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Washington Highlights: September 7 , 2007

Senate Confirms Nussle as OMB Director

The Senate Sept. 4 confirmed former Iowa Representative and House Budget Committee Chair Jim Nussle (R) as Director of the Office of Management and Budget (OMB) by a vote of 69-24.

Several prominent Democrats voted against the nomination, citing Nussle's leadership in crafting the budgets that resulted in the Bush Administration's tax cuts in 2001 and 2003. Democrats also used the debate on the nomination to protest the White House's threats to veto appropriations bills for the coming fiscal year. Senate Majority Leader Harry Reid (D-Nev.) said, "The President is choosing to pick a purely political fight over less than 1 percent of the budget." Reid said his vote against Nussle will "send a clear signal of my opposition to this reckless fiscal policy."

In a statement issued after the vote, President Bush said Nussle is "a strong advocate for fiscal discipline and pro-growth economic policies, and he will help lead efforts to balance the budget by 2012 by restraining federal spending and keeping taxes low."

The confirmation came as Congress and the Administration begin to grapple with the task of completing the FY 2008 appropriations bills. Democrats want to add $23 billion to the Administration's request of $933 billion for discretionary spending in FY 2008. In response, the White House has threatened to veto seven of the 12 annual appropriations bills, including the Labor-HHS-Education bill (H.R. 3043, S. 1710), for "an irresponsible and excessive level of spending."

Nussle chaired the House Budget Committee from 2001 to 2006. He left the House in 2006 for an unsuccessful bid to become governor of Iowa.

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

AAMC, Health Professions Groups Urge Stafford Loan Limit Increase

A group of almost 60 health professions associations, organized by the AAMC, sent a Sept. 4 letter to U.S. Secretary of Education Margaret Spellings urging her to increase the aggregate combined Stafford loan limit for health professions students from $189,125 to $223,793.

Students in programs leading to a degree in allopathic medicine, osteopathic medicine, dentistry, veterinary medicine, optometry, podiatric medicine, and naturopathic medicine are eligible for additional annual unsubsidized Stafford loans beyond that of a graduate/professional student. However, many students require more than this aggregate limit and are forced to seek less favorable options.

The letter points out that "the aggregate combined Stafford loan limit for health professions students has remained stagnant for over a decade, does not account for recent increases in annual unsubsidized Stafford loan limits or reflect programs of different duration, and is not defined in regulation."

Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116

AAMC Comments on NIH Peer Review

The AAMC Sept. 6 responded to a Request for Information (RFI) soliciting comments on the "NIH System to Support Biomedical and Behavioral Research and Peer Review." The RFI states that "the NIH is especially interested in creative suggestions, even if they involve radical changes to the current approach." AAMC identified a number of challenges and suggested a number of changes, some of which might be considered radical. These suggested changes included: mandatory service on study section for all investigators receiving NIH awards; reducing the length of the review and funding cycle to 6 months or less; allowing an individual to have one application per mechanism in the system (note that one could still have more than one grant); and, reorienting the NIH intramural program to conduct research that is distinctive from and complements that conducted extramurally, such as high risk/high payoff.

Information:
Howard Dickler, Director
AAMC Biomedical Health Sciences Research
hdickler@aamc.org
(202) 828-0567

David Korn, M.D., Senior Vice President
AAMC Biomedical Health Sciences Research
dkorn@aamc.org
(202) 828-0509

Senate Approves VA Appropriations Bill

The Senate Sept. 6 approved (92-1) the FY 2008 Military Construction and Veterans Affairs Appropriations bill (S. 1645, S.Rept. 110-85). The Senate bill provides $36.6 billion for VA medical care, a $4.5 billion (14 percent) increase over the FY 2007 joint funding resolution, matching the House version [see Washington Highlights, June 15].

The Senate bill also includes $500 million for VA Medical and Prosthetic Research, an $86.3 million (21 percent) increase over the FY 2007 joint funding resolution, and $20 million more than the House bill.

Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116

Congress, Governors Struggle with SCHIP

It appears increasingly unlikely that Congress will reach a final reauthorization agreement on the State Children's Health Insurance Program (SCHIP) before funding expires on Sept. 30. House Majority Leader Steny Hoyer (D-Md.) reportedly has referenced the possibility of a short-term SCHIP funding extension while the House and Senate work to reconcile significantly different bills. Senate Minority Leader Mitch McConnell (R-Ky.) Sept. 4 objected to a unanimous consent request by Senate Majority Leader Harry Reid (D-Nev.) to appoint conferees. The House had passed its bill Aug. 1, while the Senate passed its version Aug. 2 [see Washington Highlights, Aug. 3].

Additionally, Govs. Arnold Schwarzenegger (R-Calif.) and Eliot Spitzer (D-N.Y.) Aug. 29 sent a letter to President Bush seeking withdrawal of new requirements for states that expand their SCHIP program. As outlined in an Aug. 17 letter from CMS, states must adopt a range of "reasonable procedures" to prevent the substitution of public coverage for private coverage ("crowd-out") [see Washington Highlights, Aug. 31]. Concerned that the rules diminish state flexibility, Govs. Schwarzenegger and Spitzer state that the Administration "should maintain the innovative responsibility granted to governors under SCHIP." The letter also criticizes President Bush for "repeatedly" modifying existing Medicaid and SCHIP rules.

The National Association of State Medicaid Directors (NASMD) Sept. 4 sent a similar letter to Secretary of Health and Human Services Michael Leavitt urging him to rescind the Aug. 17 letter. According to NASMD, the new requirements limit "the authority given to states to craft and operate programs that are best tailored to their constituents." The letter also questions the Administration's "crowd-out" concerns, advising that "there is limited evidence to suggest that there is a problem."

Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526

House, Senate Approve HEA Compromise

The House and Senate Sept. 6 approved the conference report (H. Rpt. 110-317) for the College Cost Reduction and Access Act (H.R. 2669), the budgetary provisions of the Higher Education Act (HEA) reauthorization. Among other noticeable changes, the measure does not include language from the House and Senate (S. 1762) approved bills to extend the economic hardship deferment beyond the current 3-year limit. The AAMC supported this language throughout the bills' consideration [see Washington Highlights, July 13]. This proposal would have allowed medical residents to postpone repayment of their student loans, avoiding forbearance, while the government continues to pay the interest on the subsidized portion of their loan.

Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116

President Designates Weems CMS Acting Administrator

President Bush Sept. 5 designated Kerry N. Weems, M.B.A. as Acting Administrator of the Centers for Medicare and Medicaid Services (CMS). The President nominated Mr. Weems to serve as CMS Administrator in May [see Washington Highlights, May 4], but the Senate has yet to schedule a confirmation vote. Secretary of Health and Human Services Mike Leavitt issued a statement praising Mr. Weems and stressing the importance of having "solid leadership in place now with the authority to head this critical agency."

HHS Aug. 31 announced the appointment of Anand Parekh, M.D., M.P.H., as Acting Deputy Assistant Secretary for Health, following the Aug. 7 resignation of former Deputy Assistant Secretary John Agwunobi, M.D., M.B.A., M.P.H. [see Washington Highlights, Aug. 10]. Dr. Parekh also will be operationally in charge of the Office of Public Health and Science (OPHS), where he currently serves as Senior Medical Advisor. A graduate of the University of Michigan School of Medicine, Dr. Parekh also is an Adjunct Assistant Professor at Johns Hopkins Hospital.

On the Hill

Senator John Warner (R-Va.) Aug. 31 announced he will not seek reelection in 2008. Senator Larry Craig (R-Idaho) Sept. 1 announced his intention to resign effective Sept. 30. Rep. Paul Gillmor (R-Ohio) died Sept. 5. His seat will remain vacant until Governor Ted Strickland (D-Ohio) schedules a special election.