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Washington Highlights

House Subcommittee Challenges Public Health Funding under ACA, Discusses Workforce

March 11, 2011—The House Energy and Commerce Subcommittee on Health March 9 held a hearing focused on five newly-created mandatory spending programs in the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152), including the Prevention and Public Health Fund (PPHF) and payments for “teaching health centers” (THCs) or community-based, ambulatory patient care centers that operate primary care residencies. A background memo prepared by the committee’s majority staff proposes eliminating the PPHF, a mandatory appropriation that allows the Secretary of Health and Human Services to supplement annual spending on public health programs by up to $2 billion each year. The committee also suggests converting the mandatory appropriation for THC payments (a total of $230 million over five years) to a discretionary, annually-appropriated item.

Characterizing the PPHF as a “slush fund,” Subcommittee Chair Joe Pitts (R-Pa.) stated in his opening remarks that the secretary’s “full authority to use this account to fund any programs or activities under the Public Health Service Act that she chooses, without Congressional oversight…. should concern every Member.” In his opening statement, Full Committee Ranking Member Henry Waxman (D-Calif.) argued that it is “a fundamental part” of the committee’s responsibilities “to determine where mandatory funding is needed to ensure a program’s sustainability,” noting the irony of the Republican proposals amid bipartisan concerns about health workforce shortages.

Rep. Bret Guthrie (R-Ky.) targeted the THC program, stating “While I support graduate medical education [GME] – I believe we need more residency positions, particularly primary care – I support shifting this program to an authorization.” In an effort to defend the mandatory appropriation for THCs as a way to address shortages of primary care physicians, Rep. Waxman highlighted the role of mandatory spending under Medicare to support residency training at teaching hospitals. He commented, “I can think of no better use of mandatory funds than to provide funding for residents.”

Invited witness and New Jersey State Senator Joseph Vitale said, “[D]efunding programs aimed at addressing the critical shortage of primary care providers may very well be irresponsible,” in light of the primary care workforce shortages he expected to “reach critical levels as access to health care coverage expands.” He also testified that “[d]efunding primary care workforce will cripple health care delivery in states that do not already have programs in place.”

Several subcommittee members expressed concerns about various proposals to eliminate federal funding for programs intended to address workforce shortages. Rep. Tammy Baldwin (D-Wis.) mentioned that her state benefited from the Title VII Primary Care Residency Expansion program funded by the PPHF in FY 2010 [see Washington Highlights, June 18, 2010], while Rep. Marsha Blackburn (R-Tenn.) questioned the president’s FY 2012 proposal to eliminate the children’s hospitals GME program [see Washington Highlights, Feb. 18]. As he did at a March 3 hearing [see Washington Highlights, March 4], Rep. Michael Burgess (R-Texas) expressed frustration with the absence of a request from the president for FY 2012 funding to staff school-based health centers, despite mandatory funding in the ACA to build such centers. He asked, “What good are the bricks and mortar if you don’t have the doctors and nurses there to receive the children, the patients, when they come in to be seen?”

Other witnesses included former Rep. Ernest J. Istook, currently a distinguished fellow at the Heritage Foundation, and John Goodman, Ph.D., president and CEO, National Center for Policy Analysis.


Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525

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


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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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