Washington Highlights: May 16, 2008
Emergency War Spending Bills Include Extension
of Medicaid Moratorium; White House Threatens Veto
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The House of Representatives May 15 amended
its emergency supplemental appropriations legislation (H.R.
2642) to include provisions that extend until April 1, 2009
the current Medicaid moratorium prohibiting CMS action on the regulations
affecting graduate medical education ("GME proposed rule")
and cost limits/units of government ("IGT final rule").
Passing by a vote of 256-166,
the amendment also temporarily delays action on five other Medicaid
regulations and increases other types of domestic spending (eg,
unemployment insurance and education benefits for veterans).
The 32 House Republicans voting in support of the amendment included:
Reps. Buyer (Ind.); Capito (W.Va.); Hayes (N.C.); Johnson (Ill.);
Jones (N.C.); Petri (Wisc.); Platts (Pa.); Porter (Nev.); Ramstad
(Minn.); Renzi (Ariz.); Ros-Lehtinen (Fla.); Castle (Del.); Dent
(Pa.); Emerson (Mo.); English (Pa.); Fortenberry (Neb.); Fossella
(N.Y.); Gilchrest (Md.); King (N.Y.); Kirk (Ill.); Knollenberg (Mich.);
LaHood (Ill.); LaTourette (Ohio); LoBiondo (N.J.); McHugh (N.Y.);
Miller (Mich.); Murphy (Pa.); Shays (Conn.); Smith (N.J.); Upton
(Mich.); Whitfield (Ky.); and Young (Alaska).
The 7 Democrats voting against the amendment include: Reps. Bean
(Ill.); Boren (Okla.); Lampson (Texas); Mahoney (Fla.); Donnelly
(Ind.); Ellsworth (Ind.); and Matheson (Utah).
Potentially complicating but not necessarily preventing a final
bi-cameral agreement on H.R. 2642, the House unexpectedly failed
to pass (141-149) an amendment to actually fund the wars in Iraq
and Afghanistan. Expressing their overall opposition to the wars,
147 Democrats voted against allowing additional funding, while 132
Republicans voted "Present" in opposition to a bill conservative
Republican Study Commission member Mike Pence called "a backroom
deal that included billions in unrelated domestic spending."
The Senate is scheduled to reconvene on Monday, May 19, when it
is expected to begin its floor debate on supplemental appropriations
legislation. While a final floor strategy remains uncertain, the
Senate could choose to take up the House bill and then amend it
by substituting portions of the emergency appropriations bill approved
by the Senate Appropriations Committee on May 15. The committee's
bill, which passed by a voice vote, also includes AAMC-supported
language to extend the Medicaid moratorium affecting the GME proposed
rule and IGT final rule. The Senate bill also reportedly includes
additional FY 2008 funding for the NIH [see
Washington Highlights, May 9], among billions of dollars
in other domestic spending unrelated to the war.
Meanwhile, a May 15 White House
Statement of Administration Policy (SAP) warned Congress that
the President would veto the House supplemental appropriations legislation
if "presented to the President in its current form." The
SAP criticizes the bill for altering current war policies; adding
"unrequested domestic spending," including the extension
of the current Medicaid moratorium, and increasing taxes. The SAP
states that Congress "must remain focused on our troops and
national security" and not make the supplemental appropriations
bill "a vehicle for additional domestic spending."
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
AAMC Endorses Senate's Physician Payments Sunshine
Act
AAMC President and CEO Darrell G. Kirch May 2 sent a letter
to Senate Finance Committee Ranking Member Charles Grassley (R-Iowa)
endorsing the Senate's amended version of the "Physician Payments
Sunshine Act" (S. 2029). The letter states, "An effective
and principled partnership between academic medical centers and
various health product industries is critical to realize fully the
benefits of biomedical research and ensure continued advances in
the prevention, diagnosis, and treatment of disease… A fundamental
principle that should guide these interactions is that they should
be transparent."
The legislation will require drug, device, or medical supply manufacturers
that receive payments through Medicare, Medicaid, or the State Children's
Health Insurance Program (SCHIP) to disclose to the Secretary of
Health and Human Services on a quarterly basis anything of value
given to doctors, such as payments, gifts, honoraria, or travel.
Companies also must submit annual summaries of the information reported
[see
Washington Highlights, March 28]. The amended Senate
version eliminates the threshold to determine which companies will
be required to report. It also lowers the cap on mandatory reporting
from $25 to $15. In addition, the amended Senate bill will preempt
any state laws.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
AAMC Responds to Proposed HPSA Rule
In a May 15 letter
to Secretary of Health and Human Services (HHS) Michael Leavitt,
AAMC President and CEO Darrell G. Kirch, M.D., urged HHS to extend
by at least six months the public comment period for the proposed
rule, "Designation of Medically Underserved Populations
and Health Professional Shortage Areas" (73
FR 11232). The letter continues to recommend that HHS convene
a panel of affected stakeholders and community experts for a public
discussion of proposed new methodology.
The proposed rule revises and consolidates the criteria for designating
medically underserved populations (MUPs) and health professional
shortage areas (HPSAs) into a single new methodology called the
Index of Primary Care Underservice. HHS proposed the rule Feb. 29
and originally provided a 60-day period for written comments. In
response to requests for an extension, HHS pushed back the deadline
an additional 30 days to May 29 [see
Washington Highlights, May 2].
The AAMC letter notes that limited federal funding and the pending
workforce shortage warrant a careful examination of the current
designation methodology. Further, the letter states "While
we appreciate the significant effort made to develop the proposed
rule, many basic questions remain regarding its implementation and
the potential impact on many safety net providers… The AAMC
is concerned that a narrow comment period with one opportunity for
community input does not allow for a constructive dialogue between
involved parties."
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Rajeev Sabharwal, Senior Research Associate
AAMC Medical School Affairs
rsabharwal@aamc.org
(202) 828-0979
AAMC Comments on HEA Reauthorization Conference
The AAMC May 15 sent a letter
to the House and Senate education committees regarding ongoing Conference
of the "College Opportunity and Affordability Act of 2007"
(H.R.
4137) and the "Higher Education Amendments of 2007"
(S.1642).
The letter comments on provisions of the Higher Education Act (HEA)
reauthorization bills that could affect medical education including
loan repayment, financial aid, institutional grant programs, and
accreditation. Congress has not completed a full reauthorization
of HEA since 1998.
The letter urges conferees to reinstate the debt-to-income ratio
(20/220 pathway) of the economic hardship deferment. The economic
hardship deferment allows residents who meet certain debt and income
criteria to postpone loan repayments during their training, without
the additional interest that accrues in forbearance. On March 5,
2008, the Department of Education announced that they would no longer
use its regulatory authority to continue the 20/220 pathway, and
would stop accepting applications effective July 1, 2009. [see
Washington Highlights, March 14]
The letter notes that the AAMC supports full transparency in medical
schools' lender relationships. However, the AAMC "opposes the
House language that would prohibit financial aid administrators
from participating on lender advisory boards. The AAMC encourages
the reimbursement of domestic travel and "reasonable expenses"
for these purposes and recommends adoption of the Senate language
to promote the valued guidance of the institutional financial aid
community with disclosure of their interactions."
The letter is also supportive of:
- Proposed increased Perkins Loan limits, expanded intuitional
Graduate Assistance in Areas of National Need (GAANN) grants;
- A new loan forgiveness program for "medical specialists;"
and
- House
report language that clarifies the addition of institutional
mission-related accrediting criteria is not intended to alter
current accreditation requirements for training health professionals.
Conferees aim to wrap up negotiations on the HEA reauthorization
bills before adjourning for the Memorial Day recess.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Congress Clears Farm Bill with Language on Class
B Study, AWA Fines
The House May 14 and the Senate May 15 approved the conference
agreement for agricultural policy legislation (the "farm bill,"
H.R.
2419) that includes a provision examining the use of "Class
B" random source cats and dogs in research supported by the
National Institutes of Health (NIH). The conference
report directs the U.S. Department of Agriculture (USDA) to
report the results and recommendations of a pending NIH-commissioned
study on the issue to the House and Senate Committees on Agriculture.
In response to biomedical research concerns, the conference report
does not include language eliminating Class B dealers.
The conference agreement also increases from $2,500 to $10,000
the maximum fine the USDA can levy for violations of the Animal
Welfare Act (AWA).
The White House had issued a May 13 statement
expressing disappointment in the cost of the farm bill package and
the President's intent to veto the bill. The overwhelming vote margins
in both chambers (318-106
and 81-15
in the House and Senate, respectively), however, are well over the
two-thirds majorities required to overturn a veto.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
On The Hill
Democrat Travis Childers (Miss.) defeated Republican challenger
Greg Davis in a May 13 special election for Mississippi's 1st district
House seat. Rep.-elect Childers will finish the term of former Rep.
Roger Wicker (R), who was appointed to succeed former Sen. Trent
Lott (R). The victory marks a third gain for Democrats as a result
of special elections in the 110th Congress.
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