A Looming Crisis in Federal Research Funding?

January 27, 2011 by

Scientific investigators have a reputation on Capitol Hill as being reluctant to enter the fray of grassroots advocacy. But judging from a meeting I attended with key Congressional staff and advocacy representatives from a diverse group of research interests this week, it would be in the best interests of researchers to change that perception on Capitol Hill. 

I’m sure you have all read about the intent of the new Congress to tackle deficit reduction by cutting government spending. If you’re thinking that it can’t get any worse than the virtual flat funding that occurred for most of the past decade, you need to think again. The message from leading Congressional staffers was loud and clear — Republicans are now putting pencil to paper and seriously discussing several proposals on the table. The most modest of budget cuts would roll federal spending back to FY 2008 levels. That would mean an approximate cut of 4.3 percent for NIH. Several other proposals would either cut $100 billion from the overall federal budget in FY 2012 or would return federal spending to FY 2006 levels. We’re talking potential double digit level cuts to NIH of 10 percent or more. 

These proposals are not some hypothetical scenario that may pop up in discussions in the distant future. The House Republican leadership is poised to act on deep budget cutting measures in mid-February. As the Congressional staff leaders told us this week, if the scientific community has any hope of averting the deepest of cuts, we must get our message out to legislators, especially the newly elected ones, who need to understand the practical effect on jobs and the economy if these deep cuts go into effect. 

Hundreds of AGA members in private practice have heeded AGA’s call to contact their legislators when they have faced reductions in their Medicare fees of more than 20 percent due to the ongoing troubles with the sustainable growth rate (SGR) formula. These AGA members have made a meaningful impact in Congress as lawmakers have voted repeatedly to avert these steep Medicare fee reductions. We haven’t achieved the long-term goal of a permanent remedy to the SGR, but I will bet you that there is not a Congressional office on Capitol Hill that doesn’t know about the problems with the SGR formula. They have been educated by practicing GIs and their other colleagues in medicine. I don’t think the same can be said about the practical effects of deep cuts to the research budget. 

It’s time for the research community to take up their own “SGR campaign.” If we don’t take the time to effectively educate lawmakers on the real impact of deep reductions to the nation’s biomedical research investment, and the negative impact it will have on the economy and jobs, it may take decades to rebuild the commitment to improving the nation’s research enterprise.

AGA is ready to help, if you’d like to become involved. Read more about AGA’s Congressional Advocates Program on the AGA Washington Insider and contact Lauren DePutter at ldeputter@gastro2.org or 240-482-3221 to join.


Obama Speech Covers Important Issues for GI

January 27, 2011 by

(Official White House Photo by Lawrence Jackson)

President Obama delivered his annual State of the Union address in which he outlined his priorities for the coming year. As a result of the 2010 midterm elections and the tragic shooting in Arizona, the speech took on a conciliatory tone with the President trying to find common ground with Republicans and focusing on areas where they can work together.

The president talked about the Patient Protection and Affordable Care Act (PPACA) and stated that he was open to improving and amending the law. He stated that he supported repealing the 1099 provision and was open to ideas that would lower costs and improve care. President Obama also mentioned the need to reform medical liability since lawsuits drive up health-care costs, but did not offer specifics on how to change the system. 

A major emphasis was put on investing in science and technology and the president mentioned the need to invest in biomedical research. The AGA was pleased that the president expressed his continued support for biomedical research since NIH funding is an area that may be vulnerable in the budget process given the climate of cost-cutting. The Republicans have proposed cutting all discretionary spending to 2008 levels, which could mean a 4.3 percent cut for NIH. More conservative members of the Republican party have called for even deeper cuts, so it will be challenging to maintain adequate levels of NIH funding. The AGA continues to work with the research community through the Ad Hoc Group on Medical Research in advocating for sustained levels of funding for NIH.

President Obama is expected to release his budget in the next few weeks and Congress must move to enact another continuing resolution since the current budget expires on March 4. The debate over how to proceed will undoubtedly be contentious given the House Republicans’ pledge to cut spending.   

We will continue to monitor the budget process and keep you up-to-date via the AGA Washington Insider.

Senate Introduces Bipartisan Legislation to Repeal 1099 Provision

January 26, 2011 by

With the beginning of the new session in the Senate, legislation was introduced by Sens. Mike Johanns, R-NE, and Joe Manchin, D-WV, to repeal the 1099 provision in the Patient Protection and Affordable Care Act (PPACA), which requires businesses to file a 1099 form for all goods and services of $600 or more. The business community was vocal in its opposition to this provision since it would be a tremendous regulatory burden, and members of both parties have supported its repeal. 

AGA supports repeal of the 1099 provision since this will negatively impact physician practices, and we will continue to monitor progress on this legislation.  Efforts to repeal the provision fell short in the last Congress, but both parties and President Obama have stated that they would like to move the repeal legislation as one of its first orders of business. Signaling the priority that the House Republican leadership has given this issue, they have re-numbered the bill H.R. 4, which means the bill could be taken up in the next few weeks.  (The first five numbers are reserved for the majority party’s priorities for bill numbering.)      

The repeal of health-care reform continues to consume both chambers as Senate Minority Leader Mitch McConnell, R-KY, has stated that he will continue to push for a vote on the repeal of PPACA that passed the House last week and will continue to offer it as an amendment to legislation before the Senate. The Democrats have countered that they will offer amendments of their own to preserve some of the more popular provisions in PPACA and force Republicans to vote against things like eliminating pre-existing conditions, allowing parents to keep their kids on their insurance until the age of 26, preventive benefits, and eliminating the “donut hole” for seniors in the Medicare  prescription drug benefit.    

Continue to read the AGA Washington Insider and AGA eDigest for more updates on health-care reform and other key policy issues.

House Votes to Repeal Health-Care Reform Law

January 20, 2011 by

The House voted to repeal the Patient Protection and Affordable Health Care Act (PPACA) by passing H.R. 2, the Repealing the Job-Killing Health Care Law Act. The House also passed H.Res. 9, which instructs four authorizing committees in the House to replace certain provisions and sections of the law addressing issues such as medical liability reform, controlling costs and improving access to care.                     

The authorizing committees will begin to conduct hearings on these issues starting with the House Judiciary Committee hearing on medical liability reform. The committees were not given a timeline to complete their work, but it is assumed that they will try to come up with some alternatives and connect them with their efforts to reduce the budget deficit since the Republican majority sees these two issues as invariably linked. 

As part of H.Res. 9, the House also approved an amendment by Rep. Jim Matheson, D-UT, that instructs the committees to repeal the broken sustainable growth rate formula and find a viable replacement. Rep. Matheson’s amendment was the only Democratic amendment allowed during this highly partisan debate.  

These bills are not expected to be debated in the Senate, where the Democrats still control the majority, since Majority Leader Harry Reid, D-NV, has stated that he will not put them on the agenda. However, the Senate Health Education, Labor and Pensions Committee will conduct hearings on the health-care reform law to try to highlight some of the successes of the law.  

With the budget and appropriations process about to begin, we expect more efforts by Republicans in the House and Senate to strip funding for various provisions in PPACA and/or limit funding for the government agencies that are charged with implementing the law. The Republicans will try to chip away at the health-care reform law, with the following areas as their top focus: 

  • Abortion coverage.
  • Individual mandate.
  • Medicaid expansion.
  • Health insurance subsidies.
  • Structure of health insurance exchanges.

The AGA will continue to monitor this process as well as the budget process and its impact on our legislative priorities. Look for more updates on these critical issues and how they relate to gastroenterology on the AGA Washington Insider.

The Growing Legal Challenge to the PPACA

January 13, 2011 by

As the vote in Congress to repeal the Patient Protection and Affordable Care Act (PPACA) grows closer, more states are asking to sign onto the legal challenge. The original federal district lawsuit, filed in Florida, argues that “all Americans have health insurance is unconstitutional and challenges the law’s expansion of the Medicaid program,” reports CQ Roll Call. About 25 states have now signed onto this challenge, and there have been two separate suits filed in Virginia and Oklahoma.

The Republican wave in the November elections hit not only Congress but many state offices, and several ran their campaigns on repealing the PPACA. As the new Republican attorney generals and governors took office this month, they began to act on their campaign promises. The case was heard by Federal District Judge Roger Vinson in Florida, who did not seem very sympathetic to the Federal government’s arguments. According to Roll Call, this case looks to be on its way to the U.S. Supreme Court.

There are a number of states involved in some way with the lawsuit — Alabama, Alaska, Arizona, Colorado, Florida, Georgia, Indiana, Idaho, Kansas, Louisiana, Maine, Mississippi, Nebraska, Nevada, North Dakota, Pennsylvania, South Carolina, Texas, Utah and Washington. The Republican-controlled Missouri House of Representatives has called upon its Democratic Attorney General Chris Koster to join the suit. Montana’s state legislature will also be voting on whether or not to join the suit. The new Wisconsin governor, Scott Walker, authorized the attorney general to proceed with the legal challenge to the constitutionality of the PPACA, which was a campaign promise.

Stay updated on the multistate challenge to the PPACA by reading the AGA Washington Insider.

House Repeal Vote on Hold, Plum Assignments for AGA Allies Announced

January 11, 2011 by

In light of the tragic events of last weekend in Arizona that have left Rep. Gabriella Giffords, D-AZ, in critical condition after being shot at a public forum, House Majority Leader Eric Cantor, R-VA, announced that the House would postpone its schedule this week out of respect for Rep. Giffords and those that were killed and wounded in this vicious attack.

The House was scheduled to vote on H.R. 2, legislation that would repeal health care reform.  There has been no word on exactly when the House would take up this legislation but it will likely be in the next few weeks since it remains the top priority of the new Republican House majority.

Last week the Republican leadership also completed some its organizational tasks, such as determining committee ratios and committee assignments.  The AGA is pleased that some of our key allies were named to some of the most powerful and influential committees.  Rep. Bill Cassidy, R-LA, a gastroenterologist and strong champion for many AGA priorities, was named to the House Energy and Commerce Committee and to its Subcommittee on Health.  The Energy and Commerce Committee is one of the most sought after committee assignments on Capitol Hill because of the scope of its jurisdiction.  The committee has jurisdiction over public health programs such as NIH, FDA, CDC, Medicaid, and Medicare Part B which pertain to physician services.  Rep. Cassidy has made a name for himself in the Republican Caucus on health care and he will be in a great spot to influence public health policy.

Also, Rep. Erik Paulsen, R-MN, whom AGA has developed a strong relationship with in the past Congress, was also appointed to the powerful House Ways and Means Committee which has jurisdiction over all tax, trade, Social Security and Medicare programs.  Although he was not named to the Health Subcommittee on Ways and Means, he is still in a position of influence on this committee.  The AGA looks forward to working with both Reps. Cassidy and Paulsen as well as our other allies in the 111th Congress.

Stayed tuned to the AGA’s Washington Insider for more updates on key policy issues in Congress.

Repeal Vote Includes Medicare Pay Fix Amendment

January 7, 2011 by

After being sworn in this week, the House of Representatives wasted  no time setting  a date (next Wednesday) to vote on bill to repeal health reform. H.R. 2, Repealing the Job-Killing Health Care Law Act, would repeal the Patient Protection and Affordable Health Care Act and instructs the committees of jurisdiction to replace pieces of the law with “common sense” approaches and address such issues as medical liability reform, expanding coverage, lowering premiums and health care costs.

Partisan wrangling was in high gear yesterday when the House Rules Committee met to decide which amendments, if any, they would allow to H.R. 2.  They rejected more than 30 Democratic amendments aimed at preserving many of the patient protection provisions in the law.  The Republican Leadership rejected piecemeal voting since many of the patient protection provisions are very popular.

However, Rep. Jim Matheson, D-UT, a conservative Blue Dog Democrat who voted against the health care reform law, was allowed to offer his amendment, which calls for permanent solution to the Medicare physician payment formula.  Late last year, Congress passed a 13-month fix that prevented a 25 percent cut to Medicare physician payments through December 2011. Congress still needs to find a permanent solution to the broken payment system. This remains one of AGA’s top advocacy goals.

Despite the intense media focus on the House’s vote on H.R. 2, it is largely symbolic, since even if the Senate were to approve repeal, President Obama has vowed to veto.  However, this is expected to be the first of many votes in the 112th Congress to try to dismantle the health care reform law.

Look for more updates on the health care reform law repeal efforts on the AGA’s Washington Insider.

New Congress Vows to Repeal Health Care Reform Law

January 5, 2011 by

Capitol Hill feels a lot like the first day of school today. Anticipation is high as the 112th Congress is sworn in with Rep. John Boehner, R-OH, taking over as Speaker of the House from Rep. Nancy Pelosi, D-CA.  Republicans gained 63 seats in the midterm elections, providing a significant majority with which to pass many of their agenda items. 

It’s no surprise that first up on the House Republican agenda is a Jan. 12 vote to repeal the Patient Protection and Affordable Health care Act.  The legislation, titled “Repealing the Job-Killing Health Care Law Act,” is mostly a political excercise, since it faces an uphill battle in the Senate and President Obama is sure to veto it. 

Also to be introduced this week will be the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act, legislation sponsored by Rep. Phil Gingrey, R-GA, which overhauls our nation’s medical liability system and provides some necessary reforms for providers.  The AGA has supported this measure in past Congresses, but we know that, like the health care reform repeal bill, it will likely pass the House but face an uphill battle in the Senate.

Speaker Boehner has vowed that Republicans will work to curb government spending and have proposed setting discretionary spending levels at 2008 levels.  This proposal would cut AGA priorities such as biomedical research funding at NIH and the VA and colorectal cancer screening programs at the CDC.  

The AGA will continue to work with our allies in the House and Senate on our priorities such as enacting a new Medicare physician payment system and looks forward to educating the new members of Congress on the value of gastroenterology. 

Look for more updates on the activities of the 112th Congress on the AGA’s Washington Insider.    

President Signs One Year SGR Legislation

December 16, 2010 by

President Obama has signed into law the Medicare and Medicaid Extenders Act of 2010. This law prevents a 25 percent cut to Medicare physician reimbursements from being implemented on Jan. 1, 2011, and extends the fix through the end of 2011. The House and Senate overwhelmingly approved the bill last week.  

The payment fix is fully financed by changing the way the government recoups overpayments to subsidies to help purchase health insurance under the Patient Protection and Affordable Care Act. The legislation also extends several expiring Medicare provisions, such as protections for rural hospitals and physicians. The legislation was the result of a bipartisan agreement from the Senate leadership and representatives of the Obama administration. 

Although the AGA continues to believe that Congress must find a long term solution to the broken Medicare payment system, we are pleased that Congress was able to come to a one year agreement that is fully financed and does not further exacerbate the cost of fixing the formula. We will continue to monitor this issue and will work with the new Congress to implement a payment system that recognizes the cost of providing care to Medicare beneficiaries. Continue to read AGA eDigest and the AGA Washington Insider for updates.

Judge Rules Key Health-Care Provision Unconstitutional

December 13, 2010 by
A federal district judge in Virginia ruled that the individual mandate provision in the Patient Protection and Affordable Health Care Act (PPACA) is unconstitutional, although he declined to freeze implementation of the law. Judge Henry Hudson, who was appointed by President George W. Bush, ruled that the health-care reform law’s requirement that individuals purchase health insurance goes beyond the authority granted by Congress in the Commerce Clause of the Constitution. Most believe that this case will eventually make it to the Supreme Court where it will be settled since other state and interest groups have also filed lawsuits on the PPACA.

However, this ruling threatens one of the key lynchpins of the entire law since many of the major stakeholders — hospitals, insurers, pharmaceutical companies — did not oppose the legislation since they demanded that everyone be required to have coverage, which could offset some of their payment cuts, or coverage requirements, so long as they had more covered patients. This ruling could potentially unravel the health-care law — if there is no requirement for coverage, Republicans could try to chip away at the subsidies to purchase health insurance, which accounts for a large cost of the law. 

Republicans in Congress applauded the ruling, and believe it confirms their belief that the legislation “went too far,” giving them more leverage in the 112th Congress to try and repeal and replace the legislation. 

AGA recently held two webinars on health-care reform and its practice implications and the small business and personal tax implications. In case you were unable to attend, we will post them to our Web site and will announce shortly when they are available for viewing. We will continue to monitor this critical issue and its implications on practices and patients. Look for more updates on the AGA Washington Insider.