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

Washington Highlights

Senate Appropriations Panel Provides Modest Increase for NIH, Eliminates Title VII Diversity Program

June 15, 2012—The Senate Appropriations Committee June 14 approved its FY 2013 Labor-HHS-Education spending bill (S. 3295, S.Rept. 112-176) in a 16-14 party-line vote.  The Labor-HHS-Education subcommittee cleared the legislation June 12 in a 10-7 party-line vote.

National Institutes of Health (NIH): As described in a June 14 summary released by Subcommittee Chair Tom Harkin (D-Iowa), “The bill provides $30.723 billion, an increase of $100 million, to fund biomedical research at the 27 Institutes and Centers that comprise the NIH.”

The summary also notes, “The bill includes $40 million, four times the fiscal year 2012 level, for the Cures Acceleration Network at the National Institutes of Health (NIH) to help speed the translation and application of discoveries that have shown signs of success at the laboratory level but have not advanced far enough to attract significant investments from the private sector.”

The bill retains a provision limiting the direct salary that an individual may receive under an NIH grant to Executive Level II ($179,700 in 2012) and includes a new provision limiting the attendance of federal employees at any single international conference.

The committee report notes NIH’s recently-announced plan to switch to a provider-based rather than a household-based recruitment strategy for the National Children’s Study (NCS) and directs the Secretary of Health and Human Services (HHS) to enter into an agreement with the National Academy of Sciences to review the NCS sampling strategy.

During consideration of the bill, Sen. Jerry Moran (R-Kan.) offered an amendment to increase the overall funding level for NIH to $32 billion by applying an across-the-board cut to all other programs in the spending bill. He noted, “Now is not the time to waiver on America’s commitment to advancing disease cures and treatments. Without consistent, strong support of NIH, our nation is at risk of jeopardizing patient treatment advancements, losing our position as a global medical research leader, and squandering the opportunity to drive economic growth.”

In responding to Sen. Moran’s amendment, Chairman Harkin acknowledged that his preference would have been to provide the full $32 billion for NIH, recalling joint efforts with former Sen. Arlen Specter to bolster funding for medical research. He also described, however, his opposition to across-the-board cuts to advance one priority over another. The amendment failed, 12-18.

The committee adopted, 18-12, an amendment offered by Sens. Mary Landrieu (D-La.) and Thad Cochran (R-Miss.), focused on NIH’s Institutional Development Award (IDeA) program. Chairman Harkin suggested that Congress should revisit the original intent for the program, and pledged to schedule a hearing through the authorizing committee, the Health, Education, Labor, and Pensions (HELP), as it begins to consider NIH reauthorization next year.

Health Professions: The committee provides $256.6 million for the Health Resources and Services Administration (HRSA)’s Title VII health professions programs, an $11.6 million (4.3 percent) cut below FY 2012, primarily achieved by eliminating the Title VII diversity Health Careers Opportunity Program (HCOP). The president’s FY 2013 request proposed eliminating HCOP, and the committee describes in its report ways that other federal programs address diversity.

The bill provides $49 million for the Title VII primary care training and enhancement programs, a $10 million increase over FY 2012, but $2 million less than the president’s FY 2013 request. The president’s proposal directed the entire increase to physician assistant training, and the committee “urges HRSA to prioritize the training of physician assistants and includes bill language allowing HRSA to determine the funding amount for this activity.” The committee also boosts funding for Title VII workforce information and analysis to $7.8 million (a $5 million, 180 percent, increase over FY 2012).

Unlike the president’s request, the bill includes funding for the Title VII Area Health Education Center (AHEC) program ($27.2 million, as in FY 2012), but does not provide the president’s requested $5 million for the previously unfunded Title VII pediatric loan repayment program. The Title VIII nursing programs receive $231.1 million as in FY 2012 ($20 million less than the president’s request).

Children’s Hospitals Graduate Medical Education (CHGME): The committee provides $265 million for the CHGME program, the same level as in FY 2012, despite the president’s proposal to cut the program by 67 percent to $88 million in FY 2013.

Agency for Healthcare Research and Quality (AHRQ): The committee provides $364.1 million for AHRQ, and recommends a $12 million transfer from the Prevention and Public Health Fund, bringing the agency’s total to $376.1 million. The funding level constitutes a $5 million (1.3 percent) cut below the comparable FY 2012 figure, but a $17 million boost over the president’s request, which relied on a scheduled $62 million transfer from the Patient-Centered outcomes Research Trust Fund.

The report also expresses the committee’s concern “that contractual prior restraint clauses on the publication of research may inadvertently stifle scientific freedom” and “urges AHRQ to ensure that researchers have the opportunity to publish research findings in peer-reviewed journals without unreasonable restrictions to allow greater review and input from the scientific community.”

National Health Service Corps (NHSC): The committee does not appear to provide FY 2013 appropriations for the NHSC, presumably in deference to the NHSC Fund established by the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152), which provides $300 million in mandatory funding for the NHSC in FY 2013.

National Healthcare Workforce Commission: The committee provides $3 million for the commission established as an independent advisory body in the ACA. Though the Government Accountability Office appointed commissioners Sept. 30, 2010 [see Washington Highlights, Oct. 1, 2010], Congress has not approved an appropriation to fund the commission’s activities.

As they did last year, Republicans opposed the bill because they say it contains approximately $4 billion in discretionary spending to implement the ACA.  Chairman Harkin lamented Republicans voting against reporting out the bill, saying, “This is disappointing. I would have preferred to work together to produce a bipartisan bill, as was the norm for so many years on this Committee.”  He went on, “I understand that the two parties have their differences on health care reform. We will get to express those differences shortly through the amendment process. But the Affordable Care Act is the law. We have a responsibility to ensure that HHS has the funding it needs to implement it.”

Chairman Harkin also disputed the characterization of the Prevention and Public Health Fund as a “slush fund,” noting, “The money for that fund is not appropriated in this bill. The Prevention Fund was appropriated in the Affordable Care Act. It’s mandatory funding, not discretionary funding. What this bill does is allocate the Prevention Fund. The Affordable Care Act gives the Appropriations Committee the authority to say exactly how every penny of that Fund should be spent” and the HHS must follow these instructions.

Contact;

Dave Moore
Senior Director, Government Relations
Telephone: 202-828-0559
Email: dbmoore@aamc.org

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

Alexandra Khalife
Legislative Analyst
Telephone: 202-828-0418
Email: akhalife@aamc.org

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org