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Committee Reports |
Legislative Affairs Committee Report
“A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty."—Sir Winston Churchill The words of Winston Churchill hold true today in the area of legislative affairs for academic family medicine. While we have been met with many difficulties, we remain optimistic by looking for the opportunities that lie within. Our optimism has contributed to our successes on several levels in both the legislative and regulatory arenas over the past year. Below are the highlights of our activities: Title VII Appropriations This past year, the President’s budget surprised us and did not zero out Title VII funding; instead, it was not even mentioned! Fortunately, Congress debated the issue and voted to keep Title VII level-funded at a total of $184.7 million. Of this allocation, the primary care medicine and dentistry cluster was slated to receive $48.8 million, the same as last year. After an across the board budget cut on Labor-HHS appropriations of 1.747%, the primary care medicine and dentistry cluster has an appropriation of $47.9 million. In the President’s proposed 2009 budget, Title VII was in the budget but with a recommendation for no funding. That would include the primary care cluster as well as Area Health Education Centers (AHECs) and other primary care funding. To continue our advocacy efforts in this area, we played a large role in developing and participating in a briefing for Capitol Hill staff on the need for more funding for Titles VII and VIII. Under the auspices of the Health Professions and Nursing Education Coalition, we invited STFM Past President Denise Rodgers, MD, to speak at the briefing. In addition, former STFM Board member and Surgeon General David Satcher, MD, was one of the panelists. A strong case was made for fully funding these programs, and there was a great turnout, with more than 50 Hill staff attending. Title VII Reauthorization Discussions centering around reauthorizing Title VII programs, which we believe would make the battle for appropriations less difficult, have become reinvigorated over the past year. In February 2008, Senator Edward Kennedy (D-MA) held a Senate Health, Labor, Education, and Pensions (HELP) committee hearing titled “Addressing Health Care Workforce Issues for the Future.” STFM member Kevin Grumbach, MD, presented his workforce research at this meeting and stated, “Ongoing federal investment in the medical education pipeline to prepare and motivate physicians to participate in the NHSC and to work in CHCs should be considered an integral component of efforts to improve access to care for the underserved.” STFM staff was involved in prepping committee staff for this hearing and providing information to help staff prepare questions for the senators to ask. This hearing also has been useful in our staff’s subsequent conversations with Hill staffers, helping to lay the foundation for the reauthorization of Title VII programs. Graduate Medical Education The financing of graduate medical education has been hit on two levels this year, with the executive branch attacking the financing streams provided through both Medicare and Medicaid. The Medicare financing issues continue to hinge on the point of having a teaching hospital assume “all or substantially all” of the costs for training with a volunteer preceptor. We are continuing to work both with CMS staff on a regulatory fix and Hill staffers on a legislative fix but are currently at a standoff. We did get a 1-year moratorium on attacking Medicaid financing of GME. However, this moratorium expires in May 2008. While CMS has estimated the impact of this rule at the level of $15 billion over 5 years, the House Oversight and Government Reform Committee has estimated the impact at $50 billion over 5 years. We are working on extending the moratorium for another year. The FY2009 President’s budget also would cut Indirect Graduate Medical Education Funding by huge amounts, reducing the update factor from its current 5.5% to 2.2%. We will continue to work on these issues that threaten our residencies, teaching hospitals, and the primary care workforce. Awards STFM presented its third annual Advocate Award to the WWAMI Residency Network. This network has developed ways to involve all residency faculty in these five states in legislative advocacy issues, both on a state and national level. In addition, they are discussing collaborative projects, such as the concept of an Educational Health Center, and working with legislators to find funding for these new educational models. This year also featured the first Legislator Recognition Award by the Academic Family Medicine Advocacy Committee, convened by STFM. The winner of the inaugural award is Rep. Kenny Hulshof (R-MO, 9th) for his work on graduate medical education financing. Future Visions The past year has also allowed for the Legislative Affairs Committee and the STFM Board of Directors to discuss some strategic changes that will help our committee to function better. First, the Board decided to extend the terms of its current members for 1 additional year to put our committee members’ appointments in sync with the Congressional calendar. This will allow us to select a committee that can have the maximum impact on the legislative process. Second, the committee has done some prioritization of legislative issues to help guide our staff to utilize their limited time in the best manner. Here is the committee’s prioritization: Must Do
Engage as Needed
Work with AAFP and other organizations on an as-needed basis
Kudos Once again, our Washington, DC, staff continues to do an incredible job in advocating for STFM’s legislative priorities. Hope Wittenberg, MA, works daily with other lobbyists, organization staff, and Hill staffers to advocate for academic family medicine. We would not be where we are today without Hope’s dedication and leadership. We also welcomed Eric Gascho to our staff as our government relations assistant. Eric has quickly integrated himself as part of our team and is doing an amazing job. As Legislative Affairs Committee chair, I thank the members of the STFM Legislative Affairs Committee for all of their efforts. Working with 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. As my time as committee chair draws to a close, I also 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. Your phone calls, e-mails, and letters make a difference! Terence Steyer, MD, Chair Legislative Affairs Committee Terry Steyer, MD, Chair English Gonzalez, MD, MPH Dan Lasser, MD, MPH Michael Meharry, MD Osman Sanyer, MD Rick Streiffer, MD STFM Liaison: |
