The House Energy and Commerce Health Subcommittee June 4 held a hearing, “Investing in America’s Health Care,” to address a variety of health care programs, including Medicaid Disproportionate Share Hospital (DSH) payments, Patient-Centered Outcomes Research Institute (PCORI), the National Quality Forum (NQF), National Health Service Corps (NHSC), and Teaching Health Centers (THC).
In a June 4 statement for the record, the AAMC highlighted its support for these programs and urged Congress to address the Medicaid DSH cuts, reauthorize PCORI and its current funding mechanism for at least an additional 10 years, increase funding for NHSC to eliminate health professions shortage areas nationwide, support mandatory appropriations funding for the THC program through the Health Resources and Services Administration (HRSA), and support legislation to end the two-decade freeze on Medicare support for graduate medical education.
During the hearing, both Democrats and Republicans expressed support for addressing the Medicaid DSH cuts, but Republicans also called for a change in the formula to distribute payments. In his opening statement, Committee Chair Frank Pallone (D-N.J.) noted, “These cuts will place an incredible strain on hospitals that are already struggling to provide care to children with complex medical needs, low-income Americans, and rural communities. I commend Representative Engel for his efforts to permanently eliminate these harmful cuts.”
Ranking Member Greg Walden voiced his concern about Rep. Engel’s proposal, stating, “Let me be clear, Republicans have never supported the DSH cuts and worked successfully to prevent them, but we should not surrender our ability to reform and modernize the program to ensure that funding is directed to those that need it.”
During the hearing, Vidant Health Chief Executive Officer Michael Waldrum, MD, highlightedthat Medicaid DSH “helps ease the financial pressure that comes with our commitment to meeting the health care needs of all people, including those who face severe financial hardships.” He noted that if the scheduled cuts were to go into effect, it would “devastate the nation’s safety net and jeopardize health care access and jobs in eastern North Carolina and communities across the country, with a particularly acute impact on rural America.”
The subcommittee also discussed reauthorization of PCORI. Lisa Cooper, MD, MPH, Bloomberg Distinguished Professor at Johns Hopkins Medicine, testified in support of a 10-year reauthorization for the institute, whose original 10-year authorization expires in September unless Congress acts. Reps. Diana DeGette (D-Colo.) and Don Beyer (D-Va.) May 28 introduced legislation (H.R. 3030) to extend PCORI and its funding for another 10 years.
In her testimony, Dr. Cooper described the attributes of PCORI that make its work unique compared to other research agencies, noting, “For all the advances we have made with new, innovative clinical research, we sometimes still lack the information we need to help our patients make the best choice based on their own individual preferences and values. That is why [PCORI] is so important.”
Several members inquired about how the research PCORI has supported is integrated into practice and what processes are in place to measure the impact of such work. Dr. Cooper described examples of PCORI-funded studies, such as one that developed a decision aid to help people with chest pain understand their risk of a heart attack to avoid unnecessary hospitalization, and another that found that daily blood sugar testing for people with diabetes does not actually help patients manage their blood sugar levels better.
Subcommittee members also were interested in learning more about PCORI’s work to address disparities in health care and social determinants of health. Rep. Kurt Schrader (D-Ore.) noted the limitations on PCORI to explore the role of cost.
Support for the NHSC and THC programs was unanimous among panelists and the dais, though some Republican members raised concern regarding funding increases without offsets. Dean Germano, CEO, Shasta Community Health Center, testified regarding the “primary care cliff” of expiring mandatory funding for the NHSC, THCs, and Community Health Centers. Specifically, he endorsed the Training the Next Generation of Primary Care Doctors Act of 2019 (H.R. 2815), the Community Health Investment, Modernization, and Excellence (CHIME) Act of 2019 (H.R. 2328), and the Community Health Center and Primary Care Workforce Expansion Act of 2019 (H.R. 1943), which would reauthorize and increase funding for these programs.
Several members discussed physician shortages projections, raising additional health workforce issues and federal programs. Rep. Susan Brooks (R-Ind.) highlighted the Opioid Workforce Act of 2019 (H.R. 2439), of which she is an original co-sponsor [see Washington Highlights, May 3].
In addition to supporting the NSHC and THCs, Rep. Jan Schakowsky (D-Ill.) noted her introduction of the EMPOWER for Health Act of 2019 (H.R. 2781) [see Washington Highlights, May 17] with Subcommittee Ranking Member Michael Burgess, MD, (R-Texas), “When we pass this bill, we will finally reauthorize critical Title VII funding that would ensure people around the country have access to skilled physician and medical professionals regardless of who they are or where they live.” In response, Dr. Cooper noted that lack of diversity among health professionals is one significant factor in health disparities and “when there was racial and ethnic concordance and language concordance between patients and providers, patients had better experiences and, in some instances, better quality of care as well.”