Advocacy

CAFM Briefing Room:
Keeping you posted on Washington and its effects on academic family medicine.

August 23rd

Today, President Obama submitted an amendment to his proposed FY 2011 budget that included a $250 million increase in funding for HRSA health workforce training enhancements. The new funding is paid for through reductions in other programs and agencies.

July 27th

Today, the Senate Appropriations sub-committee on Labor, Health and Human Services, Education and Related Agencies passed its FY 2011 Appropriations mark up.

Highlights in the bill include an additional $170 million over the FY 2010 level to expand health training programs. Specifically, it provides $90 million, an increase of $51 million, for primary care training activities; nearly $48 million, an increase of $15.1 million, for oral health care training; and a total of $57.9 million, an increase of $20 million, for public health workforce training.

Further, the bill includes $5.1 million for the Rural Physician Pipeline (Title VII Section 749B) for the newly authorized program to create opportunities for primary care physicians to train in rural areas.

A full committee mark up is tentatively scheduled for Thursday afternoon.

The House Appropriations Committee has not scheduled a mark up on its L-HHS Appropriations Bill.

July 2nd

Several advisory bodies were created in the Affordable Care Act, including the National Health Care Workforce Commission and the Patient Centered Outcomes Research Institute. Nominations to these bodies were due to the Government Accountability Office (GAO) by June 30th. After reviewing many qualified candidates, CAFM is proud to announce the nominations of the following individuals to these advisory commission. Al Berg, MD, MPH and Barbara Starfield, MD, MSPH were nominated for the Patient Centered Outcomes Research Institute Board of Governors, and for the Workforce Commission CAFM nominated Kevin Grumbach, MD, Bob Phillips, MD, MSPH, Mark Doescher, MD, MSPH, and Russell Robertson, MD.

The Comptroller General of the GAO will appoint members to each of these advisory bodies by September 30th.

As the Affordable Care Act moves into the regulatory phase, it is important to know the agencies responsible for implementing the provisions.

The Health Resources Services Administration (HRSA) serves nearly 19 million people through funded health centers. HRSA is also responsible for implementing over 50 provisions in the health care law, 19 of which have immediate activites in 2010. HRSA is also identified as a key partner with other agencies in numerous other provisions.

April 13th

HRSA Grant Information: HRSA convened a conference call of stakeholder groups regarding the re-issuance of guidance for the ARRA and FY2010 grant awards for the primary care cluster.

They hope to re-issue the award process by the end of this week. They will provide an addendum that explains the various changes to the previous guidance. Applicants will have 30 days from the time of the issuance to submit the applications. This means that if they don't reissue this week, but put it out some time later, applicants will have 30 days from the new date of issuance.  They are also working on a one-pager that they plan on releasing next week to explain some of this.

Key points and a more in depth explanation of HRSA Grant information can be found here.

If you have any questions about HRSA grant guidance, please contact the Washington DC office.

April 6th

If you've submitted phase 1 grant applications you should have received this warning this morning. It's not clear when decisions will be made regarding changes, or how much additional time will be given to finalize the applications. One the changes they have to deal with is that the reauthorization of the primary care cluster in the health care reform bill utilizes five year grants, rather than three year as is the current practice.

Please take no further action on your Phase 2 application. This funding opportunity announcement will be reissued to reflect changes in the authorizing legislation as a result of the Patient Protection and Affordable Care Act. As additional information becomes available, it will be posted on the HRSA internet (http://www.hrsa.gov/grants/default.htm), as well as the BHPr recovery website (http://www.bhpr.hrsa.gov/recovery/).

Mar 31st

Yesterday, President Obama finished his efforts to reform the United States health care system by signing the reconciliation bill with fixes to health care reform into law. The legislation removed provisions like the "Kornhusker Kickback," made changes to the taxing of "Cadillac Plans," and reformed the student loan industry.

To see the major provisions passed in the health care reform legislation, view this chart that was put together by the government affairs office.

Mar 26th

With the passing of health care reform, major changes will be underway in the health care system and how you deliver care. The government affairs office has put together this chart briefly summarizing major consumer and primary care provisions in the health care legislation and when these provisions go into effect.  

 

Mar 23rd

Health Care Reform Arrives—What Does It Mean for You and Your Patients?

After almost a century of effort by multiple Presidents of each party; after several close calls in previous Congresses, when health care reform almost happened; after successive highs and lows in the past 16 months, when reform efforts seemed alternatively dead on arrival or moving forward to completion, health care reform is finally the law of the land. Today, Tuesday, March 23, 2010, President Obama signed H.R.3590, the Patient Protection and Affordable Care Act, into law.  

What does health care reform mean to patients, consumers, and primary care medicine—and academic family medicine? Below are some key issues included in the health care reform bill. Of note, while STFM and the other CAFM organizations' advocacy efforts on the specifics of the bill centered on key academic primary care/family medicine issues, at each opportunity for moving the bills forward, we supported movement forward as the most important concept. The concept of health care reform in terms of health care for all was our prime objective. 

First, Some Arcane Legislative Business:
Health care reform passed both the House and the Senate, and after the President's signature, the bill becomes law. Another legislative bill, called Budget Reconciliation, also passed the House of Representatives on Sunday, March 21. Today, it will begin to be addressed by the Senate. This bill will make some changes to the health care reform bill that was just passed, such as removing some of the more objectionable provisions of the Senate bill, including the "Nebraska compromise" and the "Gatorade" provisions. It also includes one primary care provision–to provide for parity for Medicaid primary care physician services equal to Medicare payment levels. Whether this budget reconciliation bill goes forward into law or not, health care reform as described below, remains in place.

Insurance and Eligibility Reform:

The health care reform legislation passed by the House of Representatives will have a profound effect on health care. According to the Congressional Budget Office, a non-partisan arm of Congress, this bill would provide an estimated 32 million people access to coverage who did not have it before. This increased coverage is achieved through the creation of state health insurance exchanges and the expansion of eligibility to Medicaid. 

Sweeping insurance reforms are also included in the legislation. These reforms include: extending the age at which a child can remain on their parents' insurance plan to age 26, banning insurance providers from denying coverage to individuals with pre-existing conditions, removing lifetime caps, and including preventive care by new insurance plans. The bill also requires all individuals to purchase health insurance or face a fine unless they can prove financial hardship. Tax credits will be available to individuals and families who cannot afford to purchase their own health insurance through the state-based exchanges. 

Cost Savings:

The $940 billion bill is paid for by cuts to and cost savings in Medicare, including the Medicare Advantage program, taxing "Cadillac health care plans," fines collected from individuals that do not purchase insurance, increasing Medicare taxes on individuals making high incomes, and creating a new Medicare tax on investment income. The Congressional Budget Office estimated that the entire bill would reduce the national deficit by $143 billion by 2019. 

Primary Care Issues We Actively Lobbied for:
Our Washington Office actively lobbied on many key elements of the bill that directly affect academic family medicine. In addition, we joined our support to the AAFP's efforts on key family medicine practice issues. Below is a short list of some of the key provisions we were actively involved in that have become law. 

• Primary Care Bonus Payment: The law contains a 10% add-on to primary care physician services. This provision sends a clear signal that primary care payments should be enhanced. Obviously a higher bonus amount would be preferable, but this is a first step in acknowledging that current Medicare payment rates are not supportive of primary care and the need the nation has for more primary care providers.
  
• Medical Home Provisions: The law allows states to create Patient-centered Medical Homes for chronically ill patients. Of key significance,  the new coverage included in the new Insurance Exchanges allows plans to include qualified primary care medical homes.
  
• Medicare Graduate Medical Education (GME) Reform:  Many provisions are included that provide fixes to multiple problems CMS regulations have caused. Many of these have been issues we have worked on since 2003. Of note, resident training time can now be counted in all training sites as long as the hospital pays the resident stipends and benefits – no longer will the 90% rule apply. Additional changes to allow didactic training in all sites and resident vacation and sick leave were included. In another area of GME funding, there will be a new redistribution of residency slots from institutions that haven't filled over the last 3 years to other institutions that apply for those positions. Unlike the first redistribution of 2003, these new positions will be reimbursed at the same rate as others slots, not at a reduced amount. Priority for the new positions would go to primary care and general surgery, to states with low resident-to-physician ratios, and to rural areas.
  

• Title VII Primary Care Cluster and Other Title VII Provisions: The Title VII primary care cluster was reauthorized at $125 million. While extremely important to our efforts to gain funding for our Title VII programs, we will still have an annual appropriations battle to increase funding for this program. A new provision would establish a grant program under Title VII for medical schools to help recruit students most likely to practice medicine in underserved rural communities, provide rural-focused training experiences, and increase the number of medical school gradua tes who practice in underserved rural communities.
  

• Primary Care Extension Program: A new program would be established to support and assist primary care providers with the incorporation of techniques to improve community health. State hubs and local extension programs may be created. The purpose of this program is to provide practice improvement help to the field. Of note, primary care departments of medical schools can apply to provide such training.
  

For a more complete understanding of the health care reform provisions, the Kaiser Family Health Foundation has a very good interactive Web site: http://healthreform.kff.org/. For a check on the veracity of claims you hear about the bill, you can might want to take a look at the following Pulitzer prize-winning site: http://www.politifact.com/.

Mar 22nd

Late last night in a historic Sunday vote, the House of Representatives passed the Senate version of health care reform with a final vote of 219-212. Following the vote on the health care reform bill as passed by the Senate, the House voted on a Republican measure to "reconsider" the reconciliation bill, or sending it to committee. This measure failed. Finally, the House voted 220-211 to send the reconciliation language "fixing" the Senate language to the Senate for consideration. A summary of the passed health care language can be found here.

President Obama is not expected to sign the legislation into law until Tuesday. The Senate will take up consideration of the reconciliation package on Tuesday as well, with a vote probably taking place Friday or Saturday.

Mar 18th

Today the Congressional Budget Office released their score of the final health care package. The CBO said the legislation will cost $940 billion and reduce the deficit by $130 billion over the next ten years. Along with the CBO score, Democrats released their reconciliation bill designed to "fix" the Senate passed health care bill. Text of the reconciliation bill can be found here.

President Obama also delayed his trip to Asia for the second time in expectation of a final vote in the House of Representatives that is expected to take place Sunday.

Mar 15th

Last night, Democrats in the House Budget committee released the bill that will become the vehicle for reconciliation fixes to Senate health care bill. The released bill contains the three House bills already passed, and changes inserting the Senate language will be made starting at 3 pm today. Speaker of the House Nancy Pelosi has said she expects a final vote for a reconciliation bill by Sunday. 

Reconciliation is a budgetary procedure that allows a bill to be passed by a simple majority. Only measures that affect the budget may be amended through the reconciliation process.

Mar 3rd

Today at 1:45 est, President Obama will deliver a speech demanding an "up or down vote" on health care reform legislation. In the speech, the President is also expected to address four republican ideas he would like to see incorporated into any final legislation. The President sent a letter to Congressional leaders yesterday explaining these proposals and can be read here.

Feb 22nd

In an an effort to kickstart the stalled health care debate, today President Obama released a summary of his health care reform proposal. The summary incompases many ideas alredy present in the House and Senate versions and focuses on insurance reform and Medicare cost savings measures. A copy of the President's summary can be found here.

On Thursday, President Obama will host a bi-partisan health care reform summitt that will be televised on C-SPAN. The Briefing Room will provide a summary following the summitt.

Feb 19th

President Obama has scheduled a televised bi-partisan summitt next week in an effort to try to broker a bill that can pass both the House and Senate and attract Republican votes. Meanwhile, negotiations to reach a compromise health reform bill continue between the White House and Senate and House leadership as rumors continue to subsist that the process known as "reconciliation," a budgetary procedure where only a simple 51 vote majority is needed to pass legislation, will be used to pass a smaller reform bill in the coming weeks.

Feb 2nd

Yesterday, President Obama unveiled his fiscal year 2011 budget, including funding for HHS. Under the President's budget, Title VII, Section 747 funding remained at the FY 2010 total of $54 million, while total Title VII funding rose by $5 million to $259 million. Community Health Center's saw a 13% increase in funding to $2.48 billion. The National Health Service Corp was given a 19% increase in funding to $169 million.

A full chart of releveant FY 2011 funding can be found here

If you have any specific questions or want more in depth funding levels, please feel free to contact me and I can provide any information you need.

Jan 26th

According to reports, President Obama is expected to announce a three year freeze on all discretionary spending for all "non-security" government agencies during his State of the Union speech Wednesday evening. The spending freeze is expected to save $250 billion dollars accoring to Politico.

The President will deliver his first State of the Union Wednesday night at 9 pm est/ 8 pm central.

The President is also expected to deliver his FY 2011 budget February 1st. Look for details on the budget in the Briefing Room.

Jan 20th

Last night, Republican Scott Brown defeated Democratic candidate Martha Coakley to fill the senate seat of the late Ted Kennedy. With a 52%-47% victory, Republicans now have 41 seats in the Senate, enough to block any future votes and force concessions from Democrats.

It is unclear what the future of health care reform is now that the Democrats no longer have a super majority, however Democrats still do have a way to pass the bill. The House can pass the Senate version as is, with the hopes of amending the bill later in the Senate through a process known as reconciliation, which is a budgetary measure that requires only 51 votes.

Jan 19th

The White House announced that President Obama will be giving his first State of the Union on Wednesday, January 27th. The White House had hoped to have a final health care reform bill on the President's desk by the speech, however this goal will likely not be met.

The President's budget will be released February 1st. Look for details on the President's budget in the Briefing Room.

Voter's in Massachusetts head to the polls today for a special election between Republican State Senator Scott Brown and Democratic Attorney General Martha Coakley to fill the late Ted Kennedy's Senate seat. Polls indicate the race is a virtual dead heat. If Scott Brown would win, he would be the 41st Republican Senator, giving Republicans enough votes to filibuster any health care legislation.

Jan 13th

Negotiations to reach a consensus health care reform bill continue between Senate and House leadership and the White House. Rather than entering into a formal conference to create a bill with the same language, leadership elected to use an informal "ping pong" process to pass versions of the bill back and forth between the House and Senate leadership until a consensus bill emerges. Democratic leaders have indicated they would like to have a final bill by the State of the Union in early Februrary.

Read CAFM's letter to the House and Senate Leadership regarding a final health care bill here.

December 24th

During a historic and rare Christmas Eve session, the Senate passed its version of health care reform with a 60-39 vote. 51 votes was necessary to pass the legislation. The bill must now be merged with the House version in conference committee or passed by the House as written by the Senate. This process is expected to be undertaken the first week of January. Senate leadership has expressed a desire to have a final bill on the President's desk by the State of the Union address.

December 21st

Despite record snowfalls in Washington, the Senate reached an agreement over the weekend with Sen. Nelson (D-NE) over abortion provisions that gave the health reform legislation 60 votes necessary to avoid a Republican filibuster. Majority Leader Harry Reid (D-NV) introduced his manager's amendment on Saturday morning, starting the process that will lead to a Christmas Eve vote for final passage of the legislation. Last night, the Senate voted 60-40 in a party line vote to end debate on the manager's amendment, the first of four votes needed to amend the health reform legislation and pass the final bill. The next vote will be held Tuesday at 7 am.

December 18th

President Obama signed the Consolidated Appropriations Act into law, granting six agencies including HHS funding at FY 2010 levels. This means that $54.43 million will be available for Section 747 Primary Care cluster when HRSA publishes its guidance. In addition to the FY 2010 funding, $47.6 million will be available from the American Reinvestment and Recovery Act when guidance is published. Agencies had been operating at FY 2009 funding levels under a continuing resolution, which was due to expire at midnight.

December 15th

According to Politico, last night Senate leadership indicated it would drop the Medicare "buy-in" provision from health reform legislation. This came after Sen. Joe Lieberman (I-CT) said he could not support a Medicare "buy-in" clause in the legislation, meaning Democrats did not have the 60 votes necessary to pass any legislation. The Senate is still awaiting a CBO cost of the Medicare "buy-in" and the expansion of a federal insurance plan ran by private companies.