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
Agrover@aamc.org
@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
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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.