Federal Legislative Update: Good News, Bad News, 2015 Forecast Learn Serve Lead 2014 AAMC Annual Meeting Atul Grover, M.D., Ph.D. Chief Advocacy and Public Policy Officer [email protected] @AtulGroverMD AAMC Advocacy Priorities 2014 1. Sustain funding for NIH research and GME 2. Minimize “sequestration” cuts 3. Fix the “SGR” – Physician pay cuts 4. Preserve ability to provide high-quality care to all populations 5. Implement the ACA 3 © 2014 AAMC. May not be reproduced without permission. The Context: Deficit politics still reign supreme; All of our “asks” have big price tags CBO adds $1 trillion to deficit forecast for next decade Although deficit is declining, debt is still historically high CBO projects deficit to rise from FY 2015 – 2023 Sequester, caps on spending still in effect Reduce total federal spending over 8 years by $1.1 trillion Medicare cut 2% annually Appropriation process trapped in CR politics Adjusted for inflation, NIH spending power is less than FY 2001 Our “asks” are critical but big: $ billions more for NIH, GME, VA, Ebola….when there’s no room in the federal budget for more spending © 2014 AAMC. May not be reproduced without permission. The Big Priorities of 2014: NIH – A glimmer of hope or a mass food fight? The Good News: NIH continues to earn strong support Strong bipartisan support in Congress – e.g., Rep. DeLauro (D-CT) and Sen. Moran (R-KS) Strong public support – research, business community, patients Strong prospects of breakthrough research – Ebola treatments, vaccines Strong NIH leadership – Director Frances Collins The Bad News: Persistent budget pressures FY 2014 CR = level funding again, at best Questions about NIH priority-setting: e.g., Coburn’s “Waste Book” Issues involving duplication vs. reproducibility affect NIH credibility 2015: The year of “Cures Initiative” legislation? Or NIH vs. AHRQ vs PCORI…food fight? © 2014 AAMC. May not be reproduced without permission. The Big Priorities of 2014: GME – The fight of our lives! The Good News: Rays of hope in 2014 GME spared by 2014 SGR package Bipartisan support for bills to lift GME cap, define GME accountability continues after election The Bad News: Threats to GME = mounting IOM committee calls for 34% average cut in GME per hospital Family physicians recommend end to GME $ for specialists Osteopathic physicians support Murray bill to give 2% of IME to THCs In 2015, budget fights could make IME everyone’s favorite offset 2015: We need to make our whole message heard - loudly We’re for both: more physicians and more reform New advocacy strategies and new analysis New politics: Budget reconciliation? © 2014 AAMC. May not be reproduced without permission. The Big Surprises of 2014: VA Physician Shortage – Chance to tell our story? The Bad News: Vets’ lives at risk Out of the blue? VA bureaucracy continues to be slow, AAMC continues to pursue VA continues to be under attack on Hill The Good News: VA has new resources - $17 B, new leaders AAMC team has built bridges to VA, new secretary AMCs ready to help – key to any effective, long term strategy Issue makes case for physician shortage, AMC standby capacity, and need for research 2015: Year of breakthrough or year of inertia? Can AMCs partner with VA nationally as well as locally? Can VA get ahead of its problem – at home, in Congress? © 2014 AAMC. May not be reproduced without permission. The Big Surprises of 2014: Ebola – Again, opportunity to tell our story? The Bad News: Inter’l. crisis shows holes in US infrastructure Both the world and U.S. appear unprepared, playing catch-up Public fear drives U.S. debate – fear ahead of policy? Again, AMCs at center, but more resources needed The Good News: AMCs are central to U.S. response Nebraska, Emory = case studies in AMC standby capacity Issue makes the case for AMC standby capacity, research AAMC team working directly with top federal officials 2015: Balancing act Quantify AMCs’ need for federal support; budget politics tough Juggle AAMC asks for long-term readiness, VA, GME, NIH, more We risk being poster child for the hand held out © 2014 AAMC. May not be reproduced without permission. The Big Surprises in 2015: Who knows? – “We don’t know what we don’t know” The only guarantees: We will be surprised We won’t know it until we see it It will come when it’s least opportune We have to have “advocacy” standby capacity, not just medical standby capacity Our GR and advocacy teams need to be stronger than ever Our capacity for grassroots, grasstops, and direct advocacy as well as media advocacy needs to be stronger than ever © 2014 AAMC. May not be reproduced without permission. Elections 2016: What’s the Overall Impact? More attempts to repeal or amend ACA • Republicans again take time to repeal ACA White House will veto. Congress can’t override. • Next, Republicans try bipartisan amendments to ACA Eliminate individual or employer mandates? Remove medical device tax? • White House still vetoes Congress still lacks override votes. © 2014 AAMC. May not be reproduced without permission. Elections 2016: What’s the Impact on US? Renewed budget politics affect NIH, GME • Return to budget politics due to Republican majority, need for budget res., debt ceiling • New pressure on NIH supporters Tough to get increase in this budget environment Risk of pitting NIH vs. AHRQ vs. PCORI, etc. • New pressure on Medicare IME $6 billion pot of untapped funds A big target for off-sets for other initiatives • Strong, strategic advocacy needed more than ever Direct, grassroots, grass tops, media advocacy © 2014 AAMC. May not be reproduced without permission.