Advocacy

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

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.

Senate Democrats are meeting with President Obama at the White House in an effort to rally support for health care reform, telling Senate Democrats this is the "last chance" for health reform. Democrats want to have a bill passed in the Senate by Christmas, but a final agreement still has not been reached. Due to Senate rules, an agreement would probably have to be reached by the end of this week in order to have a bill voted on and passed by Christmas.

December 14th

On Sunday, the Senate passed the Consolidated Appropriations Act of 2010, which combined six of the spending measures for FY 2010, including Labor-HHS appropriations. Title VII programs were funded at $154 million dollars, while Section 747 Primary Care Cluster will get $54.43 million. Other appropriated totals include $33.35 million for AHECs and $141.93 million for ARHQ. The House of Representatives passed the consolidated act last Thursday. The bill will now be sent to be signed into law by President Obama.

A chart detailing appropriated funds can be found here: Chart

The full committee report can be found here: Report

December 9th

According to Politico, moderate and liberal democratic Senators reached a tentative compromise last night on the highly contested "public option" in the health reform bill. In the agreement, men and women over age 55 would be able to "buy-in to" Medicare, and the federal government would offer a national health insurance plan under private insurance companies and would be administered by the Office of Personnel and Management. If cost savings were not achieved, a "trigger" would create a government plan. The agreement relies on the cost of the measure, which is being scored by the Congressional Budget Office.

Last night, the Senate rejected Sen. Ben Nelson's (D-Ne) abortion amendment that would prohibit subsidies or federal funds from going towards insurance plans that covered abortions. Sen. Nelson has said he would filibuster any legislation that did not prevent abortions from being covered. A similar measure was passed in the House legislation and is known as the "Stupak" Amendment.

November 19th

Majority Leader Harry Reid (D-NV) unveiled the finalized Senate health care reform legislation yesterday. According to Politico, the bill contains a public option with a state opt out clause and would expand coverage to 94% of Americans. The CBO said the bill costs $848 billion and reduces the deficit by $130 billion over the next ten years. The Senate is expected to vote this weekend to begin debate on the legislation. If passed, the Senate bill must be merged with the House bill in conference then voted on again by both the House and Senate before being sent to the President's desk.

November 9th

The House of Representatives passed H.R. 3692, The Affordable Health Care for America Act, by a vote of 220-215 late Saturday night. 39 Democrats voted against the legislation while 1 Republican voted for it. The Senate is still waiting on a CBO score to unveil its final legislative text and action is expected to continue through the rest of the year. H.R. 3692 will have to be merged in conference with the Senate bill, then voted on by both the House and Senate to be sent to President Obama.

October 27

Majority Leader Harry Reid (D-NV) announced that the merged HELP and Finance Health Care Reform legislation will include a public option that allows states to opt out of the government program. Sen. Olympia Snowe (R-ME), the lone Republican to vote in support of the Finance bill, signaled her disappointment with the inclusion of the public option clause.

October 13

The Senate Finance Committee approved Sen. Max Baucus' (D-MT) Health Care Reform legislation by a 14-9 vote. Sen. Olympia Snowe (R-ME) was the only Republican to vote in support of the legislation. The Finance Committee's bill will now be merged with the HELP committee's bill and brought to the Senate floor later this month.

October 7

The Congressional Budget Office released its score of the Senate Finance Committee's Health Care Reform Legislation this afternoon. According to the Washington Post, the expected cost of the legislation would cost $829 billion over the next decade and would meet President Obama's goal of reducing the federal budget deficit by 2019.

The Finance Committee was waiting for the score before proceeding to vote, and is expected to vote on the legislation later this week or early next week. Once it is voted on, the Finance Bill will be merged with the HELP Committee legislation by Majority Leader Reid (D-NV), Sen. Baucus (D-MT), Sen. Dodd (D-CT), and White House representatives into one bill to be presented on the Senate floor later this month.

October 2

Early Friday morning, the Senate Finance Committee concluded consideration of amendments on their health care reform legislation. The Finance Committee is the fifth and final Congressional committee to finish consideration of some form of health care reform legislation. A vote is expected sometime next week, following the CBO's release of the final cost of the legislation.

October 1

According to Politico, Sen. Tom Harkin (D-IA), Chairman of the HELP Committee, told reporters that Republicans will not be included in the merging of the HELP health reform bill and the Finance Committee bill that is being marked up this week. Sen. Harkin said "the people of this country pretty overwhelmingly elected Barack Obama last fall and to make changes…The people of this country overwhelmingly elected Democrats to the House and Senate," and when asked about a public option in the merged bill, said "the question of if it doesn't isn't even an option."

Yesterday the Senate approved a Continuing Resolution (CR) to keep the federal government operating at FY 2009 funding levels. Without the CR, funding for most federal programs (including Titles VII and VII) would have expired last night at midnight. The bill was sent to the White House to be signed by President Obama.

Sen. Mike Enzi (R-WY) introduced an amendment that would have struck Teaching Health Center (THC) language from the Senate Finance Committee's Health Reform bill. Sen. Enzi said he supported the health center language, but it was not under the Finance Committee's jurisdiction. Sen. Enzi later withdrew the amendment after Sen. Max Baucus (D-MT), Chairman of the Finance Committee, said the HELP committee had approved the THC language in the Finance bill. 

September 25

The House approved a continuing resolution (CR) to keep most of the federal government operating at FY 2009 funding levels through the end of October. Without the CR, funding for most federal programs (including Titles VII and VIII) would have expired on September 30^th.

The Senate Finance Committee continued to meet this week debating amendments to Sen.  Max Baucus' mark on the health care reform bill. The committee will continue to meet next week beginning on Tuesday, with the goal of finishing its consideration by the end of the week.

September 15

Sen. Max Baucus is expected to release his mark on the Finance Committee health care reform legislation tomorrow. The release has been delayed due to final negotiations designed to encourage Republican support and keep spending below $900 billion. These negotiations include recommendations for medical liability reform, prohibiting illegal immigrants from receiving benefits, banning federal subsidies on abortions, and determining the cost of Medicaid reform on states. Mark up is expected to begin next week.

During President Obama's address to a joint session of Congress on health care reform last Wednesday, Rep. Joe Wilson (R-SC) yelled "you lie" when the President said health reform would not benefit illegal immigrants. The House of Representatives is expected to vote today on a "resolution of disapproval" regarding Wilson's actions.  

September 10

Last night, President Obama addressed a joint session of Congress, urging lawmakers to pass healthcare reform this year. In his speech, the President made the case for reform, saying “the time for bickering is over.” The President laid out a 10 year $900 billion dollar plan that included mandatory insurance coverage, medical malpractice lawsuit reform, and making it illegal for an insurance company to drop coverage due to illness. President Obama promised any plan he signs would not increase the deficit. The President continued to reiterate his support for a public option, but would not commit to it as a deal breaker, saying it was only one part of his plan and if lawmakers came to him “with a serious set of proposals”, he would be there to listen.

September 9

This evening President Obama takes center stage at a joint session of Congress to make the case for health care reform. The address will be televised at 8:00 pm EST.

August 18

Recess Update:

Health Reform: As the healthcare debate has heated up on the news channels and in townhalls across the country, things have slowed down in Washington during the annual summer recess.  However, there are still negotiations occuring behind closed doors.  President Obama met by telecoference with 6 members (3 from each party) of the Finance Committee yesterday.  They discussed limiting the scope of the bill once Congress reconvenes, in an effort to lower the pricetag.  They also discussed the recent reactions at townhall meetings.

Link: Washington Post

Stimulus Update: We are still waiting for the release of grant guidance for the primary care training money.  However, we do know that they will be funding new applications, not just current ones. 

Also, AHRQ released a call for applications for those interested in grants to study the effectiveness of primary care practice transformation.  These are one or two year grants that can be worth up to $300,000 annually.  They could be a great opportunity for any interested family physician.  You can apply electronically between October 18 and November 18.

Link: Transforming Primary Care Practice (R18)

July 28

HRSA has released details of funding from the Recovery Act that is going to health professions programs.  The Primary Care Cluster (primary care medicine, dentistry, and physician assistants) received $47.6 million in funding.  For more information, visit the HRSA website

Link: HRSA's ARRA Details

July 24

The House has passed its 2010 Labor-HHS-Ed spending bill, 263-153.  20 Republicans voted for it, and 5 Democrats voted against it.

July 23

Senate Democrats have officially announced that they will not pass a health reform bill before the August Recess.  They will attempt to pass legislation in fall instead.

July 13

President Obama is expected to nominate Dr. Regina Benjamin, a family physician from Alabama, as the next Surgeon General.

Source: Associated Press

July 7

The Senate Finance Committee is expected to release their portion of the Senate health reform bill this Thursday or Friday.  Markup is expected to begin next Monday and be completed by the 17th.  As always, these dates are incredibly tentative.

The Finance Committee has jurisdiction over all entitlement spending, so their portion of the health reform bill will include the Medicare and Medicaid provisions.

June 24

MSNBC.com published an article about the primary care shortage.  It looks at specialty choices of young physicians which is resulting in an aging primary care workforce.

Link: msnbc.com

June 20

The Washington Post published an article entitled, "Primary-Care Doctor Shortage May Undermine Reform Efforts."

Link: WashingtonPost.com

June 16

Fitzhugh Mullen and Elizabeth Wiley recently contributed to the Health Affairs Blog a post about the proposed GME slot expansion by Sens. Nelson and Cantwell and Reps. Crowley and Schwartz.  The post offers an overview of the current GME system and the potential impact of expanding the amount of slots as 15%.  The authors share our fear that the expansion would be much more friendly to subspecialized care than to primary care.

Link: Beware the Siren Song of New GME: Graduate Medical Education and Health Reform.

June 10

The three House committees working on health reform legislation released an outline of the bill that is soon to be released.  Included in the outline is a mention of a workforce investiment that "boosts training of primary care doctors and expands pipeline of individuals going into health professions."

Link: Tri-Committee Release

The House Appropriations Committee released its subcommittee allocations.  The Labor-HHS-Education Subcommittee will receive $160.7 billion. This is a $7.5 billion increase over FY 2009.

The committee also released a tentative schedule for their FY 2010 spending bill markups.  L-HHS-Ed is scheduled to be marked up by the subcommittee on July 8 and the full committee markup is on July 14.  They are expecting floor consideration from July 22-24.  As always, these dates are incredibly subject to change.

Link: Committee Schedule

June 9

The Senate HELP Committee released their health reform bill.  The bill does not include the politically contentious provisions for a public plan option or employer mandates.

Included in the bill is a provision that would reauthorize the Title VII health professions programs.

June 4

President Obama sent a letter to HELP Committee Chairman Kennedy (D-MA) and Finance Committee Chairman Baucus (D-MT) that outlined his health reform proposals.  In the letter, he insisted that the reform include a public insurance option.  He also called for an insurance exchange program where people can find the insurance plan (public or private) that works best for them.  Payers must also stop denying coverage for preexisting conditions.  He also stressed that we most lower health care costs while not harming quality.  He wants to focus more on replicating best practices.  He also called on Congress to take more consideration of MedPAC's recommendations.

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