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American Pediatric Society & Society for Pediatric Research Public Policy Council |
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January 2007 Legislative Report |
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Overview The final hours of
the 109th Congress were marked by both grand action
and great inaction. On one hand, Congress finally
addressed several long-standing agenda items, such as passing
legislation reauthorizing the National Institutes of Health,
introducing a pediatric medical device bill, and temporarily
fixing the State Child Health Insurance Program (SCHIP) funding
shortfall for 2007. On the other hand, Congress failed to
complete what is arguably its most important task when the
session closed with only two of eleven FY 2007 spending bills
finalized. The following is an update and summary of these activities and other recent federal legislative and regulatory actions of interest to the pediatric academic community. We hope that this information will assist you in your advocacy at the start of the 110th Congress and beyond. We encourage you to share this information with your colleagues. Members of the American Pediatric Society, Society for Pediatric Research and the Association of Medical School Pediatric Department Chairs are urged to reach out to their Members of Congress to advocate for key health and pediatric-specific issues. This report includes information on the following issues:
FY 2007 Budget and
Appropriations
Continuing Resolution: When Congress adjourned for the mid-term elections on September 29, neither chamber had taken up their respective Labor-HHS-Education bill, thus missing the start of the new fiscal year, beginning on October 1. In fact Congress had failed to complete nine of the 11 FY 2007 spending bills. In order to allow government programs to continue to function, Congress passed a short-term spending bill - continuing resolution (CR) - as part of the Defense appropriations bill in late September. The first CR expired on November 17. Depending on the status of the appropriations bill, funding for programs was at FY 2006 levels or the House-passed level for FY 2007, or the Senate-passed level for FY 2007, whichever was the lowest. Consequently, for programs contained in the Labor-HHS-Education bill, funding continued at FY 2006 levels. After the election, Congress passed another CR to continue funding Labor-HHS-Education programs at FY 2006 levels through December 8. Despite its best efforts Congress could not complete their work on the remaining nine FY 2007 appropriations bills during the 109th Congress. On December 8, Congress passed a third CR, extending funding for health programs at FY 2006 levels until February 15, 2007. Following passage of the third CR, Senator Robert Byrd (D-WV) and Representative David Obey (D-WI), who chair their respective chamber’s appropriations committees in the 110th Congress, expressed their desire to pass a year-long CR with “limited adjustments” in early 2007 in lieu of passing individual appropriations bills for FY 07. The pediatric and adolescent health community should use the remaining weeks prior to February 15, to advocate for funding increases to child and adolescent health programs that could be already impacted by a year-long CR, such as the Title VII health professions program, NIH, CDC etc. The public health advocacy community, including pediatrics, is making one final push to increase the funding for public health programs in the FY 2007 Labor/HHS/Education appropriations bill. Despite
Congress’s failure to complete all of the FY 2007 appropriations
bills in a timely fashion, the FY 2008 budget process is already
underway! The President’s 2008 budget proposal will be
released on the first Monday of February 2007. It is
essential that the pediatric and adolescent health community
continue to advocate strongly for adequate FY 2008 funding in
the weeks and months ahead. Currently some advocates speculate
that the President’s FY 2008 budget proposal could be harsher to
health programs than in prior years in order to leave the now
Democratically-led Congress in the difficult position of
choosing which programs will receive funding reductions or
increased funds. This coupled with the “pay-as-you-go”
provision passed in the first hours of the 110th
Congress will make for a very difficult year ahead for
discretionary programs such as child and adolescent health care. National Strategy for Pandemic Influenza Implementation Plan: On December18, 2006, the White House released a report providing a six-month update on the National Strategy for Pandemic Influenza Implementation Plan (Implementation Plan). The Implementation Plan itself was released in May 2006. In conjunction with the report’s release, Rajeev Venkayya, M.D., Special Assistant to the President for Homeland Security, hosted an interactive teleconference call with stakeholders to address their concerns regarding the status of the implementation plan. Staff participated in this call. The report finds that 92 percent of action items due within six months have been completed, with 8 percent "in progress." The due dates for twelve items related to community containment are postponed until February 1, 2007, pending additional analysis, and were not included in the report. The six-month progress report is available at http://www.pandemicflu.gov/plan/federal/stratergyimplementationplan.html Pandemic and All-Hazards Preparedness Act: The Pandemic and All-Hazards Preparedness Act passed in final hours of the 109th Congress. The legislation reauthorizes (through 2011) a law related to bio-terrorism and disease outbreak preparedness and would establish the Biomedical Advanced Research and Development Authority (BARDA) to coordinate federal efforts to produce countermeasures against biological weapons and diseases. The legislation includes a provision allowing the Secretary to track the initial distribution of federally purchased influenza vaccine in an influenza pandemic. Pediatric
Research
National
Institutes of Heath (NIH) Reauthorization:
On September 26, the House of
Representatives passed the “National Institutes of Health
Reform Act,” H.R. 6164, by a vote of 414-2, with
Representatives Edward Markey (D-MA) and Jesse Jackson, Jr.,
(D-IL) casting the only no votes. The legislation,
sponsored by the Chairman of the Energy and Commerce Committee,
Representative Joe Barton (R-TX), authorized a 5 percent annual
increase in NIH funding through FY 2009 and created a “common
fund” to support research involving more than one of the
agency’s institutes or centers. In the final hours of the
109th Congress, the reauthorization bill appeared
dead, as the Senate refused to take up the measure for a variety
of reasons both substantive and political. However, in the
final moments of the second session of the 109th
Congress, an amended bill did pass in both chambers following
significant negotiations with Senators Arlen Specter
(R-PA.) and Tom Harkin (D-IA), the chair and ranking member of
the Senate Labor-HHS-Education Appropriations Subcommittee, and
Senators Mike Enzi (R-WY) and Edward Kennedy (D-MA), the chair
and ranking member of the Senate Health, Education, Labor, and
Pensions (HELP) Committee and Representative Barton.
The amended version of the bill increases the
authorization levels for NIH to $30.3 billion in FY 2007 and
$32.8 billion in FY 2008, which represent increases of 7 percent
and 8.2 percent respectively. The bill also authorizes "such
sums as may be necessary" for FY 2009. The House passed bill
authorized 5 percent increases each year for FY 2007 through
2009, peaking at $32.8 billion in FY 2009. The revised bill
eliminated the 50% funding formula for
the common fund, replacing it with a provision leaving common
fund funding to the discretion of the NIH Director. The final version
of the bill also included a Clinical and Translational Science
Award (CSTA) provision added by the Senate and supported by the
National Association of Children’s Hospitals. The provision
requires the NIH Director to establish a mechanism within
CTSA program "to preserve independent funding and infrastructure
for pediatric clinical research by allowing the appointment of a
secondary principal investigator under a single CTSA with direct
authority over a separate budget and infrastructure for
pediatric research, or otherwise securing institutional
independence of pediatric clinical research centers with respect
to finances, infrastructure, resources, and research agenda."
The Director is to provide an evaluation and comparison of
outcomes and effectiveness in these programs as part of a
biennial report to Congress. The bill
is currently awaiting the signature of President Bush, which is
expected. National Children’s Study:
Through the 109th Congress the pediatric community
worked to increase funding for the National Children’s Study
(NCS) as well as maintaining the NCS that had been deleted in
the FY 2007 President’s Budget proposal. Congress rejected the
latter. At the time of this writing it is anticipated that the
NCS could be funded at the FY 2006 level - $12 million - that
would allow the program to continue to function, but would, most
likely, prevent any new centers from being established in the
coming year. These funding issues were of prime concern
to the December 5, NCS Advisory Committee that includes several
pediatricians on it including the chair of the Public Policy
Council Dr. Myron Genel. In addition, the Committee discussed
the following:
Further information and updates are
available at
http://www.nationalchildrensstudy.gov. Animal Enterprise Terrorism Act: On Monday, November 27, President Bush signed the Animal Enterprise Terrorism Act (AETA) into law. This legislation, which received tremendous bi-partisan support in both the House and Senate, amends the Animal Enterprise Protection Act (Title 18, Sec. 43 of the US Criminal Code) and expands criminal prohibitions against the use of force, violence, and threats involving animal enterprises and increased penalties for violations of these prohibitions. The AETA will provide greater protections against intimidation and harassment of researchers and will for the first time address campaigns of secondary and tertiary targeting that cause economic damage to research enterprises. Pediatric Workforce/Graduate Medical Education
GME Financing for Children’s Hospitals (CHGME)
–Reauthorization: On September 28, the House passed
legislation reauthorizing the CHGME program for five years
(through FY 2011) with a spending ceiling of $330 million per
year. The Senate passed the same bill two days earlier on
September 26. The bill makes improvements to the CHGME
program by strongly encouraging participating hospitals to
report important new data measures to the Department of Health
and Human Services, including:
Title VII Health Professions Program-
Appropriations: Despite the likelihood that a year-long
CR will fund Title VII at FY 2006 levels in FY 2007, the
Academy, working through the
Health Professions and Nursing Education Coalition (HPNEC),
continues its advocacy efforts to restore Title VII funding to
FY 2005 levels. This restoration is critical, as in FY
2006, Title VII funding was slashed by more than 50%, with
funding dropping from $300 million to a mere $145 million.
Reauthorization:
Although Title VII reauthorization was discussed at various
times throughout the 109th Congress, no legislative
action was taken. It remains to be seen what action, if
any, will take place in the 110th Congress. It is not
anticipated that the Title VII bill will be reauthorized in its
entirety but perhaps specific provisions may be reauthorized. Physicians for Underserved Areas Act: The Physicians for Underserved Areas Act extends the J1 visa program for an additional two years. The waiver program allows foreign physicians, including pediatricians, trained in the U.S. to remain in the nation for three years, provided that they treat patients in medically underserved areas. On December 6 Senators Chris Dodd (D-CT) and Mike DeWine (R-OH) introduced the Pediatric Medical Device Safety and Improvement Act of 2006. This legislation is supported by the National Organization for Rare Disorders, the Elizabeth Glaser Pediatric AIDS Foundation, the American Thoracic Society, the American Pediatric Society, the Association of Medical School Pediatric Department Chairs, and the Society for Pediatric Research, all of whom are committed to moving it through Congress upon its anticipated reintroduction in the 110th Congress. Deficit Reduction Act (DRA) Technical Corrections: On December 9, Congress passed technical corrections to last year’s Deficit Reduction Act (DRA) as part of the “tax extenders” bill (H.R. 6111, the “Tax Relief and Health Care Act of 2006”). The language appears to solve some of the problems caused by the DRA for foster children, as they are now exempt from any requirement to document their citizenship and identification to qualify for Medicaid. Additionally, some of the cost-sharing provisions for the poorest Medicaid recipients appear to have been rescinded. However, technical corrections do not appear to have adequately addressed the changes the DRA made to the Early and Periodic Screening Diagnostic and Treatment (EPSDT) Program, nor do they appear to have rescinded the policy change for newborns that had formerly been deemed eligible for Medicaid coverage. As such, Congress will likely consider further technical amendments to the DRA during the 110th Congress.
State Child Health Insurance Program
(SCHIP) Shortfall:
Also in its final
days of legislative activity, the 109th
Congress agreed to act on the SCHIP funding shortfall expected
in 14 states and threatening up to 500,000 children by attaching
a “temporary fix” provision on to the National Institutes of
Health reauthorization bill. The temporary fix reallocates
money from states that did not use all of their SCHIP funding
allotments in 2004 ($125 million total) and 2005 ($136 million
total) to shortfall states. Unfortunately, as of May 4,
2007, some states may begin to run out of funds and be forced to
reduce enrollment, curtail benefits, increase patient fees or
reduce provider payments.
SCHIP Reauthorization:
The incoming 110th Congress is slated to reauthorize the SCHIP
law, which is scheduled to expire Sept. 30, 2007. Some of the
key issues that must be addressed in
reauthorizing SCHIP that SCHIP has funding needed to cover more
children, eliminate red-tape barriers to enrollment, and address
quality and accountability of child health coverage.
2007
PEDIATRIC ACADEMIC SOCIETIES
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All information contained
in this Website is the property of the American Pediatric Society and
the Society for Pediatric Research unless otherwise noted. Duplication of any information contained herein for reasons other than personal use requires the expressed written permission of APS / SPR. Last Updated: 03/20/2007 |
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