Legislative Affairs Committee Report
 "It was the best of times; it was the worst of times"—Charles Dickens
While Dickens was referring to the time period around the French Revolution, this quote holds true for the legislative activities of the Society over the past year. While we had some minor victories on the funding for primary care education and the reauthorization of the National Institutes of Health, the outlook for GME financing remains bleak and continues to be attacked. Throughout this sea of change and compromise, the Society continues to advocate for the needs of academic family medicine through the work of the Legislative Affairs Committee. What follows is a recap of our work over the past year.
Title VII Appropriations
Sounding like a broken record, the Administration once again zeroed out funding for this vital program to academic family medicine. Fortunately, Congress did not listen and increased funding for all Title VII health professional programs by $39.5 million to a total of $184.7 million. Of this allocation, the primary care medicine and dentistry cluster will receive $48.8 million, of which no less than $24.6 million will go toward family medicine programs. Other key programs that received increases included geriatrics, the National Institutes of Health, community health centers, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid services, which received a $52 million increase to keep the 1-800-MEDICARE call centers open through September 30, 2007. Interestingly, in the President’s proposed 2008 budget, primary care training programs under Title VII were not even evident in the budget. They were not zeroed out; they are just not present. We will continue to advocate for these programs as a key portion of our advocacy agenda for the next year.
Graduate Medical Education
The use of volunteer preceptors to train residents remains an issue that we are working on with the Centers for Medicare and Medicaid Services (CMS). At the core of the issue is that CMS will not pay either indirect medical education (IME) or direct medical education (DME) dollars for time spent by residents in non-hospital settings with volunteer preceptors. We have long been advocating for a change in the interpretation of regulations to remedy this situation. Despite continued meetings with the administration of CMS, including the last official act of former Commissioner Mark McClellan being a conference call on this issue, no workable solution has been put forth. On February 1, 2007, CMS published a proposed rule that included a section on GME. However, this rule is not workable for family medicine. Despite others from the academic community seeing this as viable, we continue to stand up against it, as it would cost most of our programs significant amounts of money. We will continue to advocate for a solution that will have the least financial impact on our residencies.
In a new twist on the GME battle, the President’s FY08 budget held two major surprises: (1) the Administration would like to prevent Medicaid from using its dollars toward GME and (2) they would like to eliminate duplicate IME payments to hospitals for managed care beneficiaries. This Medicaid proposal will be a new legislative advocacy priority for the Society, and we know that all but three states (Illinois, North Dakota, and Texas) use Medicaid money for GME purposes. It appears that if such a proposal were to be accepted, it would wreak havoc in payments to teaching hospitals. More on this topic will be coming out over the next year.
National Institutes of Health Reauthorization
In this newest legislative advocacy arena, there have been some small victories for family medicine. In the Senate Finance Committee’s report this fall, the Committee recognized the importance of translational research, and its comments helped to guide the appropriation of a new $40 million program for “thinking-outside-the-box research,” according to Senator Tom Harkin (R-IA). In addition, $91 million was set aside for grants to first-time investigators.
In the reauthorization process, a late compromise between Senate and House negotiators led to the passage of the National Institutes of Health Reform Act of 2006 in the waning days of the 109th Congress. This legislation reauthorizes NIH for the next several years. However, this bill does not provide for an authorized fund for translational research but rather a common fund that the NIH director will establish as a reserve account from each of the individual institute’s and center’s budgets. We will continue to advocate for translational research as part of our research advocacy efforts.
Title VII Reauthorization
With the results of the 2006 election changing the leadership in Congress from the Republicans to the Democrats, every committee leadership structure has changed. Title VII reauthorization now falls under the leadership of Senator Edward “Ted” Kennedy (D-MA). Both Senator Kennedy’s and Senator Hillary Rodham Clinton’s (D-NY) staffs are working on portions of Title VII reauthorization. STFM staff has been active in these discussions and will continue to work for the development of a new, revitalized Title VII authorization.
Other Issues
With the continued push of the AAMC for an increase in the medical school class size of 30%, efforts need to be taken to ensure that the resulting physician workforce accurately represents the needs of our society. After much discussion, the Society has agreed to accept the workforce principles of the AAFP with some additional caveats.
STFM presented its third annual Advocate Award to Robert Crittendon, MD, of the University of Washington. Dr Crittendon received this award for his long-term advocacy efforts in the area of health care financing and health insurance as a social right. He is the founder of the Herndon Alliance, a national coalition of organizations advocating for health insurance for all.
Milestone
This report would be remiss if it did not celebrate the 15th anniversary of Hope Wittenberg’s role as lobbyist for the Society. Because of her dedication, long hours, and strong relationships with key health care legislators, our Society has a much more prominent role on Capitol Hill and is a key player in academic health care decisions. One needs to look no further than the GME debate to see the results of our legislative advocacy. Congratulations to Hope on reaching this milestone, and let’s hope that she has at least 15 more years with us.
As Legislative Affairs Committee chair, I would like to thank the members of the STFM Legislative Affairs Committee for all of their efforts. Working with Kathleen Elsberry, MD; English Gonzales, MD, MPH; Dan Lasser, MD; Eleanor Lisbon, MD; Mike Meharry, MD; Osman Sanyer, MD; and Rick Streiffer, MD, makes chairing the committee a pleasure. In addition to the efforts of Hope in our Washington, DC, office, I would also like to thank Kathryn DiBitetto for her work as our government relations assistant and congratulate her on her 1-year anniversary working for STFM. Finally, I want to thank each of you, as members of STFM, for your personal advocacy efforts and ask that you continue this work to advance the efforts of our Society.
Terence Steyer, MD, Chair
Legislative Affairs Committee
Terrence Steyer, MD, Chair
Medical University of South Carolina
Kathleen Elsberry, MD
University of Washington
English Gonzales, MD, MPH
Medical Center East FMR
Birmingham, Ala
Dan Lasser, MD
University of Massachusetts
Eleanor Lisbon, MD
University of Kansas
Mike Meharry, MD
University of Iowa
Osman Sanyer, MD
University of Utah
Rick Streiffer, MD
Tulane University
STFM Liaison:
Hope Wittenberg, MA
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