legislative update michael j. dyer, jd vice president for government relations, aacom ome conference...
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Legislative Update
Michael J. Dyer, JDVice President for Government Relations, AACOM
OME ConferenceJanuary 13, 2007
Current Environment
Themes Control Shift
Recurring ThemesRecurring Themes
Cost
Accountability
Transparency
Baseline Deficit ProjectionsBaseline Deficit Projections[in billions of dollars][in billions of dollars]
-600
-500
-400
-300
-200
-100
0
2006 2011 2016
President's Budget Plus Omitted Items
Source: OMB, 02/06; House Budget Democratic Staff, 02/06
Accountability
Benefits to the Public Biggest Bang for Fewest Bucks
Transparency
Lobby Reform Ethics Reform Earmark Reform
Who’s In Charge?
Meet the New Chairman
House Appropriations Committee
David Obey (D-Wis.)
Meet the New Chairman
Senate Appropriations Committee
Robert C. Byrd (D-W.Va.)
Meet the New Chairman
House Energy and Commerce Committee
John Dingell (D-Mich.)
What’s Up, Doc!andWhat it Means to OME
Labor-HHS-EducationLabor-HHS-EducationSubcommittee AllocationSubcommittee Allocation
FY 2004 $139.2 billion (+5.2%)FY 2005 $142.7 billion (+2.4%)FY 2006 $141.1 billion (-1.1%)FY 2007 (President) $137.8 billion (-2.3%) FY 2007 (House) $141.9 billion (+0.6%) FY 2007 (Senate) $142.8 billion (+1.1%)
Source: House and Senate Appropriations Committees and OMB
Title VII Health ProfessionsTitle VII Health ProfessionsDiversity ProgramsDiversity Programs (in millions)(in millions)
FY 2005 Final
FY 2006 Final
Percent Change
FY 2007 House
Percent Change
FY 2007
Senate
Percent Change
Centers of Excellence
$33.6 $11.9 -64.7% $11.9 0% $11.9 0%
Health Careers Opportunity Program
$35.7 $4.0 -88.9% $0 -100% $4.0 0%
Faculty Loan Repayment
$1.3 $1.29 -1% $0 -100% $1.29 0%
Scholarships for Disadvantaged Students
$47.1 $46.7 -1% $46.7 0% $46.7 0%
Title VII Health ProfessionsTitle VII Health Professions (in millions) FY 2005
FinalFY 2006
FinalPercent Change
FY 2007 House
Percent Change
FY 2007 Senate
Percent Change
Primary care medicine & dentistry
$88.8 $40.9 - 54% $40.9 0% $50 22.4%
AHECs $29.0 $28.7 - 1% $28.7 0% $28.7 0%
HETCs $3.8 $0 - 100% $0 0% $0 0%
Allied health $11.8 $4 - 66.3% $4 0% $4 0%
Geriatric training $31.6 $0 - 100% $31.5 -- $0 0%
Rural training $6.1 $0 - 100% $0 0% $0 0%
Public health, preventive medicine
$9.1 $7.9 - 12.9% $0 -100% $8 0%
Health administration
$1.1 $0 -100% $0 0% $0 0%
Workforce analysis
$0.7 $0 -100% $0 0% $0 0%
FY 2007 Appropriations
109th Congress failed to pass a Departments of Labor, Health and Human Services, and Education Appropriations bill for fiscal year (FY) 2007
Current continuing resolution (CR) continues funding at FY 2006 levels FY 2006 level for Title VII programs – 51.5% cut from FY
2005 level $ eliminated for Geriatrics Training, Health Education and
Training Centers and Burdick Rural Training Significant cuts in $ for primary care training Near total elimination for HCOP and COE
FY 2007 Appropriations (continued) Current CR expires on February 15th
Seek restoration of some funding for the long-term CR Specter/Harkin Amendment Veterans health care will be a priority
FY 2008 Appropriations
President’s Budget - first week of February Proposal likely to include huge Title VII cuts Depending on a Budget Resolution, Title VII
may have a better shot
Reauthorizations
Student Assistance Title VII
What About GME?
IME Adjustment On Oct. 1, 2007 and beyond:
5.5%
Resident Limits
Advisory Commissions and Councils Medicare Payment Advisory Commission
(MedPAC) IME Recommendation
Reduce the IME Adjustment by 1% from 5.5% to 4.5%. The 1% differential should be used to fund implementation of the severity adjustment.
MedPAC (continued)
2.7% Empirical Adjustment IME in Appropriations ? Interest in workforce
Council on Graduate Medical Education (COGME) Ongoing interest in workforce Flexibility in GME funding New paradigm for physician service in
improving access to healthcare
Children’s Hospital GME
Has been reauthorized (P.L. 109-307) Increasing funding support Possible model ?
Other Major GME Issues for the 110th Congress Caps Non-hospital training
“Democracy is the theory that the common people know what they want and deserve to get it good and hard.”
- H.L. Mencken
To download this presentation: www.aacom.org
On the Government Relations page
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