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Senate Appropriations Committee Postpones Labor-HHS Markup, Approves FY 2020 Allocations

September 13, 2019--The Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) Sept. 10 postponed the scheduled markup of its fiscal year (FY) 2020 spending bill. The full Appropriations Committee Sept. 12 approved 302(b) allocations for all 12 appropriations subcommittees for fiscal year (FY) 2020 by a party line vote of 16-15.

The Senate-approved spending level for the for the FY 2020 Labor-HHS spending bill, which funds the National Institutes of Health (NIH), Health Resources and Services Administration, and other health programs, includes $178.3 billion in budget authority which reflects a $200 million (0.1%) increase over comparable FY 2019 levels. The Senate-approved levels include an additional $9.4 billion from Changes in Mandatory Programs (CHIMPs) for a total of $187.7 billion for FY 2020, a $2.2 billion (1%) increase over comparable FY 2019 levels. The House Appropriations Committee May 8 passed its FY 2020 302(b) allocations, including a total of $202.2 billion with CHIMPs, a $16.7 billion (9.0 %) increase over comparable FY 2019 levels [see Washington Highlights, May 10].

The committee Sept. 12 also approved the Department of Defense and Energy and Water FY 2020 spending bills. The Labor-HHS subcommittee postponed the originally scheduled Sept. 10 markup of the FY 2020 Labor-HHS spending bill preventing its inclusion in the Sept. 12 full committee meeting. Press reports Sept. 9 indicated a $3 billion increase for the NIH over FY 2019 levels in the Senate bill, though no materials have officially been released by the Senate Appropriations Committee to confirm this funding level.

Committee Chair Richard Shelby (R-Ala.) shared during the Sept. 12 business meeting that disagreements about an amendment to address family planning funds provided by the Title X program contributed to the postponement. Sen. Shelby stated, “Unfortunately, the threat of poison pill amendments delayed [the bill’s] consideration because they would have prevented Senate passage and drawn the President’s veto … Such poison pills are expressly prohibited by the terms of the budget deal,” formally the Bipartisan Budget Act of 2019 (P.L. 116-37), which Congress passed Aug. 1 [see Washington Highlights, Aug. 2]. No new date has been established for the Labor-HHS subcommittee markup.

Congress needs to come to an agreement on spending bills by Sept. 30 or agree on a continuing resolution to keep agencies funded into the start of the new fiscal year on Oct. 1. The House of Representatives has passed 10 of its 12 FY 2020 spending bills.

Contact:

Christa Wagner, PhD
Senior Legislative Analyst
Telephone: 202-828-0595
Email: chwagner@aamc.org

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AAMC Asks Court to Issue Preliminary Injunction, Prevent Public Charge Rule from Going into Effect

September 13, 2019--The AAMC joined with five other hospital associations Sept. 11 in an amicus brief filed in California in support of the request by the City and County of San Francisco and County of Santa Clara to issue a preliminary injunction to stop implementation of the Public Charge Rule [see Washington Highlights, Aug. 14]. The rule makes significant changes to the standards by which legal immigrants will be considered “public charges” and may be subject to deportation.

While the Department of Homeland Security, which issued the rule, says that it supports a policy of self-sufficiency, the brief shows that this is not the case. The rule will have a “chilling effect” as legal immigrants and their children decide not to use public benefits to which they are legally entitled for fear that this may lead to deportation. Immigrants who are entitled to Medicaid will likely forgo enrollment, thus not receiving preventive care and meaning that they will be sicker when they finally seek care. These individuals also will experience increased rates of poverty and housing instability and see impaired development of their children. The brief notes, “These harms to health constitute precisely the kind of irreparable harm warranting a preliminary injunction.”

The harm also extends to hospitals that will be faced with treating sicker patients for whom there will be no compensation for the care provided. This financial harm will reduce the resources that hospitals need to serve their patients and communities.

Contact:

Ivy Baer, J.D., M.P.H.
Senior Director and Regulatory Counsel
Telephone: 202-828-0499
Email: ibaer@aamc.org

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AAMC Responds to Bipartisan Policy Center Rural Health Comment Solicitation

September 13, 2019--The AAMC submitted comments in response to the Bipartisan Policy Center’s (BPC) Rural Health Task Force request for comment on rural workforce, graduate medical education (GME), and solutions on barriers and opportunities for rural participation in new delivery models.

Regarding GME, the AAMC supports efforts to promote rural health training opportunities for both medical students and residents. Currently, urban hospitals can partner with rural hospitals and nonhospital settings to form Rural Training Tracks (RTTs). However, RTTs are currently limited to primary care residents. Congress should expand RTTs to include other specialties in order to promote training in rural areas. Furthermore, rural hospitals should be able to increase their full-time equivalent resident cap in order to accommodate more residents.

Some medical schools are also working to identify students who may be interested in practicing in rural areas by allowing students to experience unique opportunities in rural and underserved communities as part of their curriculum. Medical schools should be encouraged to partner with rural and underserved communities in order to expose students to these unique care settings.

Regarding rural participation in new payment and delivery models, rural providers face unique challenges in adopting new delivery models. Success or failure in many of these models depends upon a variety of factors, including timely access to care, the number of patients treated as part of the bundle, and a facility’s infrastructure. In addition, rural providers are often operating on leaner budgets and treating a population with higher prevalence of chronic conditions. Due to these considerations and other challenges faced by rural communities in providing health care to their residents, participation in new delivery models may be difficult for rural communities.   

Contact:

Mary Mullaney
Director, Hospital Payment Policies
Telephone: 202-909-2084
Email: mmullaney@aamc.org

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AAMC Joins Letter on Balancing Scientific Collaboration and National Security

September 13, 2019--The AAMC joined over 60 organizations on a Sept. 4 letter to the White House Office of Science and Technology Policy (OSTP) and federal research funding agencies stressing the importance of balancing “an openly collaborative scientific environment and protecting our economic and national security.”

In addition to OSTP, the letter was sent to research leadership at the Department of Energy, Department of Defense, National Institutes of Health, and National Science Foundation. It emphasizes the critical contributions of international scientists to the U.S. scientific enterprise and requests that the federal government solicit input from the science and engineering community when developing policies and requirements to address scientific integrity and security concerns. 

The issue of undue foreign influence at U.S. research institutions has been an increasing area of focus for federal science agencies over the past several years. The AAMC is developing a set of issue briefs on this topic, and the first two communications focused on NIH policy and the broader federal response are now available.

Contact:

Anurupa Dev, Ph.D.
Lead Specialist, Science Policy
Telephone: 202-862-6048
Email: adev@aamc.org

Stephen Heinig
Director, Science Policy
Telephone: 202-828-0488
Email: sheinig@aamc.org

Heather Pierce, JD, MPH
Sr. Director, Science Policy & Regulatory Counsel
Telephone: 202-478-9926
Email: hpierce@aamc.org

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Immigration and Health Organizations Urge USCIS to Restore Medical Deferred Action

September 13, 2019--The AAMC Sept. 4 joined over 150 organizations in a letter calling for the U.S. Citizenship and Immigration Services (USCIS) to reverse in full its policy shift under which the agency ended its acceptance and adjudication of nonmilitary deferred action requests at field offices, including medical deferment.

USCIS Aug. 7 announced they are no longer adjudicating requests for nonmilitary "deferred action," a form of temporary relief from deportation for immigrants facing special and often life-threatening circumstances. Reportedly, Immigration and Customs Enforcement (ICE) will assume the exclusive responsibility for deferred action requests, but no formal process to request assistance from ICE has been released.

The letter notes that “this change forces sick children and other vulnerable individuals to make an impossible choice—either: (1) remain in the shadows and opt not to seek life-saving relief; or (2) risk deportation—the very outcome they need relief from—by voluntarily placing themselves in deportation proceedings and seeking the deferred action determination of an enforcement agency.”

USCIS Sept. 3 announced they would reopen nonmilitary deferred action cases that were pending on Aug. 7, 2019, and would send letters reopening these cases. The community letter highlights, “While reopening of denied requests pending as of that date is necessary corrective action, it is wholly insufficient to prevent needless deportations and deaths” caused by this new policy.

Contact:

Matthew Shick, JD
Sr. Director, Gov't Relations & Regulatory Affairs
Telephone: 202-828-0525
Email: mshick@aamc.org

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House Energy and Commerce Subcommittee Discusses Maternal Mortality

September 13, 2019--The House Energy and Commerce Health Subcommittee convened witnesses at a Sept. 10 hearing to discuss current legislative proposals to address the rising number of maternal deaths in the United States. The four bills considered were the Mothers and Offspring Mortality and Morbidity Awareness Act (H.R. 1897), the Quality Care for Moms and Babies Act (H.R. 1551), the Maternal Care Access and Reducing Emergencies Act (H.R. 2902), and the Healthy MOMMIES Act (H.R. 2602).

Chair Anna Eshoo (D-Calif.) opened the hearing by noting that the United States is the most dangerous place to raise an infant of any developed nation. She expressed urgency at the nearly 700 women who die, and the nearly 50,000 who are severely injured every year as a result of pregnancy-related complications. Rep. Eshoo stated that this is unacceptable, and that a “high maternal death rate is a reflection of how society values women.”

Ranking Member Michael Burgess (R-Texas) concurred with Eshoo’s concern about maternal deaths, stating that, “Addressing maternal mortality is one of my top priorities.” Burgess also mentioned that there were several bipartisan bills from the 115th Congress that he believes Congress should consider.

Full Committee Chair Greg Walden (R-Ore.) agreed with Burgess but went further in expressing dismay at what he considered to be a partisan hearing. Walden stated that he was disappointed that the Subcommittee was not considering the Excellence in Maternal Health Act (H.R. 4215) which is a companion bill to the Senate Health, Education, Labor, and Pensions (HELP) Committee bill the Lower Health Care Costs Act (S. 1895) [see Washington Highlights, June 28].

Witness Wanda Irving told the story of her daughter who died three weeks after giving birth to her daughter after suffering several unexplainable health conditions. Irving urged the Subcommittee to ensure that they look not only at insurance coverage and financial resources of patients, but other systemic issues in health care. Irving stated that “sending folks to cultural sensitivity or implicit bias training is not going to fix the problem. We must demand the transformation of the health care systems in order to better respond to the needs and priorities of women, especially women of color.”

Elizabeth Howell, MD, MPP, director of Blavatnik Family Women’s Health Research Institute at the Icahn School of Medicine at Mount Sinai, noted that there is a growing recognition that social determinants of health contribute to increased rates of maternal mortality. She also discussed ongoing efforts at the national and state levels to, “address quality of care, standardize care, and improve outcomes for pregnant women” including perinatal quality collaboratives which, “are working to improve quality of care for mothers and babies.”

David Nelson, MD, chief of obstetrics at Parkland Health and Hospital System and assistant professor of Obstetrics and Gynecology at the Division of Maternal-Fetal Medicine at University of Texas Southwestern Medical Center, focused his testimony on highlighting specific efforts Parkland has taken as a “geographically based public health prenatal care program,” to ensure that mothers are adequately cared for by measuring quality data and understanding the areas of improvement. He discussed some of the best practices they have learned across 44 labor and delivery rooms, including a “debrief every time we use [emergency] protocols, to understand if there are opportunities to learn from nurses or physicians.” 

Usha Ranji, associate director of women's health policy at the Kaiser Family Foundation, used her opening statement to emphasize the need for extended Medicaid coverage for low-income mothers. Currently, there is no requirement that low-income women remain on Medicaid for more than 60 days postpartum, and in some states, a new mother can lose Medicaid coverage two months after giving birth. She emphasized that access to health coverage before, during, and after pregnancy promoted access to care, and that “for low-income women, Medicaid is comparable to private insurance in terms of many measures of access to care.”

Members of the Committee largely agreed that something needed to be done about the increasing rates of maternal death, with most Members focusing their questions on access to coverage and better training. Rep. Robin Kelly (D-Ill.), the lead sponsor of H.R. 1897, stated that, “Our laws can change the way care is delivered in our hospitals," and that laws, “can support the collection of consistent data on who dies on the way to motherhood, and why.”

Chair Eshoo closed the hearing by stating that the Subcommittee was “not going to rest until we have solid legislation that addresses this.”

Contact:

Allyson Perleoni
Senior Legislative Analyst
Telephone: 202-862-6042
Email: aperleoni@aamc.org

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NIH Releases Final Report Streamlining Requirements in Animal Research

September 13, 2019--The National Institutes of Health’s (NIH) Office of Laboratory Animal Welfare issued the final report of a multiagency working group, including the U.S. Department of Agriculture and the Food and Drug Administration, for reforming requirements in the care and use of animals in medical research.

The working group review was conducted in response to the 21st Century Cures Act (P.L. 114-255), which included provisions to address the various types of “regulatory burden” on medical researchers and institutions, including for the protection of animal welfare. Critically, the working group review, the Cures Act itself, and the communities providing input committed to sustaining current, high levels of protection for the welfare of animals used in research. Specifically, these stakeholders sought to remove duplicative or contradictory requirements, and streamline or “harmonize” regulations remaining in effect to remove any efforts that were not productive to the protections for research animals. 

The final report advances several changes to inspections, protocol review, and reporting requirements. The report also commits to improved coordination among agencies funding animal research. In comments on a draft version of the working group report, the AAMC commended the agencies’ diligence in the review, but expressed concern that the recommendations were not commensurate with the scope of reform called for by the 21st Century Cures Act [see Washington Highlights, Feb. 21, 2019]. The final report reflects the incremental changes proposed in the earlier draft, but nevertheless commits to important reforms that will be implemented, some through rulemaking, over the next year.

Contact:

Stephen Heinig
Director, Science Policy
Telephone: 202-828-0488
Email: sheinig@aamc.org

Anurupa Dev, Ph.D.
Lead Specialist, Science Policy
Telephone: 202-862-6048
Email: adev@aamc.org

Heather Pierce, JD, MPH
Sr. Director, Science Policy & Regulatory Counsel
Telephone: 202-478-9926
Email: hpierce@aamc.org

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AHRQ Report Shows Disparities Persist Despite Overall Improvements in Quality and Access

September 13, 2019--The Agency for Healthcare Research and Quality (AHRQ) Sept. 10 released the 2018 National Healthcare Quality and Disparities Report.

The 16th annual report tracks 250 health care process, outcome, and access measures and presents trends from 2000 to 2017 related to health care quality and care disparities. Since 2003, AHRQ has been congressionally mandated to report on progress and challenges to achieving health care equity in the United States.

According to the 2018 report, while almost all quality priority areas improved overall — for example, 70% of person-centered care measures and 60% of patient safety measures improved from 2000 to 2017 — few gains were seen in quality and access disparities. Specifically, for all quality measures with racial/ethnic disparities in the baseline year of 2000, only 6-10% had narrowed by 2017, with the overwhelming majority remaining unchanged. Blacks, American Indians/Alaska Natives, and Native Hawaiians/Pacific Islanders received worse care than whites for 40% of measures assessed, than Hispanics for 35%, and than Asians for 27%.

Contact:

Philip M. Alberti, PhD
Senior Director, Health Equity Research and Policy
Telephone: 202-828-0522
Email: palberti@aamc.org

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HHS Solicits Nominations for Secretary’s Advisory Committee on Human Research Protections Membership

September 13, 2019--The Department of Health and Human Services’ (HHS) Secretary’s Advisory Committee on Human Research Protections(SACHRP) Sep. 10 issued a notice seeking nominations for three candidates to be considered for appointment as voting members of SACHRP.

SACHRP is responsible for providing advice and recommendations to the HHS Secretary on matters related to “the responsible conduct of research involving human subjects with particular emphasis on special populations [e.g., children, pregnant women, prisoners, investigator conflict of interest].” The Committee is also responsible for the review of ongoing activities of the HHS Office for Human Research Protections(OHRP) and other offices or agencies within the Agency that oversee human subjects protection issues, such as the revisions to the Federal Policy for the Protection of Human Subjects also known as the “Common Rule.”

Nominations are being sought from candidates with diverse backgrounds, including public health, medicine, social sciences, and biomedical ethics. The information that must be included in the nomination application, including where to submit nominations, are included in the OHRP notice. Nominations must be submitted to SACHRP by Oct. 28, 2019.

Contact:

Daria C. Grayer, JD, MA
SA- Lead Specialist, Science Policy and Regulation
Telephone: 202-741-5474
Email: dgrayer@aamc.org

Heather Pierce, JD, MPH
Sr. Director, Science Policy & Regulatory Counsel
Telephone: 202-478-9926
Email: hpierce@aamc.org

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On the Agenda

Sept. 17: Senate Appropriations Subcommittee Markup of MilCon-VA Spending Bill
10:30 a.m., 124 Dirksen Senate Office Building
The Senate Appropriations Subcommittee on Military Construction and Veterans Affairs, and Related Agencies will hold a markup of its Fiscal Year (FY) 2020 Military Construction-VA appropriations bill.

Sept. 18: Joint Economic Committee Hearing on Gun Violence
2:15 p.m., 210 Cannon House Office Building
The Congressional Joint Economic Committee will hold a hearing titled, “Gun Violence in America: Understanding and Reducing the Costs of Firearm Injuries and Deaths.

Sept. 19: House Select Committee on the Modernization of Congress Hearing on the Budget and Appropriations Process
10:00 a.m., 2359 Rayburn House Office Building
The House Select Committee on the Modernization of Congress will hold a hearing titled, “Recommendations for Improving the Budget and Appropriations Process: A Look at the Work of the Joint Select Committee.”

Sept. 19: House Small Business Committee Hearing on SBA Programs
10:00 a.m., 2360 Rayburn House Office Building
The House Small Business Committee will hold a hearing titled, “SBA Programs Spurring Innovation.”

Sept. 19: House Higher Education Subcommittee Hearing on Loan Forgiveness
10:15 a.m., 2175 Rayburn House Office Building
The House Education and Labor Higher Education and Workforce Investment Subcommittee will hold a hearing titled, “Broken Promises: Examining the Failed Implementation of the Public Student Loan Forgiveness Program.”

Sept. 19: House Energy and Commerce Subcommittee Hearing on Pharmaceutical Companies
10:30 a.m., 2322 Rayburn House Office Building
The House Energy and Commerce Consumer Protection and Commerce Subcommittee will hold a hearing titled, “Profits Over Consumers: Exposing How Pharmaceutical Companies Game the System.”

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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.


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For More Information

Jason Kleinman
Senior Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org