Washington Highlights: February
6 , 2009
President Obama Signs Legislation to Expand CHIP
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President Obama Feb. 5 signed into law the "Children's Health
Insurance Program (CHIP) Reauthorization Act of 2009" (P.L.
111-3). The law reauthorizes CHIP through Sept. 30, 2013, and
increases current program funding levels by over $32 billion. The
costs are offset by increasing the excise tax rate on tobacco products.
The House Feb. 5 voted (290-135)
to adopt the Senate-passed CHIP package [see Washington
Highlights,
Jan. 30] which did not include the House-passed language establishing
a prospective prohibition on self-referrals to physician-owned hospitals.
The law will maintain CHIP coverage for the 6.7 million children
currently enrolled in program and expand health coverage to an estimated
4.1 million additional low-income, uninsured children. It requires
states to offer a dental benefit and allows states the option of
extending CHIP and Medicaid to newly arrived legal immigrant children
and pregnant women (i.e., eliminate the 5-year waiting period).
However, included in this law is a phase-out of coverage for non-pregnant
childless adults by Dec 31, 2009.
The law establishes a child enrollment contingency fund for states
to utilize if their enrollment levels exceed an average target number
determined by the Secretary. Additionally, the law creates a CHIP
performance bonus payment to offset additional enrollment costs
resulting from expanded enrollment and retention efforts. Under
the newly signed law, states have two years to spend CHIP allotments
made in FY 2009 and thereafter. It also establishes criteria and
a process for redistributing unused allotments to "shortfall
states;" the process applies to allotments made in FY 2007
and thereafter.
The new CHIP law also takes significant steps to strengthen pediatric
quality of care and health outcomes. It directs the Secretary to
develop by Jan. 1, 2010, an initial core set of child health quality
measures under Medicaid and CHIP. By Jan. 1, 2011, the Secretary
must establish a pediatric quality measures program to improve and
strengthen the initial core child quality measures. The Secretary,
in conjunction with the states, must also develop a voluntary quality
reporting system within two years of enactment. Additionally, the
Institute of Medicine (IOM) shall study and submit by July 1, 2010,
a report to Congress on the extent and quality of the aforementioned
efforts.
Upon signing the expanded CHIP bill into law President Obama said,
"This is only the first step. As I see it, providing coverage
to 11 million children through CHIP is a down payment on my commitment
to cover every single American."
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Senate Considers Economic Recovery Package
The full Senate Feb. 2 began consideration of its version of an
economic recovery package (S.AMDT.
98 to H.R.
1) that includes increased funding for the National Institutes
of Health (NIH) and other Public Health Service agencies, among
other items.
The Senate approved by voice vote an amendment supported by Labor-HHS-Education
Appropriations Subcommittee Chair Tom Harkin (D-Iowa), Ranking Member
Arlen Specter (R-Pa.), and Majority Whip Dick Durbin (D-Ill.) to
add $6.5 billion to the funding provided in the bill for the NIH.
With the additional funding - which is to be distributed to NIH
Institutes and Centers for scientific research - the bill provides
$10 billion for NIH. The package also includes $400 million that
is to be transferred to NIH from the Agency for Healthcare Research
and Quality (AHRQ) for comparative effectiveness research [see Washington
Highlights,
Jan. 30].
The legislation includes a series of incentives for health information
technology adoption and implementation as well as additional health
information privacy provisions. Among the privacy provisions, the
package:
- Requires entities employing electronic health records to account
for disclosures of personal health information related to treatment,
payment, and health care operations;
- Suggests that the Secretary of Health and Human Services can
"narrow" the definition of "health care operations"
(currently defined under the HIPAA Privacy Rule);
- Limits certain "marketing" communications and excludes
fundraising from the definition of "health care operations,"
thereby requiring written consent from patients before protected
information can be used or disclosed for fundraising purposes;
and
- Grants state attorneys general the authority to bring a civil
action as a means of enforcing the HIPAA Privacy Rule.
As introduced, the Senate bill included language to reverse the
FY 2009 (50 percent) cut to Medicare's capital IME payments. The
provision would restore an estimated $175 million in funds for teaching
hospitals.
AAMC President and CEO Darrell G. Kirch, M.D., sent a Feb. 6 letter
supporting an amendment filed by Senators Amy Klobuchar (D-Minn.),
Orrin Hatch (R-Utah), Robert Bennett (R-Utah), and Herb Kohl (D-Wis.)
that would address one element of the privacy language. The amendment
would prevent the HHS Secretary from requiring data de-identification
or written consent for providers' quality assessment and improvement
activities under the HIPAA Privacy Rule's definition of health care
operations. The letter reiterates the AAMC's belief "that the
current definition and function of health care operations - crafted
to 'allow activities that are essential to quality health care to
occur unimpeded - maintains an appropriate balance between providers'
needs for appropriate use of protected health information and patients'
needs for privacy." As of press time, the Senate had not yet
considered the amendment.
As of press time, a bipartisan group of Senators was working on
a proposal to cut the overall price tag of the legislation by reducing
a number of spending provisions. Majority Leader Harry Reid (D-Nev.)
has expressed his desire to have the Senate vote on final passage
on Feb. 6.
The House completed work on its version of the economic recovery
legislation (H.R.
1) Jan. 28 [see Washington
Highlights,
Jan. 30]. The Democratic leadership has stated its intent to
present a final, compromise bill to the President by the week of
Feb. 16.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
AAMC Urges Increased Student Loan Limits in Economic
Stimulus
AAMC President and CEO Darrell G. Kirch, M.D., sent a Feb. 3 letter
to the Senate leadership urging them to consider increasing subsidized
Stafford loan limits for graduate and professional students. As
introduced, the Senate's "American Recovery and Reinvestment
Plan" does not include increased student loan limits.
The AAMC letter notes, "Whereas undergraduate subsidized Stafford
loan limits increased by $1,875 in 2007, the graduate and professional
limit has not increased in over a decade." Addressing concerns
that increased loan limits will increase student debt, the letter
continues, "Rather than taking on additional debt, this will
allow medical students to avoid less favorable private loans and
higher interest GradPLUS loans."
The House of Representatives Jan. 28 approved its version of an
economic recovery package (H.R.
1) that increases annual unsubsidized Stafford loan limits for
undergraduates by $2,000 [See Washington
Highlights, Jan. 30].
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
House VA Committee Holds Oversight Hearing with
Sec. Shinseki
The House Committee on Veterans Affairs Feb. 4 held an oversight
hearing
on the "State of the U.S. Department of Veterans Affairs."
Secretary of Veterans Affairs Eric K. Shinseki was the only witness.
In his opening statement Sec. Shinseki noted that he is "committed
to fulfilling President Obama’s vision for transforming the
Department of Veterans Affairs into a 21st Century organization."
In doing so, he noted that the VA must be "veteran-centric,"
"results-driven," and "forward looking."
Rep. Vic Snyder, M.D., (D-Ark.) stressed the importance of appropriate
and adequate funding for the VA research program. Dr. Snyder urged
the Secretary to be an advocate for medical research within the
VA system.
President Bush Sept. 30 signed the Consolidated Security Appropriations
Act (P.L.
110-329) providing $510 million for the VA research program
in FY 2009. For FY 2010, the Friends of VA Medical Care and Health
Research (FOVA) coalition
and the veterans service organizations' Independent
Budget recommend $575 million for VA research and
$142 million for VA research facilities. The AAMC is a member of
the FOVA executive committee.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
On the Hill...
President Obama Feb. 3 nominated Sen. Judd Gregg (R-N.H.) for Commerce
Secretary. New Hampshire Gov. John Lynch (D) Feb. 3 announced he
would appoint J. Bonnie Newman (R) to serve the remaining two years
of Sen. Gregg's term. Ms. Newman has held a number of high-profile
positions in higher education, including several posts at the University
of New Hampshire (including interim president) and executive dean
of Harvard's John F. Kennedy School of Government.
Former Sen. Tom Daschle Feb. 3 asked President Obama to withdraw
his nomination for Secretary of Health and Human Services (HHS)
following tax problems. President Obama Dec. 11 had announced Sen.
Daschle would serve as Secretary of HHS and director of a new White
House office of Health Care Reform.
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