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June 19, 2009


June 19, 2009

Senate HELP Buried in Amendments, Senate Finance Buried in Cost

This week, two Senate committees with key roles in crafting healthcare reform legislation moved at a snail's pace. The Senate Health Education Labor and Pensions (HELP) committee began marking up their version of healthcare reform legislation. Yesterday, the HELP committee considered and voted--mostly along party lines--on 5 of the 388 pending amendments to their healthcare reform proposal. Of the 388 proposed amendments, 364 were offered by Republicans, leading many Democrats to accuse Republicans of engaging in delay tactics.

Delay was theme of the Senate Finance Committee as well, as the committee postponed until after the July 4 recess mark up of their healthcare bill. The Finance Committee is dealing with the Congressional Budget Office's estimate that the bill would cost $1.6 trillion over 10 years, while expanding coverage to only 16 million uninsured Americans. Senate Finance Committee members are trying to reduce the cost of the bill to about $1 trillion, while considering measures to fund reform. Provisions under consideration range from taxes on sugared soft drinks and health insurance benefits to limits on charitable deductions and a value-added tax, just a name a few.

The Senate Finance Committee is also considering a wide range of Medicare cuts to help finance reform.

Health Care Reform: President Takes Health Care Reform Message to AMA

Earlier this week, President Obama spoke at the AMA House of Delegates meeting in Chicago to make the case for the need for healthcare reform. While President Obama noted likely areas of disagreement with the AMA, including caps on malpractice awards and a public options, he spent the majority of the speech describing areas of mutual interest, including expanding coverage, improving quality and addressing variations of care, expanding comparative effectiveness research, health information technology, administrative simplification and fixing the Medicare Sustainable Growth Rate (SGR) factor. President Obama explained in detail how his healthcare proposal would be budget neutral and described the $950-billion mix of spending cuts and tax provisions he has proposed to fund healthcare reform.

In hosting President Obama, the AMA President Nancy Nielsen MD made a point of recognizing policy actions the Obama Administration has already taken to help physicians, including funding for comparative effectiveness research and health information technology in the stimulus bill and crafting a budget proposal that pays for fixing the SGR.

Joseph Sokolowski, MD, ATS delegate to the AMA House, who listened to President Obama's speech commented , "The presence of President Obama at the annual meeting of the American Medical Association reflects his awareness that any healthcare reforms achieved by the administration require the engagement of the physicians of the nation. Compromises will be required by parties on both sides of issues to achieve the desired goals that will most benefit our patients."

Clean Air: AMA Adopts Resolution of EPA NOx Standard

In related news, the AMA adopted a resolution introduced by the ATS that calls on the EPA to issue a stricter standard for oxides of nitric exposure under the Clean Air Act. The current average annual standard of 53 ppb was first established in 1971 and has not been revised since. The ATS position, adopted by the AMA, seeks a new hourly standard ranging from 50-75 ppb. Since the NOx standard was first established, our understanding of the short-term effects of exposure to nitrogen oxides has improved and evidence supports the need for an hourly standard to protect individuals from short-term exposures.

The EPA is under a court order to issue a proposed NOx rule by June 26. A final rule is expected by December, 2009.

Tuberculosis: House Panel Approves Global TB Funding Increase

This week, House Appropriations subcommittees began considering FY2010 spending bills. On June 17, the State-Foreign Operations Subcommittee, chaired by Rep. Lowey (D-NY), approved the House version of the international affairs, global health and State Department budget. The full House Appropriations Committee will vote on the bill on June 24.

The FY2010 State- Foreign Operations Appropriations bill passed by the subcommittee includes a 25 percent increase in funding for USAID's global tuberculosis control program, from $162 million in FY09 to a proposed $202 million. Also included in the bill is an additional $162 million included under the Office of Global AIDS for HIV/TB integration, and an increase of $100 million for the Global Fund for AIDS, TB and Malaria. The Global Fund is the largest funder of in-country TB programs around the world.

In accordance with passage of the Stop TB Now Act as part of the Lantos-Hyde PEPFAR (President's Emergency Plan for AIDS Relief), last year and the increased funding levels recommended for the program, USAID's global TB program is now working to implement the global Stop TB strategy of expanded DOTS coverage, health system strengthening and promotion of the International Standards of Care for TB Treatment (an ATS/CDC/WHO collaboration).

On July 8, the House Labor-Health and Human Services and Education Appropriations Subcommittee is expected to consider the FY2010 health research and services spending bill, which includes funding levels for NIH and CDC.

Points of Contact

Gary Ewart Senior Director, Government Relations
Nuala Moore Senior Legislative Representative
Joe Kirby DC Office Administrator