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Monthly Briefing

Monthly Briefing

June 2014 Monthly Briefing

The Bottom Line

  • FY 2015 Senate Labor-HHS-Education Subcommittee: NIH + 2%; CDC +2.5%; HRSA +0.4%; AHRQ +0.6%

  • July 12: Faces of Austerity Briefing

  • July 22: Georgia GOP Senate Run-Off

  • November 4: Mid-Term Elections; December 6: Louisiana Run-Off (if needed)

What's New

Appropriations Update

The Senate Labor-HHS-Education Appropriations Subcommittee on June 10 approved their version of the fiscal year 2015 funding bill that includes accounts of interest to ASPPH. The bill provides $30.459 billion for NIH, an increase of $605.7 million, or 2 percent, over the FY 2014 level. The bill also provides $7.054 billion in “program level” funding for the CDC, a 2.5 percent increase or $170.9 million over the comparable FY 2014 level. For the Agency for Healthcare Research and Quality (AHRQ), the subcommittee provides $373.3 million, $2.3 million more than the FY 2014 funding level. For the Health Resources and Services Administration (HRSA), the subcommittee provides $6.3 billion, an increase of 0.4 percent over the FY 2014 level. The full texts of the bill and related report have not yet been released. By tradition, they are not released until full committee action is completed. Many of ASPPH’s specific advocacy priorities are detailed in the committee’s report.

Appropriations Time-Line

Despite early hopes that a majority of the twelve FY 2015 appropriations bills would see House and Senate floor action before summer, such prospects have dimmed. A planned mark-up of the FY 2015 Labor-HHS-Education appropriations bill by the full Senate Appropriations Committee on June 12 was cancelled and a new mark-up date has not been rescheduled. Other appropriations bills have been pulled from full House and Senate consideration in the past week. Various media sources report that the scheduling delays and cancellations relate to GOP plans to offer a series of provocative amendments intended to force vulnerable Democratic incumbents to cast difficult votes.

House action on the Labor-HHS bill has been delayed because the House Subcommittee chair, Cong. Jack Kingston, is involved in a July 22 runoff for the GOP’s nomination for an open Senate seat in Georgia. The House had hoped to have all appropriations bills cleared by the House Appropriations Committee before the July 4 recess, a deadline that will not be met.

Regardless of whether the Senate and House Appropriations Committees complete action on the Labor-HHS bill, it is expected that a final compromise bill will not be enacted before the November 4 general election, well after the start of the fiscal year 2015 on October 1. As such, one or more continuing resolutions are expected.

Taps and Assessments

During the House Appropriations Committee hearing on NIH funding in March, GOP members of the panel were critical of the use of the 2.5 percent evaluation tap that in past years has been assessed on Public Health Service (PHS) accounts. The tap, mandated and allocated by Congress, has resulted in NIH funds being used to support other PHS agencies. In response, the Senate Labor-HHS Appropriations Subcommittee, in the FY 2015 bill, reallocated the taps so that NIH is a net beneficiary. It also resulted in AHRQ being funded directly with budget authority for the first time in several years, rather than being funded through evaluation tap transfers. (The tap is the reason NIH is often referred to as “The Bank of Bethesda” by appropriations’ policy wonks.)

Other Developments with Appropriations’ Implications

School Lunches – The appropriations bills funding the US Department of Agriculture have been snagged by amendments aimed at delaying or allowing waivers to rules mandating that more fruits, vegetables and whole grains (and less sodium, fat and sugar) be on school lunch menus. The bill was pulled from the House floor when the issue could not be resolved. Some GOP members see it as local vs. federal control issue and others as a way to needle the First Lady. Complicating the issue is the involvement of the School Nutrition Association (SNA), which represents school food service workers. They have been aggressively lobbying for the waiver provision, but ten of the SNA’s past presidents have come out against the SNA’s position. Media reports indicate that the group now receives 49 percent of its funding from food service companies.

Children’s Health StudyThe National Academy of Sciences on June 16 released its long-awaited report of the NIH’s National Children’s Study. More than $1 billion has already been spent on the study and billions more would be required going forward. The report identified the need for major changes in the study’s design. In a statement on the report, NIH Director Francis Collins said: “We are at an inflection point where critical questions need to be answered: 1) Is this study, as currently outlined, actually feasible in the face of significant budget constraints? 2) If yes, how do we move forward to implement necessary changes, including some of those outlined in the NAS report? 3) If no, are there new methods to answer key research questions that are most important to pediatric health today that capitalize on research and technology advances developed in the intervening years since the inception of the study?” He also said, “I am assembling a team of experts in pediatrics, clinical study design, environmental science, genomics, computer bioinformatics, and other relevant areas within the next several weeks to advise me on the right thing to do with the study.” Dean Ana Diez Roux of Drexel was on the IOM panel. This is only the latest setback for the National Children’s Study; in 2009 Congress criticized NIH for misrepresenting the project’s costs.

VA Health Care – The House and Senate have both passed legislation to address the health care scheduling scandal at the Department of Veterans Affairs. The Congressional Budget Office has estimated that the bill could cost over $50 billion annually. Depending on the structure of the final bill being negotiated by a joint House-Senate conference committee and how such spending is allocated, the measure could put additional strain on the non-defense discretionary accounts in order to meet already enacted budget targets.

DOD-Funded Research – The FY 2015 Department of Defense Appropriations bill approved by the House Appropriations Committee on June 10 includes an increase of $600 million in medical research funding, to $1.2 billion. The increase would go to research for prostate and ovarian cancer, orthopaedics, reconstructive transplants, global HIV/AIDS prevention, and therapeutic sevice-dog programs.

Student Loans and the HEA Reauthorization

President Obama on June 9th issued a Presidential Memorandum on student loans. Most notably, he ordered the Department of Education to issue regulations expanding the “Pay As You Earn” program. According to the White House, the changes will allow up to 5 million additional students to qualify for the program, which limits payments to 10 percent of income and provides loan forgiveness after 20 years of payments. The change will be subject to the standard rulemaking process. The White House has issued a fact sheet on the announcement. The President also voiced support for legislation to allow more student loan borrowers to consolidate and refinance their current loans. The legislation, championed by Senator Ellizabeth Warren, failed in the Senate on June 11 when it did not receive a filibuster-proof majority.

The Higher Education Act, which authorizes many education-related programs, is set to expire this year. Reauthorization legislation is now being floated by key leaders, but will not be considered until next year. Many of the proposals would streamline student loan programs. Senator Lamar Alexander (R-Tenn.) is proposing to consolidate student aid programs to create “one undergraduate loan program, one graduate loan program, and one parent loan program.” He is also proposing to simplify the Free Application for Federal Student Aid (FAFSA) form 10 pages to a two-question post card. Senator Harkin is planning to reveal his draft HEA reauthorization bill in the next few weeks. His bill is expected to include, among its dozens of provision, a requirement for schools to track graduates’ success in the work force.

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May 2014 Monthly Briefing

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