Washington Highlights: November
16, 2007
ContentsPrior Issues  |
House Fails
to Override HHS Funding VetoThe House of Representatives Nov. 15 failed
to override President Bush's veto of the FY 2008 Labor-HHS-Education Appropriations
bill (H.R. 3043).
The 277-141 tally fell
2 votes short of the two-thirds majority needed to override the veto. A total
of 51 Republicans voted to override; no Democrat voted to sustain the veto. The
President vetoed the bill Nov. 13. In his message returning the bill to the House
of Representatives, the President stated, "This bill spends too much. It
exceeds the reasonable and responsible levels for discretionary spending that
I proposed to balance the budget by 2012. The Congress is on a path to spend $205
billion more over the next 5 years than I requested. This puts a balanced budget
in jeopardy and risks future tax increases." Noting that the bill includes
nearly $10 billion more than he had requested, the President said, "Health
care, education, job training, and other goals can be achieved without this excessive
spending, if the Congress sets priorities." Following the President's
veto, AAMC President Darrell G. Kirch, M.D., issued a statement
calling for the Congress to override the veto and sent a letter
on Nov. 14 to all Members of the House of Representatives urging them to vote
to override the veto. During the debate prior to the vote, House Appropriations
Chair David Obey (D-Wis.) stated,
"People may like to cast a vote without having to take responsibility for
knowing the consequences. But there are severe consequences for voting against
overriding the President's veto of the Labor-Health-Education bill." He noted,
"If this veto is not overridden, then the best that could happen is we wind
up splitting the difference with the President's wholly inadequate budget." Chairman
Obey went on to warn that if Congress agreed to a 50 percent cut to the difference
between the Labor-Health-Education bill and the President's budget, "For
medical research into diseases like cancer, Parkinson's and diabetes at the National
Institutes of Health, meeting the President halfway would put us $700 million
below the bill we are considering today. That means about 700 fewer grants for
research to treat and cure so many deadly diseases." Chairman Obey
referenced an announcement earlier in the day by Senate Majority Leader Harry
Reid (D-Nev.) that the chairman and Senator Robert Byrd (D-W.Va.), chair of the
Senate Appropriations Committee, were working on an omnibus spending bill to be
considered in December that would split the difference between Congress and the
President. Congressional Democrats have been seeking to add $22 billion to the
President's FY 2008 budget, including $9.8 billion in the Labor-HHS bill. The
bill was sent to the White House Nov. 8, after Congress approved the conference
agreement on the bill [see Washington Highlights,
Nov. 9]. The Labor-HHS conference agreement includes $30 billion for NIH in
FY 2008, an increase of $1.1 billion (3.8 percent) over the FY 2007 level, and
$212 million for Title VII health professions training programs, an increase of
$27.3 million (14.7 percent). Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525 Bush Signs Defense Spending
Bill, Includes Second Short-term Funding ExtensionPresident Bush Nov.
13 signed the FY 2008 Department of Defense Appropriations bill (H.R.
3222, P.L. 110-116). The bill also includes a second continuing resolution
(CR), which extends funding at FY 2007 levels for other federal programs (including
NIH) through Dec. 14. The new CR funds the Veterans Health Administration
programs at a rate equal to the levels proposed in the President's FY 2008 budget.
The President's budget included a 2.3 percent increase for VA medical care and
a 7.9 percent reduction for the VA Medical and Prosthetics Research program, compared
to the FY 2007 appropriated levels (including funding provided in the FY 2007
emergency supplemental, P.L. 110-34). The CR also includes short-term extensions
of funding that falls outside the appropriations process, including for the State
Children's Health Insurance Program (SCHIP). The federal government had
been operating under a CR (P.L.
110-92) that was set to expire Nov. 16. Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525 Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116 Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
CMS Issues Delay of Stark III The
Centers for Medicare and Medicaid Services (CMS) Nov. 9 announced
a delay until Dec. 4 of the "stand in the shoes" provision of the physician
self-referral regulation, known as Stark III [see Washington
Highlights, Aug. 31]. The delay is
limited to compensation arrangements between the following physician organizations
and entities only:
- With respect to an academic medical center (AMC),
compensation arrangements between a faculty practice plan and another component
of the same AMC; and
- With respect to an integrated section
501(c)(3) health care system, compensation arrangements between an affiliated
designated health services (DHS) entity and an affiliated physician practice
in the same integrated section 501(c)(3) health care system.
CMS notes that the
purpose of the delay is "to evaluate any unintended impact of the Phase III
'stand in the shoes' provisions." The Stark law prohibits physicians
from referring Medicare and Medicaid patients for specific services to entities
with which the physicians have a direct or indirect financial relationship, unless
the arrangement fits into an exception. Teaching hospitals and academic medical
centers have a number of exceptions available to them to protect the mission support
payments that flow among the various entities from violating Stark. If CMS does
not make changes in the "stand in the shoes" provision during the moratorium,
the effect will be that some, if not all, of the exceptions that typically are
used will no longer be available. Many experts feel that if that were the case,
the only way to be in compliance with the Stark requirements would be to restructure
their compensation arrangements. Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.orc
(202) 828-0490
HELP Committee Approves CHC, NHSC Reauthorization Bill
The Senate Health, Education, Labor and Pensions (HELP) Committee Nov.
14 unanimously approved the "Community Health Centers Renewal Act of 2007"
(S. 901) to
reauthorize the Community Health Centers (CHC) program and the National Health
Service Corps (NHSC). During the mark-up, Sen. Lisa Murkowski (R-Alaska)
offered and withdrew an amendment to establish grants for residency training at
CHCs with the understanding that the committee would hold hearings on health professions
shortages in rural areas. Sen. Murkowski intends to reintroduce the reworked amendment
when the bill is brought to the Senate floor. In a Nov. 14 letter
from AAMC President Darrell G. Kirch, M.D., the association endorsed Sen. Murkowski's
amendment. The letter states, "coupled with medical residency programs, [community
health centers] can help to ensure an adequate supply of well-trained physicians
to care for the nation's neediest populations." S. 901 incrementally
increases the authorized funding level for CHCs over 5 years to $3.537 billion
in FY 2012, a $1.3 billion (60 percent) increase over the $2.213 billion proposed
for CHCs in the FY 2008 Labor-HHS-Education Appropriations conference report (H.R.
3043). S. 901 also pulled language from a bill that HELP Committee Chair
Edward Kennedy (D-Mass.) introduced earlier this year, the "Health Care Safety
Net Act of 2007" (S.
2333), to reauthorize the NHSC. This language incrementally increases the
authorized funding level for the NHSC over 5 years from $131.5 million in FY 2008
to $186 million in FY 2012. The FY 2008 Labor-HHS-Education Appropriations conference
report proposes $131.5 million for the NHSC. Members of the committee expressed
support for CHCs and the NHSC, emphasizing the benefits of the programs for rural
America. Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116 Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
House Panel Approves HEA
Reauthorization BillThe House Committee on Education and Labor Nov. 15
unanimously approved the "College Opportunity and Affordability Act of 2007"
(H.R. 4137)
to reauthorize the Higher Education Act (HEA, P.L.
105-244). Authority for the HEA expired on Sept. 30, 2003; however, several
extensions have been enacted, making no policy changes but allowing uninterrupted
administration of the programs authorized under the law. The current extension
is set to expire March 30, 2008. The bill authorizes a loan forgiveness
program for medical specialties with residency training programs that require
more than 5 years of training and have fewer U.S. medical school graduate applicants
than the total number of training and fellowship positions available. Several
provisions, pulled from the "Student Loan Sunshine Act" (H.R.
890), would dramatically affect medical education financial aid counseling.
The Sunshine Act language would: - Require institutions to develop and
administer a code of conduct for their financial aid offices;
- Require
institutions to disclose all relationships with lenders;
- Ban all gifts,
opportunity pools, and revenue-sharing between lenders and institutions;
- Prohibit
financial aid administrators' participation on lender advisory boards; and
- Require
"preferred lender lists" to include at least 3 unaffiliated lenders.
The
bill also contains several provisions designed to curtail "unfair and deceptive
private educational lending practices." Several amendments were approved
during the marathon 10-hour mark-up. Rep. Tom Price (R-Ga.), an orthopedic surgeon
-- on behalf of Rep. Charles Boustany (R-La.), a heart surgeon, and himself --
offered an amendment to require the Government Accountability Office (GAO) to
conduct a study of education-related indebtedness of medical school graduates.
The amendment was approved by a voice-vote. The bill was referred to multiple
House committees and it is unclear when it will reach the House floor. A final
Manager's amendment of the bill with additional changes is expected to be released
before the full House consideration. The Senate July 24 passed the "Higher
Education Amendments of 2007" (S.
1642), its version of the HEA reauthorization [See Washington
Highlights, July 27]. Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116 HELP Committee Passes Alteration
to CHIMP ActThe Senate Health, Education, Labor and Pensions (HELP) Committee
Nov. 14 approved legislation (S.
1916) prohibiting removal of chimpanzees from the federal sanctuary for chimps
retired from research. The "Chimpanzee Health Improvement, Maintenance and
Protection Act" of 2000 (CHIMP Act, P.L.
106-551) established the sanctuary administered through the National Institutes
of Health's (NIH) National Center for Research Resources (NCRR), for chimpanzees
that are no longer thought to be needed in NIH and Food and Drug Administration
(FDA) research. The current legislation, introduced Aug. 1 by Sen. Richard
Burr (R-N.C.), deletes the provision in the CHIMP Act that allows chimps to be
removed from the sanctuary for research. The bill still allows the use of sanctuary
chimps for research on noninvasive behavioral studies and medical studies based
on information collected during the course of normal veterinary care, if such
research takes place within the sanctuary, located in Shreveport, La. A
companion bill (H.R.
3295), introduced Aug. 1 by Rep. Jim McCrery (R-La.), awaits consideration
of the House Energy and Commerce Subcommittee on Health. Information:
Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
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