AAMC (Association of American Medical Colleges) President and CEO David J. Skorton, MD, and Chief Public Policy Officer Danielle Turnipseed, JD, MHSA, MPP, issued the following statement upon the release of text for the Consolidated Appropriations Act, 2023 (H.R. 2617) that would fund the federal government through fiscal year (FY) 2023, ending September 30, 2023, and include a number of other policies and provisions. The legislative package contains provisions that will support patients, learners, scientists, teaching hospitals, faculty physicians, and other health care providers, including FY 2023 funding for the National Institutes of Health (NIH) and Health Resources and Services Administration (HRSA) workforce programs, and provisions that will expand funding for Medicare-supported graduate medical education (GME), among other priorities.
“The AAMC appreciates that House and Senate negotiators have reached a bipartisan agreement on legislation that includes numerous crucial investments that will enable America’s medical schools and teaching hospitals, known collectively as academic medicine, to continue to improve the health of patients, families, and communities nationwide. The package’s key provisions – related to medical research and innovation, unsustainable hospital and provider Medicare payment cuts, graduate medical education and other health workforce programs, telehealth and other care delivery innovations, mental and behavioral health, and Medicaid coverage – are all important elements to expand access to high-quality, life-saving care for people nationwide.
Specifically, we are grateful for Congress’s bipartisan commitment to the National Institutes of Health with a base funding level of $47.5 billion in the bill. At this level, the agency’s budget will be able to keep pace with biomedical inflation and allow researchers at medical schools and teaching hospitals to continue advancing medical research—providing cures, diagnostics, treatments, and prevention strategies that improve the health of all. Together with the bill’s other key investments in science and public health agencies, this funding will help lay the scientific foundation for solutions to new and emerging medical challenges. Furthermore, we appreciate that Congress included separate funding for the new Advanced Research Projects Agency for Health (ARPA-H), rather than supplanting NIH’s base budget.
The unprecedented events over the past three years—ongoing public health emergencies (PHE) coupled with additional challenges related to prevailing economic conditions, including staffing shortages and financial strain—have placed an inordinate burden on teaching hospitals and faculty physician practices. It is laudable that Congress has averted the Statutory Pay-As-You-Go (PAYGO) sequester and lessened the scheduled cut to Medicare payments to physicians. However, we remain concerned about the pending physician fee schedule reductions. We urge lawmakers to act swiftly to avoid the full magnitude of these potentially catastrophic cuts and allow the nation’s medical schools, teaching hospitals, and faculty practices to continue providing the highest quality care to patients across the country by ensuring adequate payments for physician services.
We are appreciative and encouraged that the legislation includes 200 additional AAMC-supported Medicare graduate medical education (GME) residency slots. The AAMC remains very concerned by the projected shortage of up to 124,000 physicians by 2034, and these additional GME slots—only the second increase in over 25 years—signal Congress’ bipartisan understanding and acknowledgment of the need to address this shortage and increase patients’ access to much needed care by allowing teaching hospitals to train additional physicians. This growth is particularly important in light of the COVID-19 pandemic, which has negatively affected the health and well-being of many people and resulted in a greater demand for providers, including mental and behavioral health professionals.
We thank Congress for extending policies that have maintained access to care during the COVID PHE for millions of individuals, including two-year extensions of critical telehealth flexibilities and the Acute Hospital Care at Home program. These innovations in health care delivery have become vital to providing high-quality care and increasing access for patients nationwide, particularly those in rural and medically underserved areas. Similarly, we appreciate the bill’s extension of alternative payment model (APM) bonus payments and the patient care delivery innovations they support.
We are also grateful that Congress provided protections to ensure continued access to coverage and care for Medicaid beneficiaries during the impending “unwinding” period. In addition, we thank lawmakers for providing coverage to historically marginalized populations by ensuring children have one year of continuous Medicaid eligibility, and permanently expanding the state option for Medicaid coverage to 12 months post-partum.
Additionally, the AAMC appreciates the increased funding levels for Health Resources and Services Administration (HRSA) health workforce development programs, including the Title VII health professions and Title VIII nursing workforce programs, the National Health Service Corps, and Children’s Hospitals Graduate Medical Education. Support for these critical programs will strengthen the supply, diversity, and distribution of the health care workforce.
As a long-standing partner in improving the health of veterans, the AAMC commends the inclusion of the VA Infrastructure Powers Exceptional Research (VIPER) Act of 2021. This legislation is key for increasing the breadth of research opportunities within the VA research program and avoiding harmful disruptions to research with academic affiliates.
We also are pleased that lawmakers did not include provisions that would have interfered with the delivery of innovative, cutting-edge medical care by subjecting laboratory-developed tests (LDTs) at academic medical centers to a new regulatory mechanism. While the AAMC affirms that it is essential for LDTs to be accurate and clinically valid in their use as diagnostics informing treatment decisions for patients, the legislation would have negatively impacted patient access to critical new tests.
The AAMC urges the Senate and House to pass the year-end package as quickly as possible to provide the necessary investments that support important programs benefiting patients, families, and communities. We look forward to continuing to work with all members of Congress and the administration to support these and other critical programs in 2023.”