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“Doc Fix” Uncertain

Congress continues to discuss how best to overhaul the system that Medicare uses to determine physician reimbursements, known as the sustainable growth rate (SGR).  The current rates are set to expire at the end of the year but little legislative progress has been made. Most lawmakers agree that they want to replace the current formula but there are still questions about the government’s role in determining doctors’ payments. These questions, along with disagreement on how to pay the nearly $300 billion cost of repealing the current formula, are obstacles to any comprehensive solution.

The current reimbursement formula was put in place to try to limit spending growth in Medicare. For ten years, the formula has called for cuts in physician payment rates, and Congress has enacted a series of payment patches to avoid those reductions. Physicians face a nearly 28 percent rate cut when the latest patch expires at the end of this year. UW physicians would be negatively affected if Congress allows the current SGR extension to expire.

Labor-HHS-Ed Bill Status

The House Appropriations Committee has not yet announced a full committee markup for its FY 2013 Labor-HHS-Education spending bill, and now many are raising doubts that it will ever do so. On Monday, Congressman Norm Dicks (D-WA), ranking Democrat on the House Appropriations Committee, expressed his belief that his GOP colleagues have “indefinitely postponed” further work on the Labor-HHS-Education bill. The current draft of the bill seeks to de-fund implementation of the 2010 health care overhaul (Affordable Care Act), and also contains policy riders and cuts to education programs. In the Senate, appropriators still say they will mark up two spending bills before the August recess. The committee may unveil its Defense and Legislative Branch measures next week, although expectations are dim for a markup of the Interior-Environment bill.

The Labor-HHS-Education bill is the last one remaining to be finished by the House Appropriations Committee, which already has approved its 11 other bills. The Senate Appropriations Committee has approved nine of their 12 bills.

Congress Talks CR, Appropriations, and Sequester

FY 2013 Continuing Resolution:  Several Republican lawmakers are advocating for an early vote on a stopgap spending bill for FY 2013 that would keep the government running into early next year, leaving contentious funding decisions for the next Congress. Most believe they are betting that they’ll have more power next year – possible control of the Senate and the White House – and will be in a better position to force deeper spending cuts. In a letter circulated by Senator Jim DeMint (R-SC), and signed by 20 members of the House and Senate, lawmakers said they would try before the August recess to clear a continuing resolution (CR) at a “fiscally responsible” level that would avert a new standoff over a potential government shutdown in the fall. Conservatives may support at CR at roughly the current annual spending level of $1.043 trillion if it extended into the next session of Congress, offering a temporary cease fire in the House GOP’s current efforts to cut $15 billion from discretionary spending through the FY 2013 appropriations process.  Regardless of this new effort, no decisions are likely before September. Few Democrats are likely to back a CR that extends beyond December. You can read the Republicans letter here.

L-HHS-ED Appropriations:  On Wednesday, the House L-HHS-ED Appropriations Subcommittee approved their FY 2013 draft spending bill mostly along party lines 8-6. The bill would provide a total of $150 billion in discretionary funding, which is $6.3 billion below FY 2012 levels and $8.8 billion less the President’s request. Much of the House panel’s debate centered on the bill’s health provisions and primarily on GOP efforts to repeal the Affordable Care Act, but Democrat’s efforts to restore that funding fell short. Congressman Norm Dicks (D-WA) also offered an amendment that would have removed GOP-supported language that would rescind funding for the Corporation for Public Broadcasting and National Public Radio.   

Sequester:  Also on Wednesday, House lawmakers approved legislation that would force the Administration to detail how automatic budget cuts due early next year would be implemented. The bill (HR 5872) would require the White House to produce a report within 30 days explaining how the $109 billion in cuts scheduled to take effect January 2, 2013 would affect both domestic and defense programs. The Senate passed similar legislation in June, but that plan calls for more detailed reports from the Defense Department, the Office of Management and Budget, and the White House on the cuts. It’s unclear how the issue will be resolved between the House and Senate bills.  The Senate could back the House bill, but it’s unclear if Democrats leaders, who pushed for the version that requires more detail about the impact on domestic cuts, will allow it to come up. Lawmakers would prefer to have a deal in place before the August recess, so they can have the information when they return in September to argue for averting the sequester.

FY 2013 Labor-HHS-ED Draft Bill

The House Appropriations Committee this morning released their draft FY 2013 Labor-Health and Human Services-Education (LHHS) Appropriations bill, which will be considered in subcommittee tomorrow morning (Wednesday).  As expected, the draft bill includes $150 billion in discretionary funding, which is $6.3 billion below last year’s level and $8.8 billion below the President’s budget request.

Health and Human Services: The Department of Health and Human Services receives a total of $68.3 billion, a reduction of $1.3 billion below last year’s level and $1.8 billion below the President’s budget request. Hightlights include:

  • Health Resources and Services Administration (HRSA) The bill provides HRSA with $5.9 billion in new discretionary budget authority, which is $453 million below last year’s level and $315 million below the President’s budget request.
    • Community Health Centers are funded at $1.5 billion – the same as last year’s level. This includes a rescission of $300 million in previous-year funding that was provided under the Affordable Care Act for this program. 
    • The bill also provides $623 million in total funding for health professions training, including $275 million for the Children’s Hospital Graduate Medical Education program. The President requested only $88 million for this essential program. In addition, the bill includes $139 million for rural health programs, an increase of $1.4 million above last year, and eliminates funding for the Family Planning Program. 
  • Centers for Disease Control and Prevention (CDC) – The legislation includes an appropriation level of $5.75 billion for the CDC – $66 million above the FY 2012 level. Further, the bill allows for an additional $126.5 million for the CDC by reducing the ability of HHS to divert funds away from CDC programs.
  • National Institutes of Health (NIH) – The bill includes $30.6 billion for the NIH, which is the same as last year’s level and the President’s request.
    • Within this funding, the legislation includes $175 million for the National Children’s Study, $488 million for Clinical and Translational Sciences Awards, and $376 million for Institutional Development Awards (IDeA) programs.
    • This funding will support 16,670 training research awards – the pipeline of support for future researchers.  The legislation also includes language to ensure the NIH support only research projects that are highly meritorious, based on peer review processes, and that continue the agency’s historical unbiased position toward specific diseases.
  • Substance Abuse and Mental Health Administration (SAMHSA) – The bill funds SAMHSA at $3.1 billion, which is $194 million below last year’s level and $1.2 million above the President’s budget request. Within this funding, criminal justice activities, such as drug courts, receive an increase of $5 million over last year for a total of $72.3 million, and the Substance Abuse Block Grant for states and localities receives $1.73 billion, an increase of $10 million.
  • Centers for Medicare and Medicaid Services (CMS) – The recommendation provides $3.5 billion for CMS management and operations (“Program Management”), which is $409 million below the FY 2012 enacted level and $1.4 billion below the President’s request. The bill does not include additional funding to implement Affordable Care Act programs and prohibits funds for the new Center for Consumer Information and Insurance Oversight.

The Office of Federal Relations will post more as we continue to read through the draft legislation.

Read the subcommittee draft text of the FY 2013 LHHS Appropriations bill.

Read the House Appropriations Committee press release.