Washington Highlights: October
19, 2007
ContentsPrior
Issues  |
AAMC Testifies
on VA Physician RecruitmentRichard D. Krugman, M.D., Dean and Vice Chancellor
for Health Affairs at the University of Colorado School of Medicine and Chair
of the AAMC, testified Oct.
18 before the House Veterans Affairs Health Subcommittee on the recruitment and
retention of physicians at the Department of Veterans Affairs (VA). Dr.
Krugman thanked the committee for their leadership in the House passing FY 2008
VA appropriations with $36.6 billion for medical care and $480 million for VA
Medical and Prosthetic Research. However, he urged the committee to address a
critical shortage of adequate VA research space that is necessary for VA to recruit
the best clinician scientists. The AAMC recommends an annual appropriation of
$45 million in the VA's minor construction budget dedicated to renovating existing
research facilities. Dr. Krugman described how the VA shares many problems
with the rest of the physician education community. In particular, he noted that
the recent shift of medical care to a more satellite-based outpatient approach
is decentralizing the standard graduate medical model and limiting the volume
of patient contact and faculty interaction. He also noted that a growing salary
discrepancy between more specialized fields of medicine and the other disciplines
is a concern at both VA and non-VA teaching hospitals. When asked by subcommittee
Chair Michael Michaud (D-Maine) what tools would best address the pending physician
shortage, Dr. Krugman described existing programs that are successful, but lack
adequate funding; specifically, Dr. Krugman named the Title VII health professions
programs and the National Health Service Corps. Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116 AAMC Supports Medicaid Moratorium
Extension BillAAMC President Darrell G. Kirch, M.D., sent Oct. 16 letters
of support to sponsors of legislation to extend for one year the moratorium on
implementation of the May 29 Medicaid final rule regarding cost limits and units
of government and the May 23 proposed rule to eliminate the federal "Medicaid
match" for graduate medical education (GME) payments [see Washington
Highlights, Sept. 21]. The bill, "The
Public and Teaching Hospital Preservation Act" (H.R.
3533), was introduced Sep. 14 by Reps. Eliot Engel (D-N.Y.) and Sue Myrick
(R-N.C.). The current moratorium expires May 25, 2008. The letter explains
that, because teaching hospitals care for a disproportionately high number of
Medicaid beneficiaries, they rely on Medicaid payments to fund their missions
and provide specialized services unavailable at other hospitals. Dr. Kirch
expresses "particular concern" about the loss of Medicaid GME funding,
"since these payments help teaching hospitals sustain one of their core responsibilities-training
physicians who will care for Medicaid and other patients for decades to come."
He adds that physician education "has never been more important given the
numerous studies suggesting current and future physician shortages." Eliminating
federal matching payments for Medicaid GME, he advises, "could cripple training
programs as they try to assure that the nation will have an adequate physician
supply." Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
AAMC Comments on College Cost Reduction and Access ActAAMC
President Darrel G. Kirch, M.D., sent an Oct. 12 letter
to Secretary of Education Margaret Spellings commenting on the recently enacted
"College Cost Reduction and Access Act of 2007" (P.L. 110-84). The new
law, which is part of the ongoing Higher Education Act reauthorization, significantly
alters medical education loan repayment by eliminating the debt-to-income ratio
that qualifies medical residents for an economic hardship deferment. The
AAMC is concerned that the new law creates a "gap" in coverage for medical
residents between Oct. 2007 and July 2009, during which time they are not eligible
for either the economic hardship deferment or a new income-based repayment program.
In the letter, the AAMC recommends:
-
Temporarily extending
the debt-to-income ratio pathway until the new loan repayment program takes effect
in 2009; and
-
Allowing current participants in economic hardship deferment
to finish out their remaining years of eligibility.
The economic hardship
deferment allowed residents to postpone payment of their loans for up to 3 years,
while the federal government paid the interest on the subsidized portions of their
loans. Previously, over two-thirds of the new medical school graduates qualified
for the economic hardship deferment under the debt-to-income ratio qualifying
pathway, which considers a borrower's income and debt. Effective Oct. 1, 2007,
the new definition of economic hardship only considers a borrower's income. Medical
residents are unlikely to qualify under this new definition.
Effective July 1, 2009, the new income-based repayment program
caps a resident's monthly repayments at 15 percent of their income
that exceeds 150 percent of the poverty line for the borrower's
family size ($15,315 for an individual). With an average first year
resident stipend of $44,753, the monthly payment would be $368 compared
to the current typical repayment of $2,025 a month. All residents
will qualify for this program regardless of income or debt.
Residents will still be able to postpone repayment of their student
loans under the mandatory medical internship/residency forbearance.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116 Senate Considers HHS Spending
BillThe Senate Oct. 17 began debate on the FY 2008 Labor-HHS-Education
appropriations bill (H.R.
3043). Senate Majority Leader Harry Reid (D-Nevada) announced late Oct. 18
that the goal was to finish the bill by noon on Oct. 23. No roll call votes were
scheduled for Oct. 19, and a late session is anticipated for Oct. 22 as the Senate
must consider dozens of amendments to the bill. At the beginning of the
Senate debate, Senators Tom Harkin (D-Iowa) and Arlen Specter (R-Pa.), the chair
and ranking Republican, respectively, on the Senate Labor-HHS Appropriations Subcommittee,
offered an amendment to drop a provision that would expand federal funding of
embryonic stem cell research. The senators acted in response to the Administration's
threat to veto the bill over the provision, which they added during committee
consideration of the bill. The White House reiterated its threat to veto
the bill in a Statement
of Administration Policy (SAP) issued Oct. 17 that states, "The Administration
strongly opposes S.
1710 because, in combination with the other FY 2008 appropriations bills,
it includes an irresponsible and excessive level of spending and includes other
objectionable provisions." The AAMC joined a diverse group of 850 education,
training, disability, public health, medical research, child welfare organizations
and labor unions in an Oct. 18 letter
urging the Senate to pass the Labor-HHS spending bill. The letter states the programs
funded by the bill "share a common, fundamental goal of strengthening this
nation by investing in and improving the quality of life of its people, especially
the most vulnerable." The letter also notes the bill, which received broad,
bipartisan support by the Senate Appropriations Committee, "provides a modest
overall increase for programs in the bill, most of which have experienced significant
cuts, lost purchasing power, or both over the past three years." Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525 House
Fails to Override SCHIP Veto
The House of Representatives Oct. 18 failed,
273 - 156, to secure the two-thirds majority (289 votes) required to override
President Bush's veto of H.R.
976, the "Children's Health Insurance Program Reauthorization Act"
[see Washington Highlights,
Oct. 5]. A total of 44 Republicans and all but 2 Democrats voted to override
the veto. During floor debate, Representatives opposing the override cited concerns
that H.R. 976 covered illegal immigrants and was not appropriately financed.
Upon
conclusion of the vote, Speaker Nancy Pelosi (D-Calif.) stated that "we will
continue to insist on insuring the full 10 million children covered by this bill."
Senate Majority Leader Harry Reid (D-Nev.) called the vote "heartless"
and criticized the Republicans' "misinformation campaign." According
to a statement issued by President Bush, he was "pleased" by the vote.
The President directed Secretary of Health and Human Services Michael Leavitt,
National Economic Council Director Al Hubbard, and Office of Management and Budget
Director Jim Nussle to lead discussions with Congressional leaders to find "common
ground on legislation that covers...poor children who are eligible for SCHIP but
have not yet been enrolled." The President added that if additional funding
was needed to enroll these children, "we will work with Congress to find
the necessary money." The State Children's Health Insurance Program is currently
funded under continuing resolution (H.J.
Res. 52) at FY 2007 levels through Nov. 16. Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
CMS Makes No Changes in Clinical Trial Policy
The
Centers for Medicare and Medicaid Services (CMS) Oct. 17 issued a final decision
on national coverage of clinical trials [see Washington
Highlights, July 13]. In the decision
memorandum, CMS announced that it "has decided that no change to the July
9, 2007 [Medicare clinical trial] policy is appropriate at this time and therefore,
we are not imposing any additional conditions of coverage." The July 9 policy
made a few minor changes to the 2000 National Coverage Decision on Medicare payment
for clinical trials. In a Q
& A also released Oct. 17, the agency indicated that it is "working
to develop clearer standards for Medicare trials."
Additional CMS
documents related to coverage of clinical trials are available on the CMS website.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.orc
(202) 828-0490
Senate
Approves NSF Spending BillThe Senate Oct. 16 approved, 75-19, the FY 2008
Commerce-Justice-Science Appropriations bill (H.R.
3093) providing $6.553 billion for the National Science Foundation (NSF).
The Senate Appropriations Committee approved the bill on June 28, while the House
passed its version of the spending bill on July 26 [see Washington
Highlights, Aug. 3]. The House bill
provides $6.509 billion for NSF. The President has threatened to veto several
spending bills, including H.R. 3093, since together, they exceed by $23 billion
the discretionary total recommended in the administration's FY 2008 budget request.
In a statement
of administration policy issued Oct. 4, the administration "commends
the Committee's implementation of ACI [American Competitiveness Initiative] with
its strong support for the National Science Foundation," but criticizes funding
for education programs at NSF. Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525 On the Hill
Rep. Niki Tsongas
(D-Mass.) was sworn into Congress Oct. 18. Rep. Tsongas succeeds former Rep. Marty
Meehan (D), who resigned in July to become the chancellor of the University of
Massachusetts - Lowell.
Rep. David Hobson (R-Ohio) Oct. 14 announced that he
will retire at the end of the 110th session of Congress.
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