCD's correct implementation. CMS is required to publish a final
NCD within 6 months of issuing the tracking sheet and requests that
comments be submitted by Aug. 9. The AAMC has been assisting members
with this issue since the NCD was first published and will be working
with members to prepare comments.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.orc
(202) 828-0490
House, Senate Letters Urge Delay of Medicare Inpatient
Rule
Fifty-three Senators, including 15 Finance Committee members, signed
a July 12 bipartisan letter
urging Centers for Medicare and Medicaid Services (CMS) Administrator
Mark McClellan to delay implementation of the FY 2007 Medicare inpatient
proposed rule. An identical letter
signed by 189 House members was sent on July 13. Sens. Rick Santorum
(R-Pa.) and Kent Conrad (D-N.D.) and Reps. Phil English (R-Pa.)
and Earl Pomeroy (D-N.D.) circulated the letters among their colleagues.
The letters encourage Administrator McClellan to postpone implementation
of a "cost-based" DRG weighting methodology until FY 2008
(i.e., a one year delay), and then simultaneously implement the
change along with the refined DRGs. They also ask Administrator
McClellan to "give full consideration to MedPAC's recommendation
that the new payment system be phased in...given the magnitude of
payment redistribution."
While the letters credit CMS for its efforts to improve the payment
system, they iterate the importance of doing "everything possible
to ensure that the best policy be implemented in the most appropriate
timeframe."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Senate HELP Committee Approves Public Health Security
Reauthorization
The Senate Committee on Health, Education, Labor, and Pensions
(HELP) July 19 easily approved legislation to reauthorize until
2011 a law (PL
107-188) aimed at improving preparedness for public health and
bioterrorism crises. The "Pandemic and All-Hazards Preparedness
Act" (S.
3678) is sponsored by HELP Subcommittee on Bioterrorism and
Public Health Preparedness Chair Richard Burr (R-N.C.).
The bill grants the Secretary of Health and Human Services (HHS)
the authority to oversee emergency public health and medical response,
and creates within HHS an Assistant Secretary for Preparedness and
Response who will serve as principal advisor to the Secretary on
all matters related to federal public health preparedness. The Assistant
Secretary also would maintain the Strategic National Stockpile,
oversee countermeasure research, and coordinate with other federal
officials, such as the Chief Medical Officer at the Department of
Homeland Security (DHS). The measure also returns the National Disaster
Medical System to HHS from DHS.
Further, the legislation creates partnerships for state and regional
hospital preparedness to improve surge capacity. Partnerships will
consist of one or more hospitals, at least one of which is a designated
trauma center; one or more other local health care facilities; and
one or more political subdivisions, such as a state. The provision
allows the Secretary to reserve an amount he deems appropriate for
these partnerships, with the remainder awarded to states; this splits
the existing Bioterrorism Hospital Preparedness program, which awards
all funds to states to be distributed to hospitals. The bill authorizes
$474 million for the revised program, the same amount appropriated
in FY 2006.
Other provisions in the legislation include an Emergency Medical
Treatment and Active Labor Act (EMTALA) waiver to allow for the
transfer of individuals during an emergency involving a pandemic
infectious disease, and the creation of a Volunteer Medical Reserve
Corps.
Information:
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@aamc.org
(202) 828-0525
Senate Appropriations Committee Reports FY 2007
VA Spending Bill
The Senate Appropriations Committee July 20 approved its FY 2007
Military Construction and Veterans Affairs spending bill (H.R.
5385, S.Rept.
109-286). The Senate provides $32.258 billion for VA medical
care, a $3.555 billion (12.4 percent) increase over the FY 2006
levels and the same as the President's request for FY 2007. The
House May 10 appropriated $32.283 billion for VA medical care, a
$3.580 billion (12.5 percent) increase over FY 2006.
The Senate bill combines the VA Medical Service and VA Medical
Administration into a single account and provides $28.689 billion,
a $3.284 billion (12.9 percent) increase over FY 2006. The committee
rejected the President's legislative proposals for fee and co-payment
increases. The bill also provides $3.569 billion for VA Medical
Facilities, a $271 million (8.2 percent) increase over FY 2006.
The VA Medical and Prosthetic Research program receives $412 million,
the same as in FY 2006. For the second consecutive year, the Senate
Committee designates $15 million of the VA Research funds to the
Gulf War Illness Research Center of Excellence at the University
of Texas, Southwestern Medical Center. The earmark is part of a
5 year commitment to this Center. The Senate bill does not include
the additional $12 million for research facilities upgrades that
the House approved in May.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Senate Appropriations Committee Approves NSF Funding
The Senate Appropriations Committee July 13 approved the FY 2007
Commerce-Justice-Science spending bill (H.R.
5672, S.Rept.
109-280), including $5.99 billion for the National Science Foundation
(NSF). The NSF appropriation constitutes a $410.5 million increase
(7.4 percent) over FY 2006, and includes $4.65 billion for Research
and Related Activities, an increase of $314.94 million (7.3 percent)
over the previous year.
Relative to the House-passed bill, the Senate measure provides
$28.52 million less for NSF overall, and $19.53 million less for
Research and Related Activities, both of which were funded level
with the President's request in the House version.
Senate floor consideration has not been scheduled, and it is unclear
whether the bill will be considered as a stand-alone or together
with other measures as part of a large omnibus package.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Higher Ed Commission Comments on Physician Workforce
Shortages
The Secretary of Education's Commission on the Future of Higher
Education July 14 released a second draft of its final report.
The new draft is widely acknowledged as less critical of higher
education than the original report. Among the additions, a findings
section outlines concerns that "current and projected shortages
in physicians, registered nurses, and other medical specialties
may affect the quality of care for the increasingly aging population
of Baby Boomers" and the report recommends "increasing
federal and state investment in education and research in critical
areas such as the STEM fields (science, technology, engineering
and mathematics) teaching, nursing, biomedicine, and other knowledge-intensive
professions."
Additionally, the draft report broadly calls for increased transparency
and accountability; developing - at the institutional level - new
and innovative means to control costs and improve productivity;
simplifying the financial aid process; and a shift to financial
aid awards based on need rather than merit.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
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