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Second Opinion

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

Washington Highlights

Senate Approves FY 2014 Budget Blueprint

March 29, 2013—The Senate March 23 passed its version of the FY 2014 budget resolution (S.Con.Res. 8).  The vote on final passage was 50-49, with Democrats Max Baucus (Mont.), Mark Begich (Alaska), Kay Hagan (N.C.), and Mark Pryor (Ark.) joining all 45 Republicans to oppose the measure.  All four Democrats are up for re-election in 2014.

The Senate budget includes a discretionary spending cap for FY 2014 of $966 billion, as mandated by the Budget Control Act of 2011 (BCA; P.L. 112-25) and modified by the American Taxpayer Relief Act of 2012 (ATRA; P.L. 112-240).  This is approximately $18 billion less than the level of FY 2013 discretionary spending after sequestration.

The discretionary cap includes a “firewall” between revised “security” and “nonsecurity” categories.  For FY 2014, the revised security category includes all discretionary funding in budget function 050 [defense] and is capped at $497 billion.  The nonsecurity category includes all other discretionary funding and is limited to $469 billion.

In contrast, the budget (H.Con.Res. 25) passed by the House March 21 also includes an FY 2014 spending cap of $966 billion, but assumes all the sequestration cuts will come from nondefense spending.  The House budget sets defense spending at the BCA level of $552 billion and nondefense spending at $414 billion, which is $55 billion less than the Senate cap.

The Senate resolution allows the chair of the Budget Committee to modify these spending limits and allocations to reflect subsequent legislation to replace sequestration.  The resolution assumes if sequestration is nullified, the overall spending cap would be $1.058 trillion, with $552 billion for security defense spending and $506 billion for nondefense, as specified under the BCA and ATRA.

The Senate budget also includes a large number of “deficit-neutral reserve funds” to afford the Senate Budget Committee flexibility to modify spending allocations to reflect subsequent legislation.  Among the provisions relevant to academic medicine, the Senate adopted an amendment offered by Senators Dick Durbin (D-Ill.) and Jerry Moran (R-Kan.) to create a deficit-neutral reserve fund to increase funding for the National Institutes of Health. Senators Richard Blumenthal (D-Conn.), Ben Cardin (D-Md.), Bob Casey (D-Pa.), Susan Collins (R-Maine), Amy Klobuchar (D-Minn.), and Barbara Mikulski D-Md.) cosponsored the amendment.

Other health-related amendments include deficit-neutral reserve funds to:

  • protect women's access to health care, including primary and preventative health care, family planning and birth control, and employer-provided contraceptive coverage, such as was provided under the Affordable Care Act (P.L. 111-148), offered by Senators Jeanne Shaheen (D-N.H.) and Debbie Stabenow (D-Mich.);
  • restore a sensible definition of full-time employee for purposes of the Patient Protection and Affordable Care Act, offered by Senator Collins;
  • establish a deficit-neutral reserve fund to sunset the provision of Patient Protection and Affordable Care Act that increases payments to hospitals in a few states by reducing payments to the majority of states through the Medicare hospital wage index, offered by Senator Tom Coburn (R-Okla.);
  • provide full funding for the Biomedical Advanced Research and Development Authority (BARDA) and the BioShield Special Reserve Fund, offered by Senators Richard Burr (R-N.C.) and Casey;
  • address prescription drug abuse in the United States, offered by Senators Joe Manchin (D-W.Va.) and Jay Rockefeller (D-W.Va.); and
  • repeal the 2.3 percent excise tax on medical device manufacturers, offered by Senator Harry Reid (D-Nev.).

Contact:

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

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For More Information

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