November 23, 2009
In this issue:
Currently in Washington
This week Members of Congress return to their districts for the Thanksgiving Holiday Recess on the heels of continued debate over President Obama’s top 3 priorities: healthcare reform, climate change, and student aid reform. Senate Democrats scored a major victory last week when a vote to invoke cloture on the Senate healthcare bill passed 60-39 along party lines. The measure, which required a minimum of 60 votes, allows the Senate to begin debating amendments to the bill when the Senate returns after the Thanksgiving break. Senate Majority Leader Harry Reid unveiled the Senate bill – the Patient Protection and Affordable Care Act (H.R. 3590) – earlier this week. The Congressional Budget Office estimates that the legislation will cost roughly $848 billion over 10 years and will extend coverage to 31 million people by 2019. However, it will leave 24 million without coverage. The Senate bill includes a public option with a state opt-out provision. The bill, which merges the versions previously considered under the Senate Health, Education, Labor and Pensions (HELP) Committee and the Senate Finance Committee, also creates insurance exchanges designed to expand access to affordable insurance and create new non-profit co-ops. With several procedural hurdles to final passage of the bill remaining, a House-Senate conference is unlikely to send a final version of the bill to the President’s desk before late January – mid February.
Meanwhile, the timelines for President Obama’s two other top priorities have also slipped into next year. Last week Senate Foreign relations Committee Chairman John Kerry (D-MA) confirmed speculation that a Senate climate bill will not emerge before next spring. Supporters of the cap-and-trade legislation had hoped a bill might be produced before the international climate conference in Copenhagen this December. However, the since the bill passed the Senate Energy and Public Works Committee with no Republican support (including a boycott of the markup) it has become increasingly clear that further work will need to be done to garner the 60 votes needed to break a filibuster. President Obama’s third major priority, student aid reform, is also unlikely to see Senate action before the December holiday because the senate bill has been tied to passage of health care reform.
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Healthcare Overhaul Legislation
Last Wednesday Senate Majority Leader Harry Reid released an $849 billion healthcare overhaul bill (H.R. 3590) that includes a public option and will extend coverage to 31 million uninsured Americans. The Congressional Budget Office estimates the bill would extend insurance to 94 percent of eligible Americans. This compares to a House bill that would cost $894 billion and extend coverage to 96 percent of eligible Americans. The measure, which would reduce the deficit $127 billion over a decade, creates an insurance exchange where people can compare and purchase coverage; allows insurance co-ops to be formed; expands Medicaid to those earning 133 percent of the federal poverty level; and offers federal subsidies to help those without employer-sponsored coverage purchase insurance. The first procedural vote on the bill was taken last week when a vote to invoke cloture on the Senate healthcare bill passed 60-39 along party lines. The measure, which required a minimum of 60 votes, allows the Senate to begin debating amendments to the bill when the Senate returns after the Thanksgiving break.
Under H.R. 3590, nearly 15 million people will be newly eligible for Medicaid and the Children's Health Insurance Program, at an estimated cost of $374 billion over 10 years. Similar to the previous passed bills, H.R. 3590:
- Redistributes 65 percent of currently unused residency training slots and directs those slots to hospitals in certain states;
- Establishes a new Center for Medicare and Medicaid Innovation (CMI) to test innovative payment and service delivery models. New language in H.R. 3590 references AAMC-supported Healthcare Innovation Zones (HIZs) as one of the models that may be tested;
- Provides a one-time 0.5 percent Medicare physician payment update for CY 2010 (costs $11.3 billion);
- Reduces Medicare updates for most providers (saves $192 billion over 10 years);
- Reduces Medicare and Medicaid disproportionate share hospital payments (saves $22 billion and $21 billion respectively);
- Establishes new payment policies for hospital readmissions (saves $7 billion);
- Implements a value-based purchasing program for hospitals (budget neutral);
- Establishes an Independent Medicare Advisory Board, that would implement Medicare payment policy changes with limited input from Congress (saves $23 billion);
- Includes provisions to reauthorize some of the Title VII health professions and Title VIII nursing education programs; and
- Increases the authorization for the National Health Service Corps (NHSC) to $1.15 billion in FY 2015.
The bill is paid for in part through Medicare cuts; an increase in the Medicare payroll tax for individuals making $200,000 or more and couples earning $250,000 or more to 1.95 percent; and a tax on high-cost "Cadillac" insurance plans valued at $8,500 for individuals and $23,000 for families. The Medicare payroll tax will bring in $54 billion and the Cadillac tax raises $149 billion in revenue. In regards to graduate medical education (GME), the bill redistributes unused residency slots to increase training, particularly in primary care and general surgery. The House bill reduces authorized residency levels if an institution’s residency level for any of three most recent reporting periods is less than authorized by 90 percent of the difference between the actual and authorized levels. Unused slots would be redistributed to primary care. The bill includes a long-term insurance program known as the CLASS Act that some senators have concerns with, saying its early savings would eventually be eaten up by benefits paid to enrollees. Reid attempted to appease them by not applying the $75 billion in savings from the program to the offsets.
On abortion, the bill attempts to extend current law, prohibiting federal funds from being used for abortions by requiring those funds be segregated by private insurers that offer abortion coverage. The HHS secretary would determine if the public option will cover abortion. That sets up a conflict with the more restrictive House bill. It also might face challenges via amendments from anti-abortion senators on both sides of the aisle. A few Democrats are still on the fence over whether they will vote to proceed to the bill. Democratic Senators Ben Nelson (D-NE), Mary Landrieu (D-LA), and Blanche Lincoln (D-AR) were undecided on how they would vote on the motion to proceed, but Senate Majority Whip Dick Durbin (D-IL) said he will argue that Democrats should agree to move to the bill and hash out disagreements through the amendment process. A vote on the motion to proceed is expected on Saturday.
A timetable for passage of the bill remains elusive and depends largely on the substance of debate and amendment in the Senate. Senate leaders are hopeful that a Senate version of the bill can be passed before the Winter Recess, which would suggest that a House/Senate conference on the bill might take place mid-January to early February. A comparison of the provisions included in the House and Senate versions of the bill can be viewed on AAMC’s Web Site: http://www.aamc.org/reform/
Medicare DSH: Reid's bill saves $20.6 billion over 10 years, a slight reduction over the Finance Committee bill. It reduces Medicare disproportionate share hospital (DSH) payments by 75 percent in FY 2015 and beyond to eliminate DSH payments that are above the "empirically justified" level, as determined by the Medicare Payment Advisory Commission. A portion of the 75 percent would be given back to hospitals depending on the amount of uncompensated care they provide, but this amount would be phased down as coverage increases.
Medicaid DSH: Reid's bill saves $22.4 billion over 10 years. Once each state's uninsured rate decreases by 50 percent, the state DSH allotment decreases by 50 percent. That state's DSH allotment would continue to decrease as the rate of uninsurance decreases further. The DSH allotment could not decrease below 35 percent of the 2012 DSH allotment, adjusted for inflation.
Readmissions: Reid's bill saves $7.1 billion over 10 years, a significant increase over the Finance Committee bill, which proposed savings of $2.1 billion over 10 years. Reid's bill incorporates a policy similar to the House's readmission policy for hospitals; however, it would take effect in FY 2013 rather than FY 2012 and caps the financial penalty at 3 percent in FY 2015 and beyond compared to 5 percent in the House policy.
Independent Medicare Advisory Board: Saves $23.4 billion over 10 years. Creates a new Medicare advisory board to submit proposals to Congress to extend the solvency of Medicare and slow Medicare cost growth in 2015 and beyond. Establishes a process where the board's proposals to Congress would take effect unless Congress passes an alternative measure. The language states that providers like hospitals and hospice are excluded through 2019.
Additional Requirements for Nonprofit Tax-Exempt Hospitals: Like the Finance Committee bill, Reid's bill requires each hospital to conduct a community health needs assessment at least once every three years. It also requires hospitals to have a financial assistance policy and to limit charges to those who qualify for financial assistance, and prevents hospitals from using extraordinary collection practices.
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House Medicare Pay Fix
The House voted 243-183 today to overhaul a 1997 budget mechanism intended to control payments to doctors under Medicare, the government health plan for the elderly. Today’s measure would create a new formula that would boost doctors’ payments by 1.2 percent next year instead of the 21 percent reduction now scheduled to take effect. The $210 billion bill restructures the program so Congress does not have to pass the pay fix annually. Leaders originally planned to include the fix as part of the overhaul to gain physician support for health reform, and the American Medical Association ultimately supported the overhaul even after leaders stripped it of the pay fix, though the immediate push for passage of the separate bill is a nod to the physicians' sway. The pay fix includes pay-go rules and faces an uphill battle in the Senate. Reid tried to bring the fix to the floor this fall but couldn't get past a filibuster.
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The FY10 Appropriations bills are starting to slowly but surely reach the President’s desk for final approval. The Agriculture, Energy & Water, Homeland Security, Interior & Environment, Legislative Branch bills have all been signed into law by the President. The Commerce/Justice/Science, Defense, Financial Services, Labor/HHS/Education, Military/Veterans, State/Foreign Operations, and Transportation/HUD bills are still making their way through the committee process.
House and Senate offices are gearing up for FY11 Appropriations. The UT System Office of Federal Relations will soon be analyzing and discussing UT appropriations requests with congressional staff and members to ensure they are submitted to the Congressional offices by their individual deadlines.
Click here to follow the status of individual appropriations legislation
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Student Loan Debt Forgiveness Tax Breaks
In September, the House passed The Student Aid and Fiscal Responsibility Act (H.R. 3221) which reforms student aid programs including dissolving the Federal Family Education Loan (FFEL) program and shifting all burden onto one Direct Loan program. The Senate is now considering H.R. 3221.
The American Council on Education, along with 16 other Higher Education groups and associations sent a letter to Senate Finance Committee Chairman Senator Ma x Baucus (D-MT) and Senate Health, Education, Labor, and Pensions Chairman Senator Tom Harkin (D-IA) asking that they incorporate language, first introduced by Congressman Sander Levin (D-MI) in H.R. 2492, into H.R. 3221 that ensures that debt forgiven through the Income-Based Repayment (IBR) and Income Contingent Repayment (ICR) programs is not taxed as income. Recent Internal Revenue Service guidance would require IBR and ICR loan forgiveness to be treated as taxable income while some other loan forgiveness programs are excluded.
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Higher Edcuation Opportunity Act Regulations
The Department of Education created rulemaking committees to prepare regulations under Title IV of the Higher Education Act as amended by the Higher Education Opportunity Act. Below are the first four regulations published by the Department based on the recommendations of the committees. You can view updates on the Department of Education Higher Education Opportunity Act website.
- “On October 29, 2009, the Department published in the Federal Register final regulations amending the Federal Perkins Loan (Perkins Loan) Program, Federal Family Education Loan (FFEL) Program, and William D. Ford Federal Direct Loan (Direct Loan) Program regulations to implement provisions of the Higher Education Act of 1965 (HEA), as amended by the Higher Education Opportunity Act of 2008 (HEOA), and other recently enacted legislation. These regulations are effective July 1, 2010.
- “On October 29, 2009, the Department published in the Federal Register final regulations amending the regulations for Institutional Eligibility Under the Higher Education Act of 1965, the Student Assistance General Provisions, the Federal Work-Study (FWS) Programs, the Teacher Education Assistance for College and Higher Education (TEACH) Grant Program, the Federal Pell Grant Program, and the Leveraging Educational Assistance Partnership Program (LEAP) to implement various general and non-loan provisions of the Higher Education Act of 1965 (HEA), as amended by the Higher Education Opportunity Act of 2008 (HEOA) and other recently enacted legislation. These regulations are effective July 1, 2010.
- “On October 28, 2009, the Department published in the Federal Register, final regulations regarding Institutions and Lender Requirements Relating to Education Loans, to implement requirements relating to education loans that were added to the Higher Education Act of 1965, as amended (HEA) by the Higher Education Opportunity Act of 2008 (HEOA). The Secretary also amends the regulations for Student Assistance General Provisions, the Federal Perkins Loan (Perkins Loan) Program, the Federal Family Education Loan (FFEL) Program, and the William D. Ford Federal Direct Loan (Direct Loan) Program to implement certain provisions of the HEA that involve school-based loan issues and that were affected by the statutory changes made to the HEA by the HEOA. These regulations are effective July 1, 2010.
- “On October 27, 2009, the Department published in the Federal Register final regulations governing institutional eligibility and the Secretary's recognition of accrediting agencies. The Secretary is amending these regulations to implement changes to the Higher Education Act of 1965, as amended (HEA), resulting from enactment of the Higher Education Reconciliation Act of 2005 (HERA), and the Higher Education Opportunity Act (HEOA), and to clarify, improve, and update the current regulations. These regulations are effective July 1, 2010.”
Source: Department of Education. <http://www.ed.gov/policy/highered/leg/hea08/index.html>
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Chemical Facility Antiterrorism Bill
On November 6th the House voted 230-193 to pass the Chemical Facility Anti-Terrorism Act of 2009 (H.R. 2868). The bill, introduced by Representative Bennie Thompson (D-MS), amends the Homeland Security Act of 2002 to enhance security and regulate security practices at chemical facilities against potential terrorist attacks. The final House bill included an amendment offered by Representative Bill Foster (D-IL) that would give colleges and universities separate standards and security procedures from those of chemical manufacturing facilities. The original bill as reported by committee did not acknowledge any distinction between the laboratory structure of academic institutions and those at major chemical facilities. The Foster amendment directs the Secretary of Homeland Security to establish separate security regulations for academic laboratories at a future point in time.
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Lieberman-Collins Antiterrorism Bill
On November 4th the Senate Homeland Security and Government Affairs Committee approved legislation that would shift federal oversight over laboratories that handle danger pathogens from the Department of Health and Human Services and the Department of Agriculture to the Department of Homeland Security. The Weapons of Mass Destruction Prevention and Preparedness Act of 2009 (S. 1649) implements recommendations presented to the committee by Bob Graham, Chairman of the Commission on WMD Prevention. Amongst other recommendations, the commission’s report – World at Risk – directs DHS to develop security standards for laboratories that handle “Tier 1” pathogens including risk assessments, personnel reliability programs, and perimeter security improvements. The Lieberman-Collins bill also makes recommendations to review the list of select agents considered “Tier 1” pathogens to ensure that the correct balance is being struck between security and academic freedom to conduct research.
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NIH Conflict of Interest Report
The Inspector General of Health and Human Services (HHS), Daniel Levinson, issued a report on November 18th that found that the National Institutes of Health (NIH) is not doing enough to reign in conflict of interests despite warnings in 2008. This report examined information that 41 grantee institutions submitted to NIH in 2006 as well as records kept at NIH. The most common conflict was equity ownership such stock in a company. Certain vulnerabilities on how universities oversee conflicts were also found. For example, the vast majority of the 41 institutions allowed researchers to determine the extent of the relationship of their financial interests to their research and almost half did not seek specific amounts. Many did not verify that they are reporting truthfully. The Inspector General has asked the Director of NIH, Francis Collins, to submit a final management decision and action plan based on its recommendations and findings.
Click here to view the entire report.
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Science & Technology
Climate Change Legislation
The full Senate is unlikely to take up climate legislation in 2009, however, Senate Majority Leader Reid recently sat down with committee leaders to see how far panels can get this year and next. Reid plans to mold a bill for the floor that takes from the work done by the six committees of jurisdiction as well as from senators striving for common ground. Foreign Relations Chairman John Kerry, Senator Lindsey Graham, and Senator Joe Lieberman are trying to get a framework of a deal to Reid before U.S. negotiators travel next month to climate talks in Copenhagen, Denmark, but a bipartisan compromise on climate change legislation is not expected to finish work before the international gathering. Senate Democrats will wait until the spring to bring up a climate bill, and next month's Copenhagen talks may produce a political outline but not a final treaty.
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The House Science and Technology Committee recently unanimously approved by voice vote the Cybersecurity Enhancement Act (H.R. 4061), which combines the Cybersecurity Coordination and Awareness Act and the Cybersecurity Research and Development Amendments Act, which passed two panel subcommittees earlier this fall. The nuts-and-bolts IT security bill would require the president to assess the government's cybersecurity workforce, including an agency-by-agency skills assessment, and provide scholarships to students who agree to work as cybersecurity specialists for the government after graduation. Also recently, Senior Obama administration officials agreed that existing laws are inadequate to deal with cybersecurity threats to U.S. information networks, but they stopped short of proposing any specific changes. A 60-day, comprehensive, “clean-slate” administration review to assess U.S. policies and structures for cybersecurity operations turned up legal issues that agencies are grappling with, yet the report did not say when the administration would present legislative proposals to Congress.
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AAAS Seeks Applicants for the 2010 S&T Policy Fellowship
The American Association for the Advancement of Science has begun accepting applications for its Science and Technology Policy Fellowships for the fall of 2010. The fellowships provide scientists and engineers with an opportunity to apply their knowledge and skills to federal policymaking, both in Congress and in more than 15 federal agencies. The year-long fellowships—which for 2010 will begin on September 1, 2010, and end August 31, 2011—include a stipend, relocation allowance, health insurance, travel/training, and professional development. The application deadline for next year’s program is December 15, 2009.
Details about the program, including the application form, are available on the AAAS website at http://fellowships.aaas.org.
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National Advisory Council on Innovation and Entrepreneurship Seeks Applicants
The Department of Commerce is currently seeking applications for membership on the National Advisory Council on Innovation and Entrepreneurship (Council). The purpose of the Council is to advise the Secretary of Commerce on matters related to innovation and entrepreneurship. The Council will identify and recommend solutions to issues critical to enabling entrepreneurs and firms to successfully commercialize new ideas and technologies into high-growth, innovation-based businesses and to create new jobs. The Council will also serve as a vehicle for ongoing dialogue with the entrepreneurship community.
Notice in the Federal Register
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Application Requirements for Final $11.5 Billion in State Fiscal Stabilization Funds Available Now
The U.S. Education Department published final regulations Wednesday laying out the requirements for what states must report to the federal government to receive money in 2010 through the State Fiscal Stabilization Fund created by the American Recovery and Reinvestment Act, which provided tens of billions of dollars of economic stimulus funds. The rules, which were published in the Federal Register, focus mostly on elementary and secondary education, but they mandate that states be able to collect (from colleges) and publicly report data regarding student enrollment and credit completion.
Monday's application requires states to provide data that will lay the foundation for reform including:
- How teachers and principals are evaluated and how this information is used to support, retain, promote, or remove staff.
- The extent to which the state has a Statewide Longitudinal Data Systems that includes all of the necessary America COMPETES Act and how it will implement a comprehensive system by 2011.
- Whether the state provides student growth data on current students and the students taught in the previous year to, at a minimum, teachers of reading/language arts and mathematics in grades in which the state administers assessments in those subjects in a manner that is timely and informs instructional programs.
- The number and identity of the schools that are Title I schools in improvement, corrective action, or restructuring that are identified as persistently lowest-achieving schools.
State applications must describe the state's current ability to collect the data or other information needed for the assurance indicators and descriptors as well as the state's current ability to make the data or information easily available to the public. If the state is currently able to fully collect and publicly report the required data or other information at least annually, the state must provide the most recent data or information with its plan.
If a state is not currently able to fully collect or publicly report the data or other information at least annually, the plan must describe the state's process and timeline for developing and implementing the means to do so as soon as possible but no later than Sept. 30, 2011. The state plan must describe the state's collection and public reporting abilities with respect to each individual indicator or descriptor.
The application, requirements, and summary of the requirements can all be found here: http://www.ed.gov/programs/statestabilization/applicant.html.
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Final Race to the Top Application Announced
The Department of Education has released the final application for more than $4 billion from the Race to the Top Fund as part of the American Recovery and Reinvestment Act (ARRA). These funds support states that have raised student performance and committed to innovated reforms to accelerate achievement. The first applications will be due in January of 2010 while the second round will conclude on June 1, 2010.
Click here to read more about the application.
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White House ARRA FAQ Web Site
The White House Office of Management and Budget has posted an updated list of frequently asked questions on its web site to help provide clarification of various requirements for reporting the use of funds awarded through the American Recovery and Reinvestment Act.
The FAQ can be found here: http://www.whitehouse.gov/omb/recovery_faqs/
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Recently introduced legislation
For a listing of recent legislation sponsored by members of the Texas delegation, visit the Recent Legislation page of our Web Site.
To view Roll Call votes recently passed legislation, click here: (House, Senate)
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