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Congressional Report: Congress Has Some Unfinished Business as New Term Begins AAMC Efforts Help Roll Back CMS Paperwork Requirements Innovations in Medical Education: Doctors-in-Training Learn How to Tell Stories Healing Deep Wounds: Program at Bellevue / NYU Provides Care for Torture Survivors Nursing Shortage Prompts Creative Solutions Author Q&A: 'Sometimes Wrong, Never in Doubt' 'Flagging' Debate Continues; Data Show Score Fluctuations A Word from the President "A Day in the Life of a Medical Student"
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A Word From the President:Learning New Plays for an Old Game
During that meeting, congressional leaders agreed to limit discretionary spending for FY 2003 - i.e., the money available for the entire appropriations process - to the amount the President had outlined in his budget proposal last February: $750 billion. Why did this acquiescence to Bush's budgetary demands constitute such a dramatic change? Because the budget endgame in recent years has always had sufficient wiggle room to enable us to argue successfully for the last-minute influx of additional funds to support programs of vital interest to our community. The new rules of engagement may well mean that no "pot of gold" will be there at the end of the budget rainbow this time. This new fiscal discipline, fueled by the return of triple-digit budget deficits and coupled with increasing demands for federal dollars for defense and homeland security, raises several troubling questions for aca-demic medicine as we face the new year with a new Congress. Since almost half of the amount set aside for discretionary spending has already been appropriated to defense-related bills, a mere $385 billion is left for all non-defense spending - $10 billion less than the original figure approved by the Senate Appropriations Committee prior to the election. As matters stand, the Labor-Health and Human Services bill could lose approximately $2.8 billion from the funding approved by the Senate in July. Congress and the administration have pledged to complete the doubling of the NIH budget in FY 2003, and support for doing so has remained strong. But considering the new fiscal austerity, the question is: can the doubling be accomplished without inflicting damage on other critical healthcare-related programs? Looking at President Bush's FY 2003 budget proposal, the answer is clearly, no! Among other gloomy recommendations, the president's budget envisions dramatic cuts in funding for the health professions, the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Disease Control and Prevention (CDC). Further complicating this scenario, competition for federal dollars in the next fiscal year; i.e., FY 2004, likely will be intense. Early indications are that the administration may propose an increase of less than 1 percent for the NIH after completing its five-year doubling effort. So much for a "soft landing"! What does this new fiscal austerity mean for the prospects of payment relief for teaching hospitals and physicians? As many of you know, despite our intense advocacy efforts, the 107th Congress failed to reverse already enacted Medicare payment reductions for teaching hospitals and physicians. Last October, Medicare Indirect Medical Education (IME) payments to teaching hospitals were reduced by 15 percent, further stressing institutions that are already running on budgets averaging barely 1.5 percentage points above a deficit. To make matters worse, teaching hospitals are now grappling with diminishing state Medicaid payments, with shortages of nurses and other healthcare workers and, in this post-9/11 world, with the need to prepare for the truly unpredictable. Unless Congress acts to provide IME relief, typical teaching hospitals will lose, on average, $789,000 per year, while major teaching hospitals could lose $2 million annually. Despite intense pressure from the healthcare community, Congress also failed to provide payment relief for physicians, which is another high priority of the AAMC. The AAMC will continue to press for a comprehensive Medicare package that will benefit all providers, in the not unreasonable hope that the issue of broader Medicare relief will remain alive. Much of the funding picture for academic medicine is unclear. What is painfully apparent, however, is that the game has changed. Referring to the president's enhanced role in the budget negotiations, White House spokesperson Ari Fleischer recently noted: "There's a new sheriff in town, and he's dedicated to fiscal discipline." As the nation faces significant economic and national security challenges, we must ensure that Congress and the White House work to strengthen, not weaken, our national healthcare structure. All of us will need to redouble our efforts in the coming months to guarantee that teaching hospitals receive the support they need to carry on their basic missions, and to ensure that the federal government continues to supply enough funding for crucial public health programs. Just because the rules have changed doesn't mean the game is lost. But it does mean our team had better learn some new plays.
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Contact Us © 1995-2008 AAMC Terms and Conditions Privacy Statement |
Shortly
after the election in November, a meeting took place at the White
House between key Republican leaders from Capitol Hill and President
Bush. The event gained little attention outside of Washington but
captured everyone's attention here, seeing as how it suddenly and
dramatically changed the rules of engagement for the war games over
the federal budget.