AAMC Reporter: January 2007

Congress Sets Out on Uncertain Path

As the 110th Congress was gaveled into session on Jan. 4, Democrats assumed the leadership of several key committees that oversee aspects of the nation's health care system.While many of these lawmakers have historically been proponents of health-related issues, it is unclear whether they will continue those efforts, given the current budget climate and following a flurry of activity at the close of the 109th congressional session.

"We still have a very large deficit," said David Moore, senior associate vice president of the AAMC's Office of Governmental Relations. "We still have national priorities, such as the war on terrorism and homeland security, which have to be sustained. And we still have a large number of competing domestic priorities, such as medical research, education, and veterans" health care, that must be funded."

Nevertheless, the AAMC is optimistic that progress is possible. "As a nation and as a community, it is time for serious discussions about reaffirming health care as a public good," said AAMC President Darrell G. Kirch, M.D. "Change is within our reach, but in order to effect change, we must be willing to have difficult conversations regarding our priorities and set aside partisan differences, both for ourselves and for future generations."

Following the midterm elections, Democrats now chair several committees responsible for legislation important to medical schools and teaching hospitals.

In the Senate, Max Baucus of Montana takes over the Finance Committee;West Virginia's Robert Byrd heads the Appropriations Committee; North Dakota's Kent Conrad chairs the Senate Budget Committee; and Massachusetts" Edward Kennedy assumes control of the Senate Health, Education, Labor and Pensions Committee. All four have strong commitments to various health care issues.

In the House of Representatives, the new chairs include John Spratt (D-S.C.), House Budget Committee; David Obey (D-Wis.), House Appropriations Committee; John Dingell (D-Mich.), House Energy and Commerce Committee, which oversees legislation concerning the National Institutes of Health (NIH) and Medicaid; Charles Rangel (D-N.Y.), House Ways and Means Committee; and George Miller (D-Calif.), Education and Workforce Committee. Each has also called health care a priority.

But the Democratic leadership has a long list of other priorities—including security, immigration and ethics reform, and increasing the minimum wage.

To date, Democratic leaders have established only two specific health care policy goals—federal funding for stem cell research and allowing the government to negotiate lower Medicare prescription drug prices. According to news reports, the White House has indicated President Bush would veto the prescription drug legislation and has not publicly acknowledged any shift in thinking on stem cells. In 2005, Bush vetoed legislation authorizing federal funding for embryonic stem cell research—the only veto of his presidency.

On ethics reform, one issue that may have bipartisan support is creating more transparency for individual spending items or "earmarks" that are attached to bills and often help a specific company or project in a lawmaker's district. Congressional leaders seem to support measures requiring lawmakers to attach their names to such items. In mid-December, Byrd and Obey announced a "moratorium" on all earmarks contained in fiscal year 2007 spending bills that have not yet been approved. Proposed fiscal year 2007 earmarks will be eligible for consideration in 2008 after new standards for earmark transparency and accountability have been established, Byrd and Obey said.

The fate of other federal policies and programs, such as the Health Resources and Services Administration's Title VII health professions programs, which receive virtually no money in the president's proposed fiscal year 2007 budget, remains uncertain. This is largely because, as of mid-December, only two of 11 fiscal 2007 budget appropriations bills—defense and homeland security— had become law. Byrd and Obey said they plan to enact a continuing budget resolution for all of fiscal year 2007, which will keep the remaining unapproved appropriations bills funded at 2006 levels.

The future of the 110th Congress follows the final days of the post-election 109th or "lame duck" session, which took action on several issues important to academic medicine.

One (H.R. 6164) reauthorizes the National Institutes of Health (NIH). The agency's budget has not kept pace with inflation since 2003, causing program cutbacks and diminished support for new and established researchers and projects. In December, however, Congress passed the NIH Reform Act of 2006, which recommends NIH funding increase 7 percent in fiscal year 2007 and 8 percent in fiscal year 2008.

Congress also averted a 5 percent cut in 2007 Medicare physician payments, passing last-minute legislation (H.R. 6111) that sets calendar-year 2007 payments at 2006 levels and establishes "bonus payments" for quality reporting from July 1 to December 31. The legislation establishes long-term quality reporting requirements— which the AAMC will work on over the next year to assure they are favorable to providers. Additionally, the bill extends for one year a 1 percent floor for the workrelated Geographic Practice Cost Index, and it temporarily prevents possible regulatory action to cut the maximum allowable Medicaid provider tax rate.

Also, Congress passed legislation to address 2007 shortfalls in State Children Health Insurance Program (SCHIP) funding. It will redirect certain unspent allotments to states that most need them. SCHIP funding will remain an issue during the 110th Congress since the program must be reauthorized next year.

—By Scott Harris

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