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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Health Care Bill Stalls on House Floor

March 24, 2017—The House of Representatives March 24 pulled the American Health Care Act (AHCA, H.R. 1628) just ahead of the scheduled floor vote. The bill repeals significant portions of the Affordable Care Act (P.L. 111-148 and P.L. 111-152) and changes the Medicaid financing structure [see Washington Highlights, March 10].

The House was initially scheduled to vote on the bill on March 23, but House Republicans delayed the vote to make changes to the legislation in order to secure additional support from more conservative members. The House Rules Committee passed several manager’s amendments, including changes to:

  • Offer states the option to convert Medicaid for children and non-disabled adults to a block grant program;

  • Further restrict Medicaid expansion to only allow states that have already expanded Medicaid to receive enhanced federal funding for expansion adults through Dec. 31, 2019;

  • Give states the option to condition Medicaid eligibility on compliance with work requirements for certain adults;

  • Eliminate the ACA’s essential health benefits beginning in 2018 and allow states to set health plan benefit requirements; and

  • Accelerate many of the proposed legislation’s tax changes.

The Congressional Budget Office (CBO) March 23 released an updated score of the bill that reflected several of the manager’s amendments. According to the updated score, the AHCA is expected to reduce the deficit by $150 billion over 10 years. Prior scores had estimated a decrease of $337 billion over the same time period [see Washington Highlights, March 17]. The updated score was unchanged from original estimates that 24 million fewer individuals would have insurance under AHCA. 

The next steps for House Republicans and the AHCA are unclear at this time.


Len Marquez
Director, Government Relations
Telephone: 202-862-6281

Jason Kleinman
Sr. Program & Policy Specialist, Govt Relations
Telephone: 202-903-0806


AAMC Joins Hospital Associations in Requesting an Extension and Changes to NQF SDS Trial Period

March 24, 2017—The AAMC March 16 joined the American Hospital Association, America’s Essential Hospitals, and the Federation of American Hospitals in a letter to the National Quality Forum (NQF) expressing concerns with the NQF’s sociodemographic status (SDS) trial period. Under the trial, which is expected to end in April 2017, certain measures can be adjusted to account for patient economic and demographic factors. The associations emphasized ongoing concerns that SDS factors impact a provider’s ability to influence patient outcomes, including readmissions and cost.

The four associations urge a minimum one-year extension of the trial period in order to address problems with the overall process, citing:

  • The lack of clear oversight and consultation;

  • The flawed rollout of the trial period; and

  • Inaccurate and incomplete communications to members and stakeholders.

These concerns focus on the lack of direction for the multiple entities involved in the trial, inadequate time for measure developers to provide analyses and the insufficient data used to make these adjustments, and an overall lack of accurate and detailed information regarding the progress of the trial.

The hospital associations also include a series of recommendations to address these concerns and improve the overall SDS process. These recommendations include clearly defining the roles of each group participating in the trial, modifying the evaluation criteria to account for the findings in the recently released Office of the Assistant Secretary for Planning and Evaluation and the National Academy of Medicine’s reports, and improving communications to the public. Over the course of the two year trial, fewer than 10 measures have been adjusted for SDS.


Scott Wetzel, M.P.P.
Lead, Quality Reporting
Telephone: 202-828-0495


House VA Committee Examines Provider Recruitment

March 24, 2017—The House VA Health Subcommittee March 22 held a hearing titled Healthy Hiring: Enabling VA to Recruit and Retain Quality Providers. Witnesses included representatives from the Department of Veterans Affairs (VA), Government Accountability Office (GAO), and veterans service organizations. Much of the hearing focused on the retirement of VA physicians and pay disparity as barriers to effective recruitment. Several members of Congress requested the VA provide the nationwide physician vacancy data, including a breakdown by region and specialty.

In testimony, Robert Goldenkoff, director, Strategic Issues, GAO, discussed VA’s broad health mission from primary care to specialized services and said, “VHA is also a leader in medical research and the largest provider of health care training in the United States.”

Max Stier, president, Partnership for Public Service, cited AAMC’s 2016 physician workforce projections, noting, “The VHA contends for talent in a highly competitive labor pool for medical professionals that already faces serious shortages, with predictions of a shortfall of between 60,000 and 90,000 physicians by 2025.”

Louis J. Celli, Jr., director, National Veterans Affairs And Rehabilitation Division, The American Legion, raised the challenges of rural recruitment. He noted, “Some clinicians prefer to practice in more urban settings with more research opportunities and quality of life that urban settings provide.”  He also highlighted the role of VA’s academic affiliates, “For almost sixty years, in accordance with VA`s 1946 Policy Memorandum No. 2, the VA has worked in partnership with this country`s medical and associated health profession schools to provide high quality health care to America`s veterans and to train new health professionals to meet the patient health care needs within VA and the nation. This partnership has grown into the most comprehensive academic health system partnership in American history.”

Rep. Mark Takano (D-Calif.) noted that the federal hiring freeze would affect administrative support for the VA’s Graduate Medical Education (GME) enhancement initiative, expressing concern that the VA had only awarded 300 of 1,500 authorized new GME positions. He continued to question the VA about their efforts to recruit foreign nationals and the impact of immigration executive orders.

The House of Representatives March 17 passed a bill introduced by Rep. Brad Wenstrup, DPM, (R-Ohio), who chairs the health subcommittee, to improve VA’s authority to hire and retain physicians (H.R. 1367) [see Washington Highlights, March 10].

Meanwhile, Rep. Beto O’Rourke (D-Texas) March 10 introduced a bill titled VA Health Care Provider Education Debt Relief Act (H.R. 1506), which would increase the VA’s Education Debt Reduction Program (EDRP) from $120,000 to $150,000 over five years per participating physician.


Matthew Shick, JD
Director, Gov't Relations & Regulatory Affairs
Telephone: 202-862-6116


On the Agenda

March 28: National Institutes of Health Advisory Committee to the Director Meeting
3:00 p.m.; National Institutes of Health, Building 1, One Center Drive, Bethesda, MD
The Advisory Committee to the Director of National Institutes of Health will host a meeting to discuss the HeLa working group report and review the Institute and Center work plans related to the 21st Century Cures Act.


March 28: House Energy & Commerce Subcommittee Hearing on Medical Device User Fees
10:15a.m.; 2123 Rayburn House Office Building, Washington, D.C.
The House Energy and Commerce Health Subcommittee will hold a hearing entitled "Examining FDA's Medical Device User Fee Program."


March 29: House Oversight & Government Reform Committee Hearing on Cancer Research
9:30 a.m.; 2154 Rayburn House Office Building, Washington, D.C.
The House Oversight and Government Reform Committee will hold a full committee hearing on "Federally Funded Cancer Research: Coordination and Innovation."


March 29: House Appropriations Subcommittee Hearing on HHS Budget

10 a.m.; 2358-C Rayburn House Office Building, Washington, D.C.
The House Appropriations Labor, Health and Human Services, Education, and Related Agencies Subcommittee will hold a hearing on the Department of Health and Human Services. Secretary Tom Price is expected to testify.


March 29: Senate Special Aging Committee Hearing on Alzheimer’s Prevention/Care
2:30 p.m.; 106 Dirksen Senate Office Building, Washington, D.C.
The Senate Special Aging Committee will hold a hearing on "The Arch of Alzheimer's: From Preventing Cognitive Decline in Americans to Assuring Quality Care for those Living with the Disease."

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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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Jason Kleinman
Sr. Program & Policy Specialist, Govt Relations
Telephone: 202-903-0806