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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.

Congress Clears 7-Day Stopgap to Finalize FY 2017 Spending Bills

April 28, 2017—The House, 382-30, and Senate by unanimous consent voted April 28 to approve a short term continuing resolution (CR, H.J. Res. 99) that would give lawmakers until May 5 to complete negotiations on the remaining 11 fiscal year (FY) 2017 spending bills and avert a government shutdown.

The vote occurred one day after Senate Democrats blocked an effort to expedite consideration of the CR over concerns that a pending omnibus spending bill to resolve FY 2017 will include “poison pill riders.” House and Senate Democratic leaders had indicated previously that they only would support a short-term CR if an agreement to fund the remainder of FY 2017 was at hand.

Senate Majority Leader Chuck Schumer (D-N.Y.) indicated April 28 that he is “confident” that a group of bipartisan, bicameral negotiators are making progress in addressing remaining disagreements, allowing the stopgap to move forward.

Its fate was unclear earlier in the week, as Democrats pledged to vote against any omnibus spending packages that would include funding for the president’s proposed border security wall and would exclude funding for cost sharing reduction (CSR) payments. The CSRs provide subsidies to insurance plans offering coverage to low-income enrollees under the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152).

Tensions eased as the week went on, as the White House signaled that the president would be willing to sign an FY 2017 spending package that excludes the wall funding, and reports suggested that congressional leaders were negotiating other forms of enhanced border security funding.

The White House also informed Democrats that the administration will continue to pay the CSR subsidies without the appropriation. The announcement reversed earlier comments from the president that the administration would withhold the CSR payments to force Democrats to negotiate on ACA repeal. House Republicans also backed off earlier plans to schedule an April 28 vote on the latest iteration of the repeal bill, the American Health Care Act (AHCA, H.R. 1628) (see related story), which also threatened to derail the CR vote.

With the president’s expected signature, the CR will give Congress seven extra days to finalize the full FY 2017 spending package. The previous stopgap was scheduled to expire April 28, after House and Senate leaders opted in December 2016 to defer final spending decisions until the new administration took office [see Washington Highlights, Dec. 9, 2016]. As a result, most of the government, including the National Institutes of Health (NIH) and other agencies at the Department of Health and Human Services (HHS), temporarily have been operating at a rate of operations that is 0.1901 percent below FY 2016 levels.

Contact:

Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525
Email: trasouli@aamc.org

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House Republicans Revive Efforts to Pass American Health Care Act

April 28, 2017—April 28, 2017 – Rep. Tom MacArthur (R-N.J.) April 25 introduced an amendment to the American Health Care Act (AHCA, H.R. 1628), legislation that repeals significant portions of the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) and changes the Medicaid financing structure [see Washington Highlights, March 10]. Following an unsuccessful effort to pass the AHCA in March, the amendment is aimed at addressing concerns from various Republican groups, including the conservative House Freedom Caucus and the moderate Tuesday Group.

The amendment would allow states to apply for three different waivers:

  • First, states could apply to set a “higher” age ratio – it is unclear whether states would be permitted to set a ratio higher than the 3:1 provided for under the ACA or the 5:1 ratio provided for under the AHCA;

  • Second, states could apply to specify their own set of essential health benefits. This would include states determining the categories and specific benefits included within each category; and

  • Third, states could engage in their own health status underwriting under certain conditions.

These waivers are deemed automatically approved by the Department of Health and Human Services (HHS) unless, within 60 days, the HHS Secretary acts to disapprove the waiver. The amendment also prohibits gender underwriting and the exclusion of individuals with pre-existing conditions.

The House Freedom Caucus April 26 issued a statement in support of the AHCA as amended, stating in part, “The MacArthur amendment will grant states the ability to repeal cost driving aspects of Obamacare left in place under the original AHCA. While the revised version still does not fully repeal Obamacare, we are prepared to support it to keep our promise to the American people to lower healthcare costs. We look forward to working with our Senate colleagues to improve the bill. Our work will continue until we fully repeal Obamacare.”

It remains unclear if the Freedom Caucus endorsement provides the necessary votes to pass the underlying legislation. However, after reading about the amendment, Tuesday Group co-chair Rep. Charlie Dent (R-Pa.), stated, “Based on what I've read, it does not change my position. I was a no, and I remain a no.”

House Democrats remain unified in opposition to the AHCA and the MacArthur amendment. In an April 26 statement about the legislation, House Minority Whip Steny Hoyer (D-Md.) noted, “This latest change would still allow discrimination against Americans with pre-existing conditions, making it substantially the same bill that House Republican leaders could not secure the votes to pass last month...Bringing their catastrophic bill back, repackaged but unchanged, will not make it any more likely to pass; nor will it make it any less dangerous to the health of the American people.”

There is currently no vote scheduled on the amendment. Several members have stated they will not vote on it until the Congressional Budget Office releases an updated cost and impact analysis.

Contact:

Len Marquez
Director, Government Relations
Telephone: 202-862-6281
Email: lmarquez@aamc.org

Catherine Spivey
Sr. Legislative Analyst
Telephone: 202-862-6042
Email: cspivey@aamc.org

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Bipartisan House Letter to Appropriations Committee Advocates AHRQ Funding

April 28, 2017—A group of 43 members of the House of Representatives joined together on a letter to the House Appropriations Committee in support of funding for the Agency for Healthcare Research and Quality (AHRQ).

The letter, championed by Rep. Donald S. Beyer, Jr. (D-Va.), asks House Appropriations Labor, Health and Human Services, and Education Subcommittee Chair Tom Cole (R-Okla.) and Ranking Member Rosa DeLauro (D-Conn.) for $364 million for AHRQ in fiscal year (FY) 2018. The funding request is level with AHRQ funding during FY 2015.

Making their case, the letter states, “[AHRQ] is the only federal agency whose sole focus is to generate reliable research on how to deliver the highest quality care, at the greatest value, with the best outcomes.” The letter continues, “Thanks in part to AHRQ, the rate of hospital-acquired conditions has dropped by 21 percent, saving Americans nearly $28 billion.”

The group’s request of $364 million for AHRQ in FY 2018 aligns with the funding recommendation put forward by the stakeholder community, including the AAMC.

Despite requests from members of Congress and the health community to increase the FY 2018 AHRQ budget, the March 16 White House Budget Blueprint includes language that suggests consolidating AHRQ within the National Institutes of Health (NIH) [see Washington Highlights, March 17]. In his response to the proposal, AAMC President and CEO Darrell G. Kirch, MD, noted that “preserving the unique work of AHRQ is vital to optimizing the effectiveness and efficiency of the nation’s health care delivery system.”

Contact:

Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525
Email: trasouli@aamc.org

Joseph Bañez
Legislative Analyst
Telephone: 202-739-2995
Email: jbanez@aamc.org

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Senators Request Review of Compliance with Stevens Amendment

April 28, 2017—Five Republican senators sent an April 25 letter requesting that the Government Accountability Office (GAO) review compliance with the “Stevens amendment,” a provision in the annual Labor-HHS-Education spending bill that requires grantees – including colleges and universities – to disclose in public statements how much public funding was used to support their projects.

Pointing to congressional oversight, the senators express concern that “not all agencies and grant recipients are abiding” by the law. They state, “we have found most of the documents and statements issued by the recipients of federal funds from [the Departments of Labor, Health and Human Services and Education and related agencies] reviewed by our offices did not disclose the costs.”

The letter, signed by Senators Jeff Flake (R-Ariz.), Ron Johnson (R-Wis.), John McCain (R-Ariz.), James Lankford (R-Okla.), and Rand Paul, MD, (R-Ky.), asks GAO to review:

  • Whether federal departments and agencies are offering guidance and/or enforcing compliance with the provision;

  • The percentage of grantees at each department that “are complying in full”; and

  • The methods being used to report the federal contribution, including whether “indirect costs are factored into these calculations.”

The “Stevens amendment” was originally included in the fiscal year (FY) 1989 spending bill as an amendment offered by the late Senator Ted Stevens (R-Alaska).

Contact:

Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525
Email: trasouli@aamc.org

Joseph Bañez
Legislative Analyst
Telephone: 202-739-2995
Email: jbanez@aamc.org

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Senate Committee Holds Hearing on GAO’s Annual Report to Reduce Fragmentation, Overlap, and Duplication in Federal Programs

April 28, 2017—The Senate Committee on Homeland Security and Governmental Affairs held an April 27 hearing on the U.S. Government Accountability Office’s (GAO) annual report on opportunities to reduce fragmentation, overlap, and duplication in federal programs. University of Wisconsin-Madison Chancellor Rebecca Blank, PhD, was among the witnesses.

As directed by Congress, GAO identifies and reports on federal agencies, programs, and initiatives with fragmented, overlapping, or duplicative goals or activities and recommends ways to reduce costs or enhance revenue. In its 2017 report, GAO identifies 79 new actions that Congress and executive branch agencies can take to improve the efficiency and effectiveness of government in 29 new areas, including federal payments for hospital uncompensated care and Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) enrollment. Additionally, GAO finds 14 areas to reduce the cost of government operations or enhance revenue.

In his opening statement, Committee Chair Ron Johnson (R-Wis.) highlighted GAO’s estimate that this report has resulted in $75 billion in savings since 2010 but noted “there are still hundreds of recommendations that have not been implemented, and far too many areas of duplication remaining in the federal government that should be addressed.” He added, “I sincerely hope we can come together, Democrats and Republicans, and use the bipartisan nature of this Committee to assist the administration in finding areas of agreement to root out waste, fraud, and duplication in the federal government.”

In her opening comments, Dr. Blank stated, “We have spent many years adding layer upon layer of federal regulations, and we’re at a point where this is seriously impeding the productivity of our scientists. There are as many as 23 different pre-and post-award administrative responsibilities associated with federal research grants. Each of these steps requires time from either the researcher or from support staff.”

To alleviate some of this burden, Dr. Blank recommends that the Office of Management and Budget (OMB) immediately establish the new Research Policy Board required by the 21st Century Cures Act (P.L. 114-255) and that current grant application and reporting requirements be streamlined and simplified as soon as possible, as required by the American Innovation and Competitiveness Act (P.L. 114-329). Additionally, she calls for the recently adopted Final Rule, which is scheduled to modernize the Common Rule in January 2018, to include training and guidance to ensure proper interpretation and application.

Contact:

Jason Kleinman
Sr. Program & Policy Specialist, Govt Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org

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On the Agenda

May 2: House Ways and Means Committee Hearing on the Regulation of Medical Technologies
10 a.m.; 2123 Rayburn House Office Building, Washington, D.C.
The House Ways and Means Committee will hold a hearing to examine improvements to the regulation of medical technologies.

May 2: House Energy and Commerce Subcommittee Hearing on Medicaid Personal Care Services Program
10:15 a.m.; 2322 Rayburn House Office Building, Washington, D.C.
The Energy and Commerce Oversight and Investigations Committee will hold a hearing on combating waste, fraud, and abuse in Medicaid’s personal care services program.

May 3: House Appropriations Subcommittee Hearing on Veterans Affairs
10 a.m.; 2359 Rayburn House Office Building, Washington, D.C.
The House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies will hold a hearing to discuss 2018 Veterans Affairs Oversight. VA Secretary David J. Shulkin, MD, will testify.

 

 

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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
Sr. Program & Policy Specialist, Govt Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org