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House Panel Votes to Eliminate Prevention Fund, Restructure THC Funding

April 1, 2011—The House Energy and Commerce Health Subcommittee March 31 voted along party lines to approve a series of bills targeting five programs with mandatory appropriations under the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152), including a bill (H.R. 1217) to eliminate the Prevention and Public Health Fund (PPHF) and a bill (H.R. 1216) to modify funding for the Teaching Health Center (THC) program. As in the subcommittee’s March 9 hearing on the proposals [see Washington Highlights, March 11], several subcommittee members spoke about how the legislation might impact the nation’s health care workforce needs.

Democrats on the panel accused the majority of “rehashing” the health care reform debate, while Republicans argued that the Secretary of Health and Human Services’ authority to award mandatory funding for the ACA programs negates Congress’s oversight responsibility over the executive branch. Regarding the THC program—for which the ACA provides $230 million over five years to support community-based, ambulatory patient care centers that operate primary care residences—Subcommittee Chair Joe Pitts (R-Pa.) noted that the ACA “disadvantages” other workforce training programs that receive funding through the regular appropriations process, such as the Children’s Hospitals Graduate Medical Education (CHGME), Title VII health professions, and Title VIII nursing education programs. Similarly, Rep. Brett Guthrie (R-Ky.), lead sponsor of H.R. 1216, described residency training at THCs as “extremely important,” but called for a more equitable funding approach; his bill converts the mandatory appropriation included in the ACA to a discretionary item that must be appropriated annually by Congress.

Democrats, however, pointed to the existing role of mandatory funding through Medicare to support graduate medical education (GME). Subcommittee Ranking Member Frank Pallone (D-N.J.) indicated that he “can’t think of any better use of mandatory funding than funding residents.” Rep. Eliot Engel (D-N.Y.) concurred, remarking that the president’s FY 2012 proposal to eliminate CHGME [see Washington Highlights, Feb. 18] exemplifies the vulnerabilities of funding residency training through discretionary appropriations; he emphasized the appropriate role of mandatory Medicare spending in supporting physician training. Though Chairman Pitts did not address the Democrats’ comparisons of mandatory THC funding to Medicare GME, he acknowledged that “some have advocated moving away from hospital-based training,” as facilitated by the THC program, but indicated that such policy decisions should be debated further.

Subcommittee members also debated whether prevention activities actually reduce federal spending. Highlighting the bipartisan support for mandatory Medicare and Medicaid spending to provide health care services for the sick, Rep. Pallone and full committee Ranking Member Henry Waxman (D-Calif.) described the irony of opposition to mandatory funding to prevent illness through the Prevention and Public Health Fund. Rep. Pallone also used the Primary Care Residency Expansion program, which received $168 million through the PPHF in FY 2010 [see Washington Highlights, June 18, 2010], as one example of initiatives that the prevention fund has supported. He observed that the recent series of FY 2011 short-term continuing resolutions to fund federal discretionary programs is “not conducive” to the long-term planning required to operate medical residencies or to conduct public health activities.

The full committee may consider the bills as early as April 5.


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


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