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AAMC Criticizes House Bill That Eliminates AHRQ, Jeopardizes Other Health Priorities
July 20, 2012—AAMC President and CEO Darrell G. Kirch, M.D., cautioned that an FY 2013 spending bill approved a day later by the House Labor-HHS-Education Appropriations Subcommittee would “impair the ability of the nation’s medical schools and teaching hospitals to conduct the groundbreaking research that improves the health of the American people and identifies ways to improve quality of care” and would “limit the efforts of these institutions to shape tomorrow’s health care workforce to respond to the nation’s changing needs.”
Among other provisions, the bill terminates the Agency for Healthcare Research and Quality (AHRQ); freezes funding for the National Institutes of Health (NIH) and imposes prescriptive management policies on the agency; cuts funding for health professions programs at the Health Resources and Services Administration (HRSA); and blocks funding for and implementation of the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152).
The subcommittee voted 8-6, to advance the spending bill, with Rep. Jeff Flake (R-Ariz.) joining all voting Democrats on the panel in opposing the measure. While Democrats criticized the bill’s numerous policy provisions and steep funding cuts, including an allocation that falls $8 billion below the comparable Senate figure and $6 billion below FY 2012, Rep. Flake previously has indicated his preference for additional cuts.
Subcommittee Chair Denny Rehberg (R-Mont.), however, maintained that the bill “represents a clear step toward returning to fiscal responsibility, while still ensuring that funding for critical and high-priority programs are maintained.” Acknowledging that the “committee cannot repeal Obamacare directly,” the chairman touted the bill’s efforts to “prevent it from being further implemented with taxpayer dollars we have jurisdiction over.”
The subcommittee rejected along party lines, 5-9, an amendment offered by Ranking Member Rosa DeLauro (D-Conn.) to restore ACA funding, as well as other Democratic amendments attempting to strip specific policy riders from the bill. The panel also defeated an amendment offered by Rep. Cynthia Lummis (R-Wyo.) to redirect savings from preventing ACA implementation to deficit reduction, which would have resulted in a 5.5 percent cut to all programs in the bill. The amendment failed on voice vote after Chairman Rehberg argued the across-the-board cut would be especially detrimental to smaller programs in the bill.
The full Appropriations Committee may consider the spending bill as soon as the week of July 23. The committee’s Senate counterpart approved its version of the spending bill June 14 [see Washington Highlights, June 15].
Provisions in the House bill of particular interest to medical schools and teaching hospitals include:
National Institutes of Health: The subcommittee freezes overall NIH funding at $30.6 billion, reducing the majority of institutes and centers by 0.02 percent below the FY 2012 comparable level. At the markup, Chairman Rehberg noted that the bill’s provisions to reconfigure the Public Health Service Evaluation tap focus “a greater percentage of these resources on basic NIH research activities rather than allowing them to be diverted by the Secretary for other, less-pressing purposes,” and that as a result, “the bill actually provides an increase of $675 million for NIH to use compared with last year.”
The bill also reduces the limit on salaries from grants funded by the bill to Executive Level III, and includes language mandating the NIH director to ensure that at least 16,670 new and competing Ruth L. Kirschstein National Research Service Awards are funded in FY 2013. Under the bill, the director must also allocate 90 percent of the agency’s budget to extramural activities, 10 percent to intramural, and “at least 55 percent toward basic science activities.”
Within the budget for the National Center for Advancing Translational Sciences (NCATS), the bill specifies that “at least” $487.8 million is provided for the Clinical and Translational Science Awards (CTSA) and prohibits changes to the CTSA program until IOM completes the review described in the report accompanying the FY 2012 Consolidated Appropriations Act (P.L. 112-74). The bill also permits “up to” $10 million within the NCATS budget for the Cures Acceleration Network, once the NIH publishes a Federal Register notice verifying that NCATS activities do not duplicate or compete with industry.
Other NIH-related provisions include language specifying “not less than” $376.48 million for the Institutional Development Award (IDeA) program (a $100 million increase); $175 million for the National Children’s Study, “with no changes to the current design or Vanguard pilot structure until at least 90 days after the IOM conducts a review of the proposed changes and impact on the results”; and language prohibiting NIH from supporting “economic research” and prohibiting any agency in the bill from supporting “patient-centered outcomes research” with appropriated funding.
Agency for Healthcare Research and Quality: The bill terminates AHRQ, rescinds any unobligated funds appropriated to the agency, and permits other agencies to carry out AHRQ activities, provided that those agencies are authorized to do so. The bill also rescinds $150 million from the Patient-Centered Outcomes Research Trust Fund established in the ACA to support the Patient-Centered Outcomes Research Institute (PCORI).
Health Professions: According to a July 17 press statement released by full committee Ranking Member Norm Dicks (D-Wash.), the bill makes $137 million in cuts to health professions programs at HRSA.
Children’s Hospitals Graduate Medical Education (CHGME): According to a press statement released by the subcommittee July 17, the bill provides $275 million for the CHGME program, a $10 million (3.8 percent) increase over FY 2012.
Centers for Disease Control and Prevention (CDC): The subcommittee provides $5.697 billion in budget authority for CDC, a $41 million (0.7 percent) increase over the FY 2012 comparable figure. However, the bill rescinds $1 billion in FY 2013 funding from the Prevention and Public Health Fund, much of which has been used to support activities through CDC. As a result, the overall funding available to CDC in FY 2013 would drop by $814 million (11.7 percent) compared to FY 2012.
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