Federal Update
June 19, 2009
There are many policy issues the office of Government Relations and Community Affairs is tracking in Washington, D.C. Below is our latest update.
Health Reform
Washington is focused on the pending healthcare reform legislation. Senator Kennedy (D-MA), chair of the Health, Education, and Labor and Pensions committee has released an outline of his proposal and Senator Baucus (D-MT), Chair of the Finance Committee, has his as well. Meanwhile the House is working on its own bill. President Obama is pushing very hard to pass a bill by November. The recent Frontiers of Health Care meeting here at Brown explored many of the issues being debated in our nations Capitol including: cost, quality of care and insurance coverage.
Senator Kennedy’s draft bill focuses on insurance coverage. Similar to the Massachusetts plan, it includes a mandate for all to have coverage and provides for a public plan. In the House, Congressman Rangel (D-NY), Chair of the Ways & Means committee, Rep. Waxman (D-CA), Chair of the Energy & Commerce committee, and Rep. Miller (D-CA), Chair of the Education and Labor committee, are working on a bill that will likely be similar to Senator Kennedy’s bill. The Senate Finance committee’s draft bill was scored by the Congressional Budget Office at $1 trillion so they are now re-working their draft. President Obama is trying to avoid the mistakes of the Clinton administration who drafted a bill in the White House with little consultation with the Congress. But in a meeting last week with Congressional leaders, he made it clear he wants to get the bill done. Congress hopes to begin to move a bill before the August recess, but that will be hard to do. The biggest obstacle to getting a bill completed will be the negotiations between the House and the Senate over their two bills.
Brown is working through the Association of American Medical Colleges (AAMC) on this legislation. The AAMC is following the legislation closely and weighing in where needed, but since they represent both the hospitals and the doctors there is only so much they can talk about. . One issue that AAMC will speak to is the issue of cost and “wasted” spending. Everyone in Washington from the President on down is reading a recent New Yorker piece, “The Cost Conundrum” by Atul Gawande which discusses research from Dartmouth that shows some cities spend a great deal more on healthcare than others. Since much of the more expensive care is provided in academic medical centers, Brown affiliated hospitals may be a target for cost saving measures. This leads to the number one issue faced by policy makers and that is how to pay for healthcare reform. Right now there is serious consideration of taxing health benefits. Another concern is that if healthcare reform is adopted, will the federal government continue to pay for Indirect Medical Education (IME) payments and Medicare Disproportionate Share (DSH). The AAMC has taken the lead on these issues trying to minimize the impact, but that will be hard to do. The President said in his Saturday address he hopes that if more people have insurance, the government could reduce the payments for indigent care.
Electronic Medical Records
The issue of Health Information Technology (HIT) is another big topic of discussion. The American Recovery and Reinvestment Act of 2009 included billions of dollars for implementing an electronic medical record. As was stated at Brown’s Frontiers of Health Care meeting, the Department of Health and Human Services is now developing the standards for such a system. One of the most critical issues being discussed is the idea of “meaningful use.” While many hospitals have been implementing electronic medical records, many doctors are not using them in a “meaningful” way. So HHS is trying to develop reasonable standards for physician adoption of such systems. Brown doctors will have to follow the standard that is set.
Energy/Climate Change
Given Brown’s recent work on energy research, not to mention the University’s long standing interest in climate change issues, we are tracking the efforts to pass an Energy/Climate Change bill.
After several months of negotiations and a number of considerations, the Senate Energy and Natural Resources committee appears ready to approve a bill to create a federal renewable energy standard and provide a framework for the siting of new electricity infrastructure. The bill does not include a ceiling on carbon emissions (and consequently no market for trading emissions credits) as in the bill approved by the House Energy and Commerce committee (H.R. 2454). However, Senate leaders indicate the cap-and-trade proposal in H.R. 2454 will be used as a foundation for a Senate plan and will be combined with the Energy and Natural Resources bill when it comes to the Senate floor--likely not for several months. The Republicans have introduced an alternative bill in the House, but most believe the Democrats will be able to pass their bill without much input from the minority. The House bill also includes regional research centers, but it is not clear how those would relate to an existing program for “Innovation Hubs.”
The American Association of Universities (AAU), which Brown is also a member of, passed a Green Energy Research and training resolution that is guiding their work on the energy legislation. It has been shared with the Obama administration.
In terms of next year’s funding for energy research, the President’s budget request for the DOE Office of Science was lower than hoped. The AAU has decided to support the President’s proposal anyway because, given the stimulus funding we received this year for DOE research, it is not likely to get another large boost. One new issue is a requirement that funding for the new ARPA-E program has a 20% match. AAU and others are trying to make the argument that such a match doesn’t make a lot of sense right now especially when other agencies like NSF are dropping their matching requirements. This will be a tricky issue to sort out on Capitol Hill.
Appropriations
The House Appropriations subcommittees were given their funding allocations for the year and they are beginning to move their bills. The proposal includes $1.086 trillion in discretionary spending--about $74 billion more than the $1.012 trillion sought for FY09.
• The Labor-HHS subcommittee that funds the NIH and the Department of Education was allocated $160.7 billion in FY10, a boost of about $7.5 billion over last year
• The Energy and Water subcommittee was allocated $33.3 billion, a slight increase of less than $100 million
• The defense number is more than $20 billion over the $488 billion FY09 Defense spending bill allocation
• The $68.8 billion Transportation-HUD figure is about $14 billion more than the $55 billion allocated last year
NIH
The President’s budget includes a modest $448 million increase for the NIH. The Advocacy community is asking for a 7% increase, and last week Senator Specter called for a slightly larger $3.5 billion increase. Following the stimulus bill, it will be difficult for the Congress to provide for significant increases for research, but they seem inclined to provide for more funding.
If you wish to express your support for the NIH please go to the AAMC Research Means Hope web page - http://www.researchmeanshope.org/.
House Republican leadership is concerned that NIH grants being funded under stimulus were of poor quality. We have already seen a list of “questionable” NIH grants from Senator Coburn. It seems the minority will oppose further increases unless the NIH can show it is using the funding wisely.
Tax Issues
Both the Ad Hoc Tax Group and the AAU Tax Working group discussed the tax issues facing higher education this year. Though it is unlikely to see a stand-alone tax bill pass this year, there is still talk of capping the tax deductibility of charitable donations to pay for other policy priorities like healthcare reform.
Higher Education
The Obama Administration is asking for ideas about how the financial aid system can be more effective. AAU requests that institutions feed comments to them and they will package them for the Department of Education. They are also interested in our views on the proposal to expand and change the Perkins Loan program from a $1 billion program to $6 billion. There was also discussion of the VA Yellow- Ribbon program, and from a show of hands, most AAU institutions are participating at some level.
On the Hill the ranking minority member of the Education and Labor committee, “Buck” McKeon (R-CA), is leaving the committee to be the lead Republican on the Armed Services committee. At times he has been helpful to the higher education community during the debate over the Higher Education Act and some of the labor issues. Rep. John Kline of Minnesota will take over his position as the lead minority member on the Education and Labor Committee.
Humanities
Former moderate Republican Congressman Jim Leach of Iowa has been tapped to head the National Endowment for the Humanities. While in Congress he was very supportive of the humanities and the NEH even when it was under attack years ago. There is also talk of a White House liaison to the NEH who will have the title of Culture Secretary. There was even talk of the actor Kal Penn taking that spot, but that is looking less likely now.
Immigration
There is still talk of moving a comprehensive immigration bill this year that would address some of the visa issues with which universities grapple. Given everything else the Congress faces moving an immigration bill is less likely. Senator Chuck Schumer (D-NY) is the lead in the Senate on this legislation and he will be holding some roundtable discussion with outside experts on it this summer. They want to work on H-1B and STEM green cards. AAU and others are getting questions about data on diversity among our international students. Labor unions want to regulate the flow of immigrants into the country.
If you have questions about any of these items please contact Tim Leshan, Director of Government Relations and Community Affairs at tim_leshan@brown.edu.
For more information please contact:
Tim Leshan
Director of Government Affairs and Community Relations
Brown University
Box 1920
Providence, RI 02912
401-863-2552
401-863-3189 (fax)
Tim_Leshan@brown.edu
http://www.brown.edu/Administration/PAUR/cgr/