Washington Highlights: February
5, 2010
President Releases
FY 2011 Budget
Contents
Prior Issues
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President Obama Feb. 1 released his FY 2011 budget. The $3.8 trillion
blueprint outlines the administration's fiscal policies and major
budgetary initiatives. The president proposes to freeze "non-security"
discretionary spending - i.e., appropriations for domestic programs
- for the next three years while increasing funding for priorities
such as research and education. For the Department of Health and
Human Services (HHS), the budget proposes $81.2 billion in discretionary
spending, an increase of $2.3 billion (2.9 percent).
The following budget items are of interest to medical schools and
teaching hospitals.
National Institutes of Health (NIH): The president proposes
$32.089 billion in discretionary budget authority, a $1 billion
(3.2 percent) increase over FY 2010. This includes $32.007 billion
through the Labor/HHS/Education appropriation bill and $82 million
for Superfund Research activities at the National Institute of Environmental
Health Sciences from the Interior appropriation.
At a Feb. 1 briefing on the president's budget, NIH Director Francis
Collins, M.D., Ph.D., reiterated the agency's new initiatives would
revolve around five priorities, including:
- applying "high throughput" technologies to understand
fundamental biology and disease;
- translating basic science into new and better treatments;
- putting science to work for the benefit of health care reform;
- encouraging greater focus on global health; and
- reinvigorating and empowering the biomedical research community,
including new scientists.
According to a summary prepared by NIH, the president's budget
would fund a total of 9,052 competing research project grants (RPGs),
a decrease of 199 RPGs from the estimated FY 2010 level. For noncompeting
continuation awards, the budget provides inflationary increases
of 2 percent. The average cost of competing RPGs also increases
by 2 percent over the FY 2010 level. Due to the receipt of Recovery
Act funds in FY 2009, NIH will temporarily suspend the NIH Director's
Bridge Award program in FY 2011. The budget also proposes $824.4
million for the Ruth L. Kirschstein National Research Service Awards,
a 6.0 percent increase over FY 2010, which will be directed to training
stipends. In addition, the budget includes a total of $500 million
for Clinical and Translational Science Awards (CTSA).
As in previous years, the president's budget proposes to reduce
the salary limit through a grant or other extramural mechanism from
NIH, the Agency for Healthcare Research and Quality, and the Substance
Abuse and Mental Health Services Administration to Executive Level
II ($179,700 in 2010). The current cap is at Executive Level I ($199,700
in 2010). AAMC, the Association of American Universities (AAU),
and the Association of Public and Land-grant Universities issued
a joint statement praising President Obama for the increased funding.
A summary of the FY 2011 President's Budget for NIH is available
on the NIH Web
site.
VA Medical and Prosthetic Research: The President's FY 2011
budget requests $590 million for VA research, a $9 million (1.5
percent) increase over the FY 2010 appropriation. For the first
time, the President's budget also requests $60.5 billion in advance
funding for FY 2012 VA medical care, a $2.4 billion (5 percent)
increase over the FY 2011 advance appropriations. Congress appropriated
$44.5 billion for VA medical care in FY 2010.
Health Professions: For Title VII health professions and
Title VIII nursing education programs, the budget requests $503.9
million, a $5.9 million (1.2 percent) increase over FY 2010. The
increase is designated for the Title VII workforce information and
analysis program, which is proposed at $8.8 million, a 210 percent
increase over FY 2010. The president recommends level funding for
all other Title VII and Title VIII programs.
National Health Service Corps (NHSC): For the NHSC, the
budget proposes $169 million, a $27 million (19 percent) increase
over FY 2010.
Agency for Healthcare Research and Quality (AHRQ): The budget
boosts funding for AHRQ to $611 million in FY 2011, a $214 million
(53.9 percent) increase over FY 2010. Within the total, the budget
increases funding for "Patient-Centered Health Research"
to $273 million, but cuts funding for Patient Safety Research and
Crosscutting Activities.
Children's Graduate Medical Education (GME): The president
proposes $318 million for the Children's program, the same funding
level as FY 2010.
Office of the National Coordinator for Health Information Technology
(ONC): The budget requests $78 million for the ONC, a $17 million
(40.4 percent) increase over FY 2010. The president proposes the
funding level entirely through budget authority, unlike FY 2010,
when $19 million was provided through Public Health Service Evaluation
funds. Additionally, the budget materials cite $2 billion provided
to ONC through the American Recovery and Reinvestment Act (ARRA,
P.L. 111-5), as well as funds throughout HHS, as additional resources
to help promote health information technology (HIT). Other HIT funding
throughout HHS includes: $32 million within AHRQ for the use of
HIT to enhance patient safety, $1 million in the Office of the Assistant
Secretary for Planning and Evaluation for evaluation of EHR adoption,
$1.6 million in the Office of Civil Rights for regional privacy
advisors, and resources within the request for the Centers for Medicare
and Medicaid Services to conduct the third year of a demonstration
project to promote EHR adoption among small physician practices.
Emergency Preparedness: The budget requests $1.1 billion
through the Public Health and Social Service Emergency Fund for
the Office of the Assistant Secretary for Preparedness and Response
(ASPR), an increase of $162 million (14.7 percent) over FY 2010,
to help achieve a previously announced initiative to "review
the public health countermeasures enterprise." Within the ASPR
total, the budget requests $476 million from the BioShield Special
Reserve Fund to fund the Biomedical Advanced Research and Development
Authority (BARDA), including management costs associated with Project
BioShield. The budget also "will permit the Secretary to make
additional BioShield funds available for advanced research and development
activities after notification of Congress" to "enable
BARDA to target resources to the most promising countermeasure candidates
whether through advanced development or through acquisition using
Project BioShield." The budget also proposes $426 million for
hospital preparedness cooperative agreements, as provided in FY
2010.
Additional HHS budget materials, including the Budget in Brief
and links to individual agency budget justifications, are available
on the HHS Web
site.
Department of Education: Similar to the FY 2010 budget,
the president's budget for FY 2011 proposes to eliminate the Federal
Family Education Loan (FFEL) program and originate all new Stafford
loans under the Direct Loan program beginning July 1, 2011. The
budget also proposes to increase to $6 billion the total annual
loan amounts available under the Perkins Loan program from its current
$1 billion. However, this proposal would also eliminate the in-school
interest subsidy on these loans. The President's budget reiterates
the President's support for enacting the Student Aid and Fiscal
Responsibility Act (H.R.3221), which includes the President's legislative
proposals. The House passed H.R. 3221 on Sept. 17, 2009, and the
bill is expected to be part of a budget reconciliation package.
The budget also proposes to reduce the repayment formula of the
Income-Based Repayment (IBR) program from 15 percent of adjusted
gross income to 10 percent, as well as reducing the maximum loan
repayment duration from 25 years to 20 years before forgiveness.
Additional materials on the budget for the Department of Education
are available on the Department's Web
site.
Centers for Disease Control (CDC): The president's budget
recommends $6.34 billion in funding for the CDC, a reduction of
$125 million (1.9 percent) bellow the FY 2010 enacted levels. The
majority of the reductions in funding are seen in cuts to administrative
functions, such as decreases in travel and reductions in advisory
and assistance service contracts, while most programmatic funding
levels are maintained at or above FY 2010 enacted levels. Programs
that are subject to reductions in funding include vector-borne activities,
including West-Nile Virus, congressionally-directed projects, and
blood disorders, among others. The CDC will also receive a $225
million transfer from the Public Health and Social Services Emergency
Fund to offset reduced budget authority for pandemic flu and for
a portion of the Strategic National Stockpile activities.
National Science Foundation (NSF): The president's budget
requests $7.42 billion for NSF, $551 million (8 percent) above the
FY 2010 enacted level. The request also includes $6.02 billion for
research and related activities, a $455 million (8.2 percent) increase
over FY 2010.
The full budget request is available at the White House's Web
site.
Contact:
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
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Shannon Curtis, Legislative Analyst
AAMC Government Relations
scurtis@aamc.org
(202) 828-0558
President's Budget Assumes Creation of Fiscal
Commission
The president's FY 2011 budget
assumes creation of a bipartisan Fiscal Commission. The commission
will be charged with recommending cost-cutting measures across the
federal government, including Medicare and Medicaid, and to return
the nation "to a sustainable fiscal path."
In a Jan. 28 letter
to Senate Budget Committee Chair Kent Conrad (D-N.D.), Vice President
Joseph Biden confirms an agreement between himself, Senate Majority
Leader Harry Reid (D-Nev.), and House Speaker Nancy Pelosi (D-Calif.)
for "congressional consideration of the Fiscal Commission's
recommendations." Under the agreement, Majority Leader Reid
commits to consider commission recommendations on the Senate floor.
If the recommendations pass the Senate, Speaker Pelosi commits to
bringing the measure for a House vote.
Contact:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Senate Democrats Plan to Introduce FMAP Extension
Legislation
Senate Majority Leader Harry Reid (D-Nev.) and Sen. Jay Rockefeller
(D-W.V.) Feb. 3 announced plans to introduce legislation extending
by six months the increase in the Federal Medical Assistance Percentage
(FMAP) that states currently receive under the American Recovery
and Reinvestment Act (ARRA). The FMAP increase under ARRA is set
to expire at the end of 2010 [see Washington
Highlights,
Feb. 13, 2009]. The House Dec. 16 passed (217-212)
H.R.
2847, which includes a six-month extension to increased FMAP
funding.
In a press
release, Sen. Rockefeller said "We absolutely need this
six months of relief while we weather this economic storm-too many
families depend on this program for us to allow a shortfall of funding."
Contact:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Senate, House Committees Hold Hearing on President's
Fiscal Year 2011 Health Care Proposals
The Senate Finance Committee on Feb.
3 and the House Energy and Commerce Committee on Feb.
4 held hearings with Department of Health and Human Services
(HHS) Secretary Kathleen Sebelius to discuss President Obama's FY
2011 health care budget proposal. Sec. Sebelius stood by President
Obama's proposal stating that her budget priorities included, "fighting
waste and fraud," "quality and access to health care,"
"public health security," and "economic security."
Sec. Sebelius also stressed
the administration's commitment to "put science first"
and to ensure that "the investments we're making are guided
by the best scientists and medical experts in the world."
During the Senate Finance hearing, Senator Debbie Stabenow (D-Mich.)
reiterated the importance of Graduate Medical Education (GME), its
current lack of funding, and the need to increase residency slots.
In the Energy and Commerce hearing, Committee Chair Henry Waxman
(D-Calif.) expressed
the need to permanently reform the Medicare physician payment system.
In response to both inquires, Sec. Sebelius expressed her commitment
to working with the House and Senate to resolve both issues.
Both Finance Committee Chair Max Baucus (D-Mont.) and Energy and
Commerce Chair Waxman explained the need to pass a comprehensive
health care reform bill to create jobs, support small business,
and strengthen the economy. Ranking Member Chuck Grassley (R-Iowa)
urged
caution in increasing spending and a greater emphasis placed on
curbing fraud and abuse.
Contact:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Shannon Curtis, Legislative Analyst
AAMC Government Relations
scurtis@aamc.org
(202) 828-0558
CMS holds listening session on 2011 Physician
Quality Reporting Initiative
The Centers for Medicare and Medicaid Services (CMS) Feb. 2 held
a listening session to seek feedback on potential changes to the
CMS Physician Quality Reporting Initiative (PQRI) for 2011. CMS
requested comments on which measures to include for the 2011 program
as well as suggested changes to the design of the program, such
as reporting mechanisms, reporting periods, criteria for satisfactory
reporting and group practice reporting option.
In the public comment period, several specialty societies noted
frustration with the process and time to get measures endorsed.
(Of the 146 measures submitted to CMS for 2011 PQRI, 109 are not
currently endorsed.) Several commenters also mentioned that the
current 80 percent reporting threshold for successfully reporting
individual measures through claims data is difficult to achieve,
particularly because professionals cannot resubmit submit claims
to correct PQRI data submissions.
CMS did not address how PQRI might interact with the HITECH act,
which requires quality reporting as one requirement for eligible
professionals to receive funding for adopting certified electronic
health record technology.
CMS will be accepting comments through Feb. 12 at PQRITEMP@cms.hhs.gov.
Copies of the meeting agenda, slides, and the background paper can
be downloaded from the PQRI Web
site.
Contact:
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
On the Hill…
Rep. Steve Buyer (R-Ind.) Jan. 29 announced he would not seek re-election
in November to focus his attention on his ill wife. Rep. Buyer has
served in the House for 18 years and currently sits on the Energy
and Commerce Committee and is Ranking Member of the Committee on
Veterans Affairs.
Sen. Scott Brown (R-Mass.) was sworn in Feb. 4, assuming the seat
held for almost half a century by the late Sen. Edward Kennedy.
Sen. Brown represents the 41st Republican vote in the Senate, ending
the Democrat's super majority.
On the Agenda in Washington
Feb. 8: National Advisory Council on Human Genome Research
8:30 a.m.; NIH Conference Center, 3635 Fishers Lane, Bethesda, MD
National Advisory Council for Human Genome Research will meet
to discuss matters of program relevance.
Meeting:
Feb. 10: House Science and Technology Committee Hearing on
FY 2011 Budget Request for Science and Technology Research and Development
10 a.m.; 2318 Rayburn House Office Building, Washington,
D.C.
House Science and Technology Committee will hold a hearing
on the fiscal 2011 budget request for science and technology research
and development programs and hear testimony from Office of Science
and Technology Policy Director John Holdren.
Feb. 10: House Veteran's Affairs Committee-Subcommittee on
Health Hearing on FY 2011 Budget Request for the Veteran's Health
Administration
2 p.m.; 334 Cannon House Office Building, Washington,
D.C.
Health Subcommittee of House Veterans' Affairs Committee will
hold a hearing
on the fiscal 2011 budget request for the Veterans Health Administration.
Hearing:
Feb. 10: National Biodefense Science Board Advisory Committee
Meeting
2 p.m.; Conference Call
National Biodefense Science Board will hold a conference call
meeting
to discuss and consider recommendations from the board's Medical
Countermeasure Markets and Sustainability Working Group report titled
"Inventory of Issues Constraining or Enabling Industry Involvement
in Medical Countermeasure Efforts." Dial-In Information: 866-395-4129;
pass-code "ASPR" Call 15 minutes prior to the beginning
of the conference call to facilitate attendance.
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