Washington Highlights: March 14,
2008
AAMC Files Suit Against Federal Government to
Stop Medicaid Rule
Contents
Prior Issues
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The AAMC, joined by the National Association of Public Hospitals
(NAPH) and the American Hospital Association (AHA), and supported
by the National Association of Children's Hospitals (NACH), March
11 asked the U.S. District Court for the District of Columbia to
issue a permanent injunction to prevent the Centers for Medicare
and Medicaid Services (CMS) from implementing a Medicaid rule that
the associations believe imposes onerous restrictions on the definition
of "unit of government" that now helps finance the state
share of Medicaid payments, as well as restrictions on cost limits.
According to the suit, if the rule is allowed to take effect, it
will have a devastating financial impact on public hospitals, many
of which are safety net providers. Congress passed a 1-year moratorium,
enacted May 25, 2007, on the rule [see Washington
Highlights, May 25,
2007].
In a press
conference to announce the filing of the suit, AAMC President
and CEO Darrell Kirch, M.D., said, "Trauma centers, burn units
and emergency preparedness programs could all be drastically affected
if this rule takes effect .… Whether it's a bus crash, a fire
or a terrorist incident, without these Medicaid funds, public hospitals
will be less able to help people when they most need our highly
specialized services."
The legal complaint asserts
that: (1) CMS has overstepped its authority by dictating to states
the governmental status of entities within their jurisdiction; (2)
the agency was barred by Congress from imposing a cost limit on
Medicaid payments to government providers; and (3) CMS improperly
issued a final rule on the same day that a Congressional moratorium
blocking the rule took effect.
The AAMC will continue to work with Congress to extend the moratorium,
since it otherwise will expire on May 25. The hospital associations
decided that it was necessary to file the lawsuit as an additional
option to prevent the rule from taking effect.
Several AAMC members are declarants in the law suit and have filed
sworn statements with the court about the impact of the rule should
it go forward: Oregon Health and Science University, the University
of Colorado Hospital, and the University of Utah Hospitals and Clinics.
Information:
Ivy Baer, Director
AAMC Division of Health Care Affairs
ibaer@aamc.org
(202) 828-0499
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Senate and House Approve Budget Plans, Senate
Calls for NIH Funding Increase
After slogging through dozens of amendments, the Senate March 12
approved its FY 2009 budget plan (S.Con.Res.
70). The vote on final passage was 51-44,
with Maine Republicans Susan Collins and Olympia Snowe voting for
the resolution and Indiana Democrat Evan Bayh voting against it.
The House also passed its version of the budget resolution (H.Con.Res.
312) March 12 by a vote of 212-207,
with 16 Democrats joining 191 Republicans to vote against the plan.
No Republicans voted for the budget. The House passed its budget
after rejecting alternative plans proposed by Republicans, the Congressional
Black Caucus and the Congressional Progressive Caucus.
The Senate overwhelmingly approved an amendment offered by Senators
Arlen Specter (R-Pa.) and Tom Harkin (D-Iowa), the ranking member
and chair, respectively, of the Senate Labor-HHS-Education Appropriations
Subcommittee, to add an additional $2.1 billion to the funding level
assumed in the budget for the National Institutes of Health (NIH).
The vote on the amendment, which also called for a $1 billion increase
in the Low-Income Home Energy Assistance Program (LIHEAP), was 95-4,
with Senators Tom Carper (D-Del.), Jim DeMint (R-S.C.), James Inhofe
(R-Okla.), and Jon Kyl (R-Ariz.) voting no and Senator David Vitter
(R-La.) not voting.
According to a March 12 statement on the Senate floor by Senator
Specter, "This $2.1 billion amendment, along with the $950
million already contained in the resolution would provide NIH with
an increase of $3 billion or 10.3 percent over the FY08 appropriation."
The Senate also approved by voice vote an amendment by Senators
Jeff Bingaman (D-N.M.) and Lamar Alexander (R-Tenn.) to add $600
million to the science portion of the budget to increase the assumed
funding levels for the National Science Foundation (NSF) and the
Department of Energy's Office of Science to funding levels proposed
in the President's FY 2009 budget.
The Senate also adopted amendments to promote the deployment and
use of electronic prescribing technologies, increase funding levels
assumed for autism research, education, and early detection, develop
biodefense medical countermeasures by fully funding the Biomedical
Advanced Research and Development Authority (BARDA), and increase
funding for the Food and Drug Administration (FDA).
In addition, the Senate adopted amendments to create deficit-neutral
reserve funds to increase federal student loan limits to protect
students against disruptions in the private credit market, provide
for disclosure by states of payments made under state Medicaid programs
to hospitals and other health institutions, fund traumatic brain
injury, and preserve and promote Medicare payment policies that
support rural health care providers.
The actual impact of most of these amendments may be limited because,
while the budget resolution sets an overall spending limit for appropriations
and articulates congressional priorities across broad categories,
it is non-binding and does not directly affect spending for either
discretionary (appropriated) or mandatory programs.
By a 29-71
vote, the Senate rejected an amendment by Senator DeMint (R-S.C.)
to establish a moratorium on congressional earmarks in FY 2009.
The two resolutions must be reconciled by a House-Senate conference
committee when Congress returns to Washington in April. Both the
Senate and House Budget Committees approved their respective budget
resolutions on March 6 [see Washington
Highlights, March 7].
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
AAMC, AMA Urge Reinstatement of 20/220 Pathway
The AAMC and the American Medical Association (AMA) March 12 sent
a joint letter
to members of the House and Senate education committees, urging
them to reinstate the debt-to-income ratio (20/220) of the economic
hardship deferment in the ongoing conference of the Higher Education
Act (HEA) reauthorization bills. The committees are expected to
finish conferencing the bills in April following the Easter recess.
The letter follows the Department of Education's announcement at
the March 4-6 Negotiated Rulemaking
sessions on student loans that the department intends to eliminate
the 20/220 pathway in regulation after July 1, 2009 [see Washington
Highlights,
March 7].
The letter notes that "medical residents rely on the 20/220
pathway to help defray their high debt burden," and "Borrowers
with high loan debt may be deterred from entering public health
service, practicing medicine in underserved areas, starting a career
in medical education or research, or practicing primary care medicine."
Medical residents will be eligible for economic hardship until
July 1, 2009, at which point they can enter the new income-based
repayment (IBR) program. The 20/220 pathway allows medical residents
to qualify for the economic hardship deferment and postpone repayment
of their student loans (without penalty). Conversely, the IBR will
require medical residents to make small monthly loan repayments.
The economic hardship deferment has been operating under the Secretary
of Education's authority after it was eliminated in statute last
year by the "College Cost Reduction and Access Act of 2007"
(P.L.
110-84).
Negotiators will meet again April 14 before the Department publishes
draft regulations in the Federal Register for public comment. Carrie
Steere-Salazar, chair of the AAMC Committee on Student Financial
Assistance, represents the AAMC and the graduate/professional education
community on the negotiated rulemaking committee.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Senate Panel Hears Impact of Flat NIH Budget on
Next Generation of Science
The Senate Health, Education, Labor, and Pensions (HELP) Committee
March 11 held a hearing
to explore the negative effects of 5 consecutive years of flat funding
for the National Institutes of Health (NIH) on the next generation
of medical researchers. The committee heard the findings of a report,
entitled "A Broken Pipeline? Flat Funding of the NIH Puts a
Generation of Science at Risk."
Prepared by a group of seven academic research institutions, the
report profiles 12 junior researchers from institutions across the
country, who - despite their exceptional qualifications and noteworthy
research - attest to the funding difficulties they and their professional
peers are experiencing.
Witnesses included Drew Gilpin Faust, Ph.D., President, Harvard
University; Edward D. Miller, M.D., Dean of the Medical Faculty
and CEO of Johns Hopkins Medicine; Jill A. Rafael-Fortney, Ph.D.,
Associate Professor of Molecular and Cellular Biochemistry, The
Ohio State University College of Medicine; Dana Lewis, student and
diabetes advocate, American Diabetes Association; and Samuel M.
Rankin, III, Ph.D., Associate Executive Director, American Mathematical
Society, and Executive Director, National Coalition on National
Science Funding (CNSF).
HELP Committee Chair Edward Kennedy (D-Mass.) characterized the
report as "a chilling statement of where our current budget
policies for NIH will lead." He noted, "If we lose the
talents of a generation of young researchers, we put in peril not
only medical progress, but America's leadership in the life sciences,
too. A culture of innovation and discovery does not just happen.
It must be nurtured or it will wither."
The report was released earlier in the day at a press conference
that featured Dr. Faust; Robert Golden, M.D., Dean and Vice Chancellor
for Medical Affairs, University of Wisconsin-Madison School of Medicine
and Public Health; Eric Fingerhut, J.D., Chancellor, Ohio Board
of Regents; two young scientists and a cancer patient.
The report, which was co-authored by Brown University, Duke University,
Harvard University, The Ohio State University, Partners HealthCare,
the University of California Los Angeles, and Vanderbilt University,
follows a similar report published last year by a slightly different
group of institutions. The 2007
report, "Within Our Grasp or Slipping Away?" focused
on how the slowdown in NIH funding is holding up promising research
and delaying potential breakthroughs in the prevention and treatment
of disease [see Washington
Highlights, March
23, 2007].
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Department of Education to Increase Health Professions
Student Loan Limits
In response to a Sept. 4, 2007, AAMC-coordinated sign on letter
to Secretary of Education Margaret Spellings [see Washington
Highlights,
Sept. 7, 2007], the Department of Education will raise the combined
aggregate Stafford loan limit for health professions students from
$189,125 to $224,000. In a Feb. 28 letter
to AAMC President and CEO Darrel G. Kirch, M.D., Secretary Spellings
announced plans to publish a "Dear Colleague" letter with
additional information shortly.
This increase is entirely in unsubsidized Stafford loans and will
allow medical students to borrow at a 6.8 percent interest rate,
avoiding higher rates under the GradPLUS and private loans. The
change likely will go into effect July 1, 2008 or July 1, 2009.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
House Approves Genetics Bill Again, White House
Issues New Statement
The House of Representatives March 5 approved mental health parity
legislation (H.R.
1424) that includes the text of the House-passed "Genetic
Information Non-Discrimination Act" (GINA, H.R.
493). GINA prohibits employers and insurers from discriminating
on the basis of genetic information. Despite a previous
statement supporting House passage of H.R. 493, the White House
March 5 released a
new Statement of Administration Policy (SAP) that expresses
"both substantive and process objections." Specifically,
the SAP seeks clarification "to ensure that health benefits
disputes are properly brought under the appropriate remedies in
ERISA, the Public Health Service Act, or the Internal Revenue Code;"
to identify how the measure interacts with other laws, including
the Health Insurance Portability and Accountability Act (HIPAA);
and to prevent "unintended" limitations on the ability
of health plans to use information "for appropriate and routine
insurance purposes."
The SAP also objects to provisions in the larger mental health
parity legislation, which includes language limiting self-referrals
to and expansion of physician-owned hospitals [see Washington
Highlights, March 7]. The genetics measure was added to the
House mental health bill in a reported effort to prompt its consideration
during conference negotiations with the Senate, which passed its
version of mental health parity (S.
558) in September. The House had passed (420-3) GINA as a stand-alone
measure April 25, 2007, but a Senate companion (S.
358) has not progressed past the Jan. 31, 2007, approval of
the Senate Committee on Health, Education, Labor, and Pensions (HELP).
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
NIH Plans Public Meeting on New Public Access
Policy, New Compliance Resources Available
The National Institutes of Health (NIH) announced plans for a March
20 public meeting
regarding implementation of its revised public access policy on
publications resulting from NIH-funded research. A separate Request
for Information (RFI) seeking comments about the public
access policy and the effectiveness of its implementation will
be published in the Federal Register later in March.
The revised policy is based on a provision included in the "Consolidated
Appropriations Act of 2008" (P.L.
110-161) that requires as of April 7 submission of all published
articles arising from NIH-funded research to the National Library
of Medicine's PubMed Central [see Washington
Highlights, Jan. 18]. Effective May 25, NIH applications,
proposals, and progress reports must include the PubMed Central
reference number when citing an article that falls under the policy
and is authored or co-authored by the investigator or arose from
the investigator's NIH award. This provision explicitly includes
applications submitted to the NIH for the May 25 due date and subsequent
dates.
A webcast
hosted March 7 by the Association of Research Libraries (ARL) and
the National Association of State Universities and Land-Grant Colleges
(NASULGC) centered on "Institutional Compliance with the NIH
Public Access Policy: Ensuring Deposit Rights." The webcast
explores options for institutional responses to the new Public Access
policy and focuses particularly on the need for institutions to
develop strategies for ensuring the retention of deposit rights
by investigators. ARL also has released an implementation
guide for research institutions.
The March 20 meeting will take place on the NIH campus from 10:00
a.m. to 4:30 p.m. Registration is required and comments can be submitted
in advance. More information on the meeting and the public access
policy is available on the NIH website.
Information:
Tony Mazzaschi, Senior Director
AAMC Scientific Affairs
tmazzaschi@aamc.org
(202) 828-0059
On the Hill
Rep. Bill Foster (D-Ill.) March 11was sworn in to the House of
Representatives to fill the seat vacated by former Rep. Dennis Hastert
(R), who resigned Nov. 26. Rep. Foster, a physicist, defeated Republican
Jim Oberweis in a special election March 8.
Rep. Andre Carson (D-Ind.) March 13 was sworn in to the House of
Representatives, after edging out Republican challenger Jon Elrod
in a special election March 11. Rep. Carson will finish the term
of his grandmother, the late Rep. Julia Carson (D).
Comptroller General of the United States and head of the Government
Accountability Office (GAO) David M. Walker resigned March 12 to
accept a position as head of the newly established Peter G. Peterson
Foundation. GAO Chief Operating Officer Gene Dodaro will serve as
Acting Comptroller General until the President nominates and the
Senate confirms a permanent successor.
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