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

Today the House of Representatives approved an amended continuing resolution to fund federal programs through the end of Fiscal Year 2013 by a vote of 318-109. The Senate had amended and approved the bill the day before by a vote of 73-26.

With a few exceptions, the continuing resolution continues funding at FY 2012 levels, but the funding in the bill will be subject to the 5.1 percent cut mandated by sequestration.The bill also gives departments and agencies 30 days following enactment to submit an FY 2013 operating plan that reflects sequestration cuts. Senator Harkin's amendment, which would have provided funding levels negotiated in December for Department of Health and Human Services programs, rather than continuing resolution funding, failed to pass last week and was not attached.

The CR was sent to President Obama and awaits his signature.

 

March 12

The CR as released includes full appropriations bills for FY 2013 for the Departments of Agriculture; Commerce, Justice, and Science; Homeland Security; and Military Construction and Veterans Affairs.   It also contains continuing resolutions for the remaining bills, including Labor, HHS, and Education.  This would essentially continue funding at FY 2012 levels.  Senator Harkin, Chairman of the Labor-HHS-Education Subcommittee has indicated he plans to file an amendment that would insert his subcommittee's spending bill, as negotiated in December, in place of a continuing resolution.  We will keep you updated as more information becomes available.

 

March 6

The House of Representatives approved the "Department of Defense, Military Construction and Veterans Affairs, and Full-Year Continuing Appropriations Act" (HR 933) by a vote of 267-151. The bill allows the Departments of Defense, Military Construction, and Veterans Affairs some funding flexibility to absorb sequestration cuts.  The bill also extends the current continuing resolution's FY 2012 funding levels for the remainder of the fiscal year, minus an across-the-board cut of 0.098 percent.  This reduction is in addition to the 5.1 percent across-the-board sequestration cuts.  The bill will now move to the Senate for consideration.

March 5

March 6

The House of Representatives approved the "Department of Defense, Military Construction and Veterans Affairs, and Full-Year Continuing Appropriations Act" (HR 933) by a vote of 267-151. The bill allows the Departments of Defense, Military Construction, and Veterans Affairs some funding flexibility to absorb sequestration cuts.  The bill also extends the current continuing resolution's FY 2012 funding levels for the remainder of the fiscal year, minus an across-the-board cut of 0.098 percent.  This reduction is in addition to the 5.1 percent across-the-board sequestration cuts.  The bill will now move to the Senate for consideration.

March 5

The House Appropriations Committee's Subcommittee on Labor-HHS-Education held an oversight hearing for HHS Public Health and Research Organizations.  Witnesses were: Dr. Francis Collins, MD, PhD, Director of NIH; Dr. Tom Frieden, MD, MPH, Director of CDC; Dr. Carolyn Clancy, MD, Director of AHRQ; Dr. Patrick Conway, MD, Director of the Center for Clinical Standards and Quality, representing Medicare and Medicaid Innovation; and Dr. Mary Wakefield, PhD, RN, Administrator of HRSA.  Each witness spoke to the importance of the work of their organization and its goals and answered questions from members of the subcommittee.  The focus of the subcommittee's questions was whether or not the federally funded research done by these organizations is duplicative and whether or not cuts should be made.  The witnesses focused on how their work is collaborative rather than duplicative, and each organization contributes a different piece to the research puzzle.  Their written testimony is available on the Appropriations Committee's website.

Congress has returned from its Thanksgiving holiday, and talks are now underway between members of both houses of Congress and President Obama on how to avoid the fiscal cliff. Sequestration and mandatory cuts to federal spending will go into effect on January 2, 2013, if no agreement is reached on a budget deal to reduce the deficit. We will keep you posted as these negotiations progress.

July 31

This afternoon, Senate Majority Leader Harry Reid announced that he, House Speaker John Boehner, and President Obama have reached agreement on a deal to continue funding the federal government through March of 2013, in order to avoid government shut down when current funding expires September 30th.  The continuing resolution will keep funding at current levels, consistent with what was set forth in the 2011 Budget Control Act.  It is still being drafted, and votes will be held in early September when Congress returns from the August recess.

July 30

The House Appropriations Committee has not yet scheduled a markup of the Labor-HHS-Education bill released by the subcommittee on July 18th.  With the August recess approaching at the end of this week, no markup is expected in the near future.

July 25

Today Senator Tom Harkin (D-Iowa), Chairman of the Senate Labor-HHS-Education Appropriations Subcommittee, released a report prepared by the committee's majority staff containing estimates of how sequestration budget cuts will impact select Labor, HHS, and Education programs should they be allowed to take effect in January.  The report makes no specific mention of health professions programs, but it does make statements about the importance of investing in health care and education.  Read the full report.

July 18

This morning the House Appropriations Subcommittee on Labor-HHS-Education met for the markup of their FY 2013 spending bill.  The bill, which also includes a reduction of $1.3 billion from HHS's current discretionary budget and a $453 million reduction for HRSA, would eliminate the Agency for Healthcare Research and Quality.  Funding levels for specific programs, i.e., Title VII Primary Care Training, have not yet been made available.  The bill was reported out to the full Appropriations Committee, with Representative Flake (R-AZ) as the sole Republican voting against it.  The full committee markup has not yet been scheduled, but we will keep you updated as more information becomes available.

July 13

Next Wednesday, July 18, the House Appropriations Subcommittee on Labor-HHS-Education will meet to markup their bill for FY 2013 program appropriations.  If the subcommittee votes to report their draft bill out, the full Appropriations Committee will then meet for another markup and a full committee vote.

July 12

Yesterday the House voted in favor of repealing the Affordable Care Act for the second time.  The vote was 244-185, with five Democrats and all House Republicans voting in favor of repeal.  However, as in January of 2011, the vote is primarily a symbolic gesture.  Repeal is unlikely to find traction in the Democrat controlled Senate.

June 28

Today the Supreme Court, in a majority opinion authored by Chief Justice John Roberts, ruled the individual mandate constitutional in a vote of 5 to 4.  Though the court rejected the government's argument that the individual mandate is permissible given the federal government's authority to regulate interstate commerce, it upheld the individual mandate based on the argument that Congress has the authority to impose a tax penalty on individuals who do not purchase insurance.

Another key piece of the ACA was the expansion of Medicaid. The law, as passed, would withhold all Medicaid payments to states that did not comply with the expansion. The court determined this to be unconstitutional. While Congress may withhold new funds related to the expansion, it cannot refuse to pay the entire Medicaid allotment to states which don't take part in the expansion. This finding does not affect the rest of the law, and states now will be able to opt out of the expansion without facing a penalty.

The two great unknowns following this ruling are whether enough revenue will be raised from insurance premiums or penalties to pay for the law and how many people will be covered under Medicaid. What we do know is that the law will stand, which means many of our key programs, such as Title VII, Medicare physician payments, and all of the trust fund programs which are tied to the law, such as Teaching Health Centers, the National Health Service Corps, Community Health Centers, and the Prevention and Public Health Fund, are safe for now.

June 15

Yesterday, the Senate Appropriations Committee met to markup and vote on the Labor, HHS, and Education spending bill for FY 2013.  The bill was reported out to the Senate following a party line vote of 16 to 14.  The bill provides $48,962,000 for Title VII Primary Care Training and Enhancement, a $10 million increase from previous funding levels.  However, language in the Senate report directs funding towards PA training.  It also includes instructions for HRSA to change its guidance in FY 2013 to allow funds to be used for the development of training programs and to apply for accreditation.  The House Appropriations Subcommittee will markup its own bill next week, leading up to what is sure to be a long bargaining process in order to reconcile the two chambers' bills.

June 13

Yesterday, the Senate Appropriations Subcommittee for Labor, HHS, and Education met for a markup of its FY 2013 spending bill.  The bill includes a $10 million increase in the funding level for Title VII Primary Care Training, but it is unclear how the Section 747 money would be directed.  The bill also restores Children's Hospital GME to current funding levels.  No amendments were offered, and the bill was approved with a party line vote of 10 to 7.  The bill will be considered by the full Appropriations Committee tomorrow.  The House is expected to have a subcommittee draft of its own brought up next week.  We will keep you posted as things unfold.

March 30

Yesterday, the House of Representatives approved Representative Paul Ryan's (R-WI) budget for FY 2013 by a vote of 228-191.  Ryan's budget calls for an overhaul of the existing tax code, major changes in the Medicare program, and a lower spending cap than the one set in last year's debt limit agreement.  Though his budget has virtually no chance of passage in the Senate, where Democrats maintain control, it is an important indicator of the Republican position on major spending and budget issues ahead of the general election.

March 23

On March 20, Representative Paul Ryan (R-WI), Chairman of the House Budget Committee, unveiled his budget blueprint for FY 2013.  On Wednesday night, the Budget Committee approved Ryan's plan by a vote of 19-18.  The budget is set to go to the House floor for a vote next week.  Highlights of Ryan's plan include reducing the discretionary spending cap and replacing automatic spending cuts with mandatory spending reductions that House committees would be responsible for making.  The full text of the budget can be accessed here.

February 17

The compromise reached late Wednesday night to extend the payroll tax holiday, extend unemployment insurance, and address the Medicare physician payment issue passed both the House and the Senate today.  The president is expected to sign it as soon as it reaches his desk.

February 16

Congressional negotiators reached a compromise agreement last night to address the Medicare physician payment issue (SGR payments), an extension of unemployment insurance, and an extension of the payroll tax holiday through the rest of 2012.  The agreement includes a freeze of Medicare physician payments through the end of the year.  Offsets, or savings used to pay for the cost of these items, have not been fully identified at this point, but it is predicted that some funding will come from the prevention trust fund created under the Affordable Care Act, as well as a reduction in Medicaid Disproportionate Share Hospital (DSH) payments to hospitals, among other places.  Congress is expected to vote on Friday, or possibly over the weekend, but it remains unclear whether or not rank and file members of Congress will go along with the compromise agreement.  We will keep you updated as information becomes available.

February 13

The Obama administration released its budget for FY 2013 this afternoon.  Highlights of the Department of Health and Human Services proposed budget include: increases in Title VII primary care training directed at physician assistant training, a proposed reduction to Medicare GME funding of almost $10 billion over 10 years, the elimination of AHECs and HCOP programs, a small increase in funding for AHRQ, and level funding for NIH.  For a more detailed summary of the budget proposal, click here.

February 9

The Center for Medicare and Medicaid Services (CMS) has revised and posted its "Guidelines for Teaching Physicians, Interns, and Residents" fact sheet.  The updated and downloadable document provides information about payments for physician services in teaching settings, as well as general documentation and E/M documentation related to graduate medical education.  Of note, the brochure clearly explains the primary care exception to the teaching physician guidelines.  Read the document here.

January 25

Last night President Obama delivered his third State of the Union address.  Though healthcare reform is certainly among the president's most significant domestic legislative accomplishments, it received little attention in last night's speech.  He signaled his continued commitment to making sure we "do not go back to the days when health insurance companies had unchecked power to cancel your policy, deny you coverage, or charge women differently from men" and cited healthcare legislation as an example of his willingness to reach across party lines, as the law "relies on a reformed private market, not a government program."  As expected, President Obama chose to focus the bulk of his speech on jobs and the economy, laying the groundwork for his coming re-election campaign.

December 23

In a last minute vote before the holiday weekend, Congress passed a bill allowing a two month extension of the the payroll tax holiday and unemployment benefits. Also included in the bill is a temporary fix to delay the 27.4% cut to Medicare physician payments that was set to go into effect January 1st.  This is a temporary, two month patch, and we continue to wait for a permanent, sustainable solution.

December 16

After a day of difficult negotiations, last night the leadership of both parties announced agreement on a conference report for FY 2012 appropriations.  The House and Senate are expected to vote on the conference report today, just in time to avert a government shutdown when the current continuing resolution expires at midnight.  The conference report includes level funding for Section 747, primary care training under Title VII, continuing our current level of just over $39 million.  This will leave approximately $4 million available for new grants, but HRSA has not yet decided how those funds will be used.  For more information on health appropriations, see the tables available on pages 95-126 of the document available here.

December 7

Tomorrow, December 8th, the House and Senate plan to hold a joint Conference Committee meeting on the outstanding fiscal year 2012 appropriations bills.  With the current continuing resolution set to expire December 16th, both parties want to achieve passage of the funding bills to avoid having to deal with them next year or having to pass more temporary spending fixes.  One of the more contentious bills the Conference Committee will consider is the Labor/HHS appropriations bill, which contains funding for the Title VII primary care cluster.  On the House side, the primary care cluster was zeroed out for 2012, while the Senate version maint