Legislative Update Michael J. Dyer, JD Vice President for Government Relations, AACOM OME Conference January 13, 2007.

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