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A Word From the President: Bracing for the Next Wave on Capitol Hill

AAMC Reporter: September 2013

The calm of Congress’ August recess is now a distant memory here in Washington. The Hill is back in full swing as the partisan rhetoric heats up and political posturing begins in advance of next year’s midterm elections. Although Congress has focused much of its attention on the recent events in Syria, lawmakers also face a daunting agenda of budget issues. Already, it is evident that the academic medicine community will have to fight some difficult battles in the weeks and months ahead to sustain federal funding for physician training and medical research as lawmakers look for ways to right our nation’s fiscal ship. While nothing is certain, there are several factors in play that we can anticipate having to confront.

First comes the appropriations hurdle. Because Congress has been unable to finish its work on any of the 12 annual spending bills, we once again are faced with starting the new fiscal year under a continuing resolution. An initial proposal to fund the federal government at slightly less than current levels through Dec. 15 had to be pulled from the House schedule over the issue of funding for the Affordable Care Act.

The second factor is the issue of the debt ceiling, which we are on track to hit by mid-October. We already are seeing that some lawmakers want to use the debt ceiling as a leverage point and will agree to raise it if, and only if, reforms are made to mandatory spending programs such as Medicare and Medicaid in order to decrease the deficit. The White House, on the other hand, has vowed not to let the debt ceiling become a bargaining chip. Only time will tell how this standoff will be resolved.

The third factor is the need to address Medicare physician payment reform and repeal of the sustainable growth rate (SGR) formula. The cost to simply repeal the SGR and freeze physician payments for 10 years is nearly $140 billion. Although there have been signs of progress this year, a long-term SGR “doc fix” would still appear to be challenging at a time when the focus is on reducing spending.

All of this will take place against the backdrop of the continuing sequester. Unless an alternate deficit reduction agreement is reached—something even optimists do not deem likely—there will be approximately $109 billion in cuts to federal spending in FY 2014 through sequestration.

When so many fiscal issues and political dynamics combine, the effect of cuts to individual programs can get lost in the fray. To this end, we must seize every opportunity to talk about the specific impact that current and potential cuts to medical research and graduate medical education (GME) could have on our institutions and, more important, about the impact on our patients.

Working in our favor for GME advocacy is increased media focus on the physician shortage. With 32 million Americans poised to gain coverage next year through implementation of the Affordable Care Act, it is more important than ever to lift the cap placed on residency training positions in 1997. A number of op-eds have run in newspapers across the country to explain that the physician shortage is not an abstract concept, but a real phenomenon that harms patients’ access to care.

Many of you made good use of the congressional recess to speak with lawmakers about the importance of increasing GME funding to help reduce the coming doctor shortage. If you have not already, please thank your senators and representatives who supported GME expansion legislation in the House and Senate. If your lawmakers have not already done so, we ask that you continue to urge your representatives to co-sponsor the Training Tomorrow’s Doctors Today Act and the Resident Physician Shortage Reduction Act of 2013, and for your senators to co-sponsor the Senate’s version, the Resident Physician Shortage Reduction Act of 2013.

We also must work to ensure that lawmakers do not attempt to pay for the SGR doc fix by taking funding from physician training. Instead, we should ask lawmakers to use physician payment reform as an opportunity to increase, not gut, our investment in GME.

On the research front, we are glad so many of you are talking to the media and policymakers about the effect that spending cuts to the National Institutes of Health will have on America’s well-being. An example is the high-profile Huffington Post story, “Sequestration Ushers in a Dark Age for Science in America,” which has made the rounds on social media and has surpassed 10,000 shares, likes, and tweets. The story showcases the devastating effects spending cuts are having on the discovery of lifesaving cures and treatments at many AAMC-member institutions.

While we must let lawmakers know about the danger sequestration poses to decades of investment in medical research, it also is important to tell the stories of the exciting discoveries and advances being made every day by your institutions so that the public and Congress recognize the return that comes from this investment. As part of our Research Means Hope campaign, the AAMC recently launched a new social media resource on Tumblr, medresearch.tumblr.com, that we hope will serve as a central, online repository of the latest advances in medical research at the nation’s medical schools and teaching hospitals. Currently, the site contains more than 300 discoveries submitted by your institutions, with more being uploaded daily. I encourage you to take a look and help us share the word about it. The content is searchable by state, institution, disease, and source of funding, making it a valuable resource for anyone who wants to see the progress that is being made—and that could be in jeopardy if federal budget cuts to medical research continue.

In these challenging and uncertain times, it is more important than ever to communicate the unique missions and value of the nation’s medical schools and teaching hospitals to our communities and our country. It is a great story to tell, but no one will tell it for us. It is up to each of us, and it is essential that we speak together, with one voice, to make sure our message does not get swept away in this next wave of political wrangling.