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Federal Issues - Budget and Appropriations

AACOM monitors and advocates on federal issues that address or may impact osteopathic medical education. Select from the topic links below to learn about these issues, related AACOM activity and additional resources.


FY 2017 Appropriations

Updated 06/15/2016

Senate Committee Passes FY 2017 Labor-HHS-Ed Appropriations

The Senate Committee on Appropriations approved the Labor, Health and Human Services, Education (Labor-HHS) appropriations bill for fiscal year (FY) 2017, which provides $161.9 billion in discretionary funding. The bill is the product of a compromise reached by Chairman Roy Blunt (R-MO) and Ranking Member Patty Murray (D-WA) of the Labor-HHS Appropriations Subcommittee. This legislation is the first bipartisan Labor-HHS appropriations bill to pass out of the Senate appropriations committee in seven years.

Highlights of interest to osteopathic medical education include the following:

  • $34.08 billion for the National Institutes of Health, a $2 billion increase over the current funding level.
  • $324 million for the Agency for Healthcare Research and Quality, a $10 million cut from current levels.
  • $7.11 billion for the Centers for Disease Control and Prevention (CDC).
  • $261 million, for CDC, Substance Abuse and Mental Health Services Administration (SAMHSA), and Health Resources and Services Administration (HRSA) programs targeted to combat opioid abuse, an increase of $126 million over current levels.
  • $297.3 million for HRSA Title VII Health Professions and Education Training Programs, a $35 million increase above FY16 levels; this funding is inclusive of the HRSA Behavioral Health Workforce Education and Training Program that was transferred from SAMHSA.
  • $152.6 million for Rural Health Care Programs, an increase of $3 million above FY16. The bill focuses resources toward efforts and programs to help rural communities, such as telehealth.
  • $160 million for Preventive Health and Health Services Block Grant (Prevent Block Grant), which is level with FY16 funding. The Administration proposed to eliminate this program.
  • The committee declined to fund the Health Careers Opportunity Program, citing funding constraints and investment in other programs with a similar but more immediate outcomes.
  • $30.25 million for the Area Health Education Centers Program, which is level with FY16 funding.
  • $21.7 million for the Centers of Excellence Program, which is level with FY16 funding.
  • $49 million for the Scholarships for Disadvantaged Students Program, a $3 million increase from FY16.
  • $38.7 million for Geriatrics Programs, which is level with FY16 funding.
Additionally, the FY17 Senate Labor-HHS appropriations bill funds the U.S. Department of Education at $67.8 billion, $220 million less than FY16.

The bill will now head to the Senate floor for consideration, however, it is not expected to be brought to a vote. The House is expected to consider its Labor-HHS appropriations bill next week, which will differ from the Senate version, and the two versions will have to be reconciled in conference, which is unlikely. FY16 ends on September 30, 2016, and it is projected that Congress will either pass a last-minute omnibus bill or a continuing resolution to fund the federal government through the elections.

FY 2016 Appropriations

Updated 10/26/2015

  • President Signs Stopgap Measure; Congress Averts Government Shutdown
    On Sept. 30, President Obama signed a short-term continuing resolution (CR) to continue funding for federal agencies, averting a government shutdown. The CR provides funding through Dec. 11, 2015 and most federal programs will be funded at FY15 levels. Earlier in the day, the House passed the CR, by a vote of 277-151, after the Senate approved it, by a vote of 78-20. In addition to House and Senate leaders working toward a two-year budget agreement, Congress must also raise the debt ceiling before the November 3rd deadline.

FY 2015 Appropriations

  • Democrats’ Release FY15 Labor-H Appropriations Bill 
    In the absence of a House majority bill, Representative Rosa DeLauro (D-CT), Ranking Member of the House Labor, Health and Human Services, and Education (Labor-HHS-Ed) Appropriations Subcommittee, recently released the Democrats’ draft proposal for the fiscal year (FY) 2015 Labor-HHS-Ed spending bill. Unlike the Senate bill, the House Democrats’ draft proposal includes funding for the Title VII Health Careers Opportunity Program ($14.8 million) and Area Health Education Centers ($30.3 million), rejecting the President’s proposal to eliminate funding for both programs.  

Additional funding highlights include the following:

    • $100 million in discretionary funding for the National Health Service Corps (NHSC). However, the NHSC Fund established by the Affordable Care Act (ACA) provides $310 million in mandatory funding for the program in FY 2015, bringing the bill’s total for the program to $410 million.
    • $5.092 billion for Community Health Centers (amount is inclusive of the mandatory spending provided under the ACA).
    • $3 million for the National Healthcare Workforce Commission, which was established as an independent advisory body in the ACA but was never funded.
    • $265.2 million for the Children’s Hospitals Graduate Medical Education (CHGME) Program, a $0.9 million increase above the FY 2014 funding level, restoring the CHGME budget to its pre-sequestration level and rejecting the President’s proposal to eliminate funding for this program.
    • $30.632 billion for the National Institutes of Health (NIH), an increase of $778 million over the FY 14 level, restoring the NIH budget to the pre-sequestration level.
    • $373.3 million for the Agency for Healthcare Research and Quality (AHRQ), a $2.3 million increase above the FY 14 funding level.

 

Although Congress voted in support of a continuing resolution (CR) to keep the federal government running and the President has signed this measure into law, Congress will need to reach a budget agreement that will fund the federal government after December 11, 2014, when the CR expires.  Additionally, although the FY 15 Senate Labor-HHS-Ed appropriations bill has yet to be approved by the full Senate Appropriations Committee this year, a bill text was released in July 2014 in order to position itself with the House on a future FY 15 omnibus bill. The House Democrats’ draft proposal will also be used as a vehicle for Democratic members to highlight the differing funding priorities between their party and Republicans.

  • Congress Passes CR and Leaves Town for Midterm Elections 
    On 9/19/14, the President signed into law a continuing resolution (CR), which will keep the federal government open at the fiscal year (FY) 2014 funding level through December 11, 2014, as Congress failed to pass any appropriations measures for FY 2015.  This short-term measure also includes $88 million for anti-Ebola efforts and additional funding for disability claims processing at the Department of Veterans Affairs.  Earlier that week, the Senate passed the CR by a vote of 78-22 before heading out of town to campaign in their home districts for the midterm elections, with 12 Republicans and 10 Democrats voting against the package; the House voted in support of the legislation in a bipartisan vote of 319-108.

     

    In order to keep the federal government open past the December 11 deadline when the CR expires, Congress will have to reach a budget agreement that will fund the federal government for the remainder of FY 2015.


Senate Labor-HHS Appropriations Committee Releases FY15 Spending Bill  The Senate Appropriations Committee recently released the bill text for its version of the FY15 Labor-HHS-Ed (LHHS) appropriations bill. The bill was previously reported out of the Senate Labor HHS Subcommittee on June 10 where it was approved. The full Committee’s version is similar as the marked- up version voted out of the Subcommittee. The legislation provides a total of $156.8 billion, maintaining the fiscal year (FY)14 funding level.  Additionally, the bill includes $1.48 billion in cap adjustment funding, to prevent waste, fraud, and abuse in the Medicare, Medicaid, and Social Security programs. Specific funding highlights include the following:
    • $30.5 billion for biomedical research at the National Institutes of Health, an increase of $605 million over the FY14 level;
    • $30.3 million for the Title VII Area Health Education Centers at $30.3 million; does not provide funding for the Title VII Centers of Excellence program, the Health Careers Opportunity Program, or the faculty loan repayment program;
    • $58 million for the Title VII Scholarships for Disadvantaged Students program, a $13 million increase over the FY14 level;
    • $41 million for primary care training and enhancement programs, a $4 million increase over the FY14 level; and 
    • $1.5 billion for Community Health Centers (CHCs) (when combined with mandatory spending provided under the Affordable Care Act, CHCs would receive a total of $5.1 billion, a $1.45 billion increase over the FY14 level).  

    Furthermore, as did the Subcommittee’s version, the full Committee’s bill rejects the President’s proposal to eliminate funding for the Children’s Hospital Graduate Medical Education Program and instead allocated $265 million, maintaining FY14 level funding.  Additionally, over $370 million was allocated to the Agency for Healthcare Research and Quality, a $2.3 million increase over the FY14 level. 

    In addition, as did the Subcommittee’s version, the full Committee’s bill does not provide an appropriation for the National Health Service Corps (NHSC), since the NHSC Fund, established by the Affordable Care Act, provides $310 million in mandatory funding for the program in FY15; however the Fund expires at the end of FY15.   

    The LHHS appropriations bill must now be approved by the full Senate Appropriations Committee prior to being considered on the Senate floor. However, a timeline still has not been determined. Additionally, the House has not yet taken any action on the bill. 

    Congress has yet to send any of the twelve appropriations bills to the president for enactment. The failure to do so before the end of the federal government’s fiscal year, September 30, could lead to another government shutdown and the passage of a continuing resolution to keep the federal government working is likely.


     

    FY 2014 Appropriations

    Posted 2/18/2014

    • President Signs FY14 Omnibus Spending Bill
      On January 17, 2014, President Obama signed into law a $1 trillion omnibus spending package, the Consolidated Appropriations Act of 2014, which will fund the federal government through fiscal year (FY) 2014, which includes all 12 appropriations bills including Labor-HHS-Education and adheres to the $1.012 trillion discretionary spending level set by the Bipartisan Budget Act of 2013, also known as the Ryan-Murray Budget Agreement. 

      The Labor-HHS-Education allocation for discretionary programs is $156.8 billion, which is $7 billion above the post-sequester FY13 spending level and $2 billion above the enacted FY13 level. While this increase is a full restoration of Labor-HHS's sequestration cuts, some of this funding was needed to pay for other "must fund" programs in the bill.  The U.S. Department of Health and Human Services' Health Resources and Services Administration (HRSA) - received approximately $6.30 billion, with its total discretionary budget authority in the omnibus about $200 million over the FY 13 post-sequestration level and roughly a 60% restoration of sequestration cuts to the agency overall. However, please note that some programs within HRSA were restored at varying levels.  The U.S. Department of Educationreceived $70.6 billion; a $739 million decrease from FY 2013.  While this level of funding was a decrease, the funding does include full restoration of the Head Start program. 

      Please see below for highlights of additional funded agencies/programs in the package:

      The National Institutes of Health (NIH) - includes $29.9 billion, a $1 billion increase over previous funding levels.  This amount should allow NIH to continue all current research programs and begin approximately 385 additional research studies and trials.

      The Agency for Healthcare Research & Quality - includes $471 million, an increase of $37 million over FY 2013 and the president's FY 2014 request.

      Centers for Disease Control and Prevention (CDC) - provides $5.807 billion in base budget authority for the CDC, a$370 million increase (6.8 percent) over the FY 2013 post-sequestration funding level. In addition to the base budget authority, the bill includes transfers to the agency, including an $831 million transfer from the Prevention and Public Health Fund.

      Workforce Training Programs - Title VII received $223.8 million, an 11.3 percent increase over FY 2013 post-sequestration funding levels, and Title VIII received $223.8 million, a 3 percent increase over FY 2013 post-sequestration funding levels.

      Public Health and Preventive Medicine Training - includes at minimum $2 million for a new competitive award to support a national center of excellence on integrative primary care. 

      Community Prevention Grants -includes language for a new initiative to prevent chronic diseases and reduce their impact by awarding three year grants to community coalitions that include businesses, schools, and non-profit organizations.

      Community Health Centers - includes level discretionary funding for the Health Centers program which, combined with already-appropriated mandatory funding for health centers available through the Affordable Care Act's (ACA) Health Center Fund, represents a $700 million increase in funding from FY 2013.

      The Centers for Medicare and Medicaid Services - received $3.7 billion; a $195 million decrease from FY 2013.  The budget for operations and management remains frozen at the current level.  The law does however, allocate $305 millionfor CMS to use specifically for processing and payment of benefits.  Please note: the law specifically precludes CMS from using new funding allocated for payment processing for initiatives related to the ACA.

      Children's Hospital GME - received $265 million, which is an increase in $10 million from post-sequestration spending levels in 2013.

      HIGHER EDUCATION

      Of note:
      The law includes a study of higher education regulations, proposed by Senator Lamar Alexander (R-TN) which would receive $1 million in funding.  This study would allow the Secretary to enter into an agreement with the National Research Council of the National Academy of Sciences to conduct a study on the impact of federal regulations and reporting requirements on institutions of higher education as authorized under section 1106 of the Higher Education Opportunity Act of 2008.

      PROVISIONS UNDER ACA 
      • Reduces funding for the Prevention and Public Health Fund by $1 billion and prevents the Administration from reallocating funding from the Fund for health reform programs.

        Reduces funding for the Independent Payment Advisory Board (IPAB) by $10 million from the original $15 million appropriation in the ACA.  As you know, IPAB, a 15 member independent panel appointed by the president and confirmed by the Senate, is charged with enforcing a limit on Medicare spending growth.
    • Congress Passes Measure to Delay Sequestration and Cut Medicare 
      After the debt limit passed, the Senate also voted 95-3 to reverse the military pension cuts put in place under the bipartisan budget deal. The legislation passed in the House just a day earlier in a 326-90 vote. The measure would restore military cost-of-living adjustments and be paid for by extending sequestration (under the Budget Control Act of 2011), including Medicare, for one more year to 2024. According to the Congressional Budget Office, the score of the House bill for the additional year of sequester amounts to $9.2 billion in cuts. The President is expected to sign the measure into law. 

      The latest sequester extension comes after last year’s bipartisan budget deal, which extended sequester for two years to 2023. The latest version to pass both chambers extends sequester for mandatory programs to include Medicare costs for another year, through 2024. The bill also sets aside $2.3 billion to fund the next “doc fix,” or patch to prevent cuts to Medicare providers called for by the sustainable growth rate. 

      AACOM continues to oppose any delay in sequestration and any impact this delay has on Medicare cuts and graduate medical education. 
    • President Signs Debt Limit Extension
      On 2/15/2014, the President signed legislation that raises the U.S. debt limit through March 15, 2015. Earlier that week, the Senate passed the legislation by a vote of 55-43, after the House voted 221-201 in support of the legislation. Ultimately, 28 Republicans joined 193 Democrats to pass the debt ceiling hike, with only two Democrats and 199 Republicans opposing the measure.  

      House Speaker Boehner needed Democrats to give him the votes to pass the clean debt ceiling measure. Republicans considered attaching the Sustainable Growth Rate and a reversal of recent cuts to military pensions (cuts in bipartisan budget agreement) to the debt ceiling bill, but in the end, the Republican leadership decided to move forward with a clean bill. Congress will not face a major fiscal decision until September 30, the end of the fiscal year for the government.
    • President Signs Two-Year Budget Agreement; Federal Spending Bill on the Horizon 
      On December 26, 2013, President Obama signed into law the Bipartisan Budget Act, a two-year, bipartisan budget agreement. 

      The agreement, crafted by Rep. Paul Ryan (R-WI) and Sen. Patty Murray (D-WA), sets discretionary spending at $1.012 trillion for the current fiscal year (FY) — a level that will rise to $1.014 trillion in FY 2015 — and eliminates $63 billion of sequestration cuts with more targeted spending cuts. The law does not extend emergency unemployment benefits or address the debt ceiling. In addition, the law includes a three-month “doc fix,” which averts a 20.1 percent cut in Medicare payments that would have kicked in January 1, 2014. Furthermore, it extends the two percent sequester cut to Medicare providers and plans. This two percent cut was set to expire in 2021 and is now extended through 2023; it was created by sequestration under the Budget Control Act of 2011.

      As Congress was unable to pass a funding bill prior to January 15, 2014, which was required by the budget agreement, Congress approved a short-term continuing resolution (CR) to fund the federal government through January 18, 2014. The measure is expected to be signed by the President. Furthermore, this will allow time for debate in Congress on a large omnibus spending bill this week, which has passed the House and is currently being considered in the Senate.
    • President Signs Deal to Reopen Federal Government and Extend Debt Ceiling
      On 10/16/2013, President Obama signed into law a continuing resolution (CR) that reopened the federal government; the bill would fund the federal government until January 15, 2014 and raise the debt ceiling through February 7, 2014. Earlier the same day, the Senate voted 81-18 to pass the measure which then the House passed by a 285 – 144 vote. The CR will deliver retroactive pay to furloughed federal employees, require income verification for people seeking health-insurance subsidies under the Affordable Care Act (ACA) – the only ACA-related provision included in the agreement – and allow the Treasury Department to use extraordinary measures to pay the nation’s bills if Congress does not raise the debt ceiling by the February 7, 2014 deadline. Of note, the bill does not include language requiring a bicameral budget conference as had been expected. Instead there was a separate agreement between House and Senate leaders to appoint negotiators to go to conference on the budget. The two chambers will be required to conclude that bicameral conference by Dec. 13, 2013

      Congress had not reached an agreement by the time the most recent CR, a six-month funding bill that passed in March 2013, expired on September 30, the end of the federal government’s fiscal year; this had led to the federal government shutdown beginning October 1.
    • House Passes Continuing Resolution
      On 9/20/2013, the U.S. House of Representatives approved a continuing resolution (CR) in a 230-189 vote. This measure would continue funding the federal government through December 15, 2013, at $986 billion, the fiscal year (FY) 2013 post-sequestration level, with the exclusion of funding for the Affordable Care Act (ACA). The bill has been sent to the U.S. Senate for consideration. The current CR, a six-month funding bill passed in March 2013, expires on September 30, which is the end of the federal government’s fiscal year.
     

    FY 2013 Appropriations

    Posted 2/13/2013

    • President Obama Signs Debt Ceiling Bill 
      On 2/1/13, President Obama signed the debt ceiling bill which temporarily suspends the public debt limit until mid-May providing more time for Congress to work out a longer-term agreement.  The "No Budget, No Pay Act of 2013" also mandates that pay for Members of Congress be held in escrow starting April 16 until their chamber has passed a 2014 budget resolution.  The day before, the U.S. Senate approved the measure by a 64-34 vote.  After the May deadline, the Treasury Department will need to use “extraordinary measures” to keep paying the nation’s bills. 
    • Congress Passes CR to Avert Federal Government Shutdown
      On 9/28/12, President Obama signed a continuing resolution (CR), which averted a shutdown of the federal government and continued funding the federal government through March 27, 2013.  On September 22, 2012, the Senate approved the six-month CR by a 62-30 vote, and almost a week earlier, the House voted to approve the measure by a 329-91 vote. As the CR adheres to the fiscal year (FY) 2013 discretionary spending limit of $1.047 trillion, the measure would maintain funding for most federal programs at close to their FY 2012 levels.
    • Congressional Leaders Forge Deal on Stopgap Bill
      Congressional leaders this week agreed to a stopgap bill to keep the federal government funded for a six-month period - from October 2011 to March 2012.  Leaders stated they will vote in September on a continuing resolution (CR) for the first half of fiscal year 2013, using the $1.047 trillion discretionary spending limit agreed to in the Budget Control Act of 2011, which passed last year and set budget caps for the next 10 years.  The CR eradicates months of work by the Appropriations committees, since their bills will not have standing in the new Congress.
    • House and Senate Set FY13 Spending Caps 
      The House voted to deem the GOP budget resolution as the final budget resolution adopted by the House and Senate, making the caps put in place by the Budget Control Act (BCA) of 2011 enforceable. The House Appropriations Committee approved its spending allocations for FY13, setting its overall cap at $1.028 trillion, or $19 billion less than its counterpart in the Senate, which used the $1.047 trillion benchmark put in place by the BCA. In terms of funding for Labor-HHS-Education, there remains a difference of $7.7 billion between the House and Senate, with the Senate allocating $157.722 billion and the House allocating  $150.002 billion.

      Traditionally, both chambers adopt a budget resolution to set target spending levels during the annual appropriations process, but Senate Majority Leader Harry Reid (D-NV), has stated that his chamber will not adopt a budget resolution for FY13 because he deemed it unnecessary due to the BCA setting an overall spending cap for FY13. Please see the Coalition for Health Funding (CHF) letter to Senate and House Appropriations leadership urging the largest possible allocation to the FY13 Labor-HHS-Ed Appropriations Subcommittee within the discretionary cap established by the BCA, while also urging them to prevent cuts to discretionary health, education, and workforce programs within the committee’s jurisdiction.  AACOM is a member of the CHF.

    Congressional Budget Office

    Posted 2/9/2012

    • CBO Releases Budget Outlook 
      The Congressional Budget Office (CBO) recently released its report “Budget and Economic Outlook.” The CBO prepares budget projections over the next 10 years, providing a baseline against which potential policy changes may be measured. According to the CBO, there will be a $1.1 trillion federal budget deficit in fiscal year (FY) 2012 if current laws remain unchanged. This is approximately two percentage points below the deficit recorded in 2011, but still higher than any deficit between 1947 and 2008. CBO reported that Medicare spending, excluding money received from beneficiary premiums, would top $1 trillion annually by 2022, nearly double that expected in 2012, while Medicaid spending would reach $605 billion by 2022. The report also stated that Medicare spending would be reduced by approximately $117 billion over 10 years, as a result of a two percent spending cut mandated when the Joint Select Committee on Deficit Reduction (“Super Committee”) failed to put forth recommendations to reduce the federal budget deficit. 

    Joint Select Committee on Deficit Reduction

    Posted 10/4/2011

    • Joint Select Committee on Deficit Reduction Holds Three Public Hearings 
      On 9/22/11, members of the bipartisan Joint Select Committee on Deficit Reduction (“Super Committee”) held their third meeting. The public hearing focused on potential tax code reform to deal with the federal budget deficit. On 9/13/11, the Congressional Budget Office (CBO) Director Douglas Elmendorf testified to the Super Committee on the drivers of the federal debt. Director Elmendorf stated that the CBO would need to receive the draft of the Committee’s recommendations by the first week of November in order to have time to determine the budgetary impact – even though the Committee’s official deadline to send recommendations to Congress is November 23. On 9/8/11, the Super Committee held an organizational meeting to consider proposed Committee rules. 

      The Joint Select Committee on Deficit Reduction, which was created by the Budget Control Act of 2011, is a 12-member bipartisan and bicameral panel to recommend $1.5 trillion in cuts to reduce the federal deficit over the next 10 years. The act requires the Committee to send its recommendations to Congress by November 23, 2011, and calls for final votes on the proposal by December 23, 2011. If Congress fails to act on the Committee's recommendations on or before December 23, 2011, then automatic cuts to defense and Medicare providers go into effect – a “trigger.”

    FY 2013 Administration Budget Request

    Posted 3/9/2011

    • On 2/13/12, President Obama proposed his administration’s fiscal year (FY) 2013 budget, which would provide an additional $3 trillion in deficit reduction over ten years, half of which would be derived from new revenue, $278 billion from non-health mandatory spending and $360 billion in savings to Medicare, Medicaid and other health programs.  The balance would come from defense spending.  In particular, Medicare spending would be reduced by approximately $303 billion over 10 years, while Medicaid spending would be cut nearly $56 billion.

      The President’s budget proposes to reduce Medicare graduate medical education (GME) payments to hospitals by about $9.7 billion over 10 years.  (Of note:  Secretary would have authority to set standards for teaching hospitals receiving GME payments that encourage training of primary care residents and skills that promote high-quality and high-value health care delivery).  The Children’s Hospitals Graduate Medical Education (CHGME) program is proposed to be funded at a level of $88 million, a reduction of $177 million from its current funding level.  Last year the President’s budget eliminated CHGME, while this year it recommends a cut of two-thirds.

      In addition, the budget proposes the following for key programs in the Health Resources and Services Administration: 
      • $228 million for the Title VII health professions program, a $40 million (15 percent) cut below FY 2012.  Within that number, it increases the Primary Care Training and Enhancement from $39 million to $51 million, (+31 percent).  It proposes to eliminate the Title VII Health Careers Opportunity Program (HCOP) and the Area Health Education Centers (AHEC) programs. 
      • For FY12 and FY13 (as proposed), the National Health Service Corps (NHSC) will operate with funds provided under the Affordable Care Act (ACA), rather than with appropriated money.  The Administration estimates total spending of $296 million for the NHSC in FY 2012 and $300 million in FY 2013. 
      • In addition, Community Health Centers are recommended to receive an additional $295 million, totaling $3.13 billion.

         Among other recommendations included in the budget are:

      • The Centers for Medicare and Medicaid (CMS) will get a 26 percent increase in program management funds.  The increase to $1 billion would help the agency with increased ACA-related responsibilities. 
      • The National Institutes of Health is level-funded at $30.7 billion (same as last year.) and the Centers for Disease Control and Prevention program levels would be reduced by about $300 million to $5.8 billion. 
      • The budget proposes $405 million for the Agency for Healthcare Research and Quality (AHRQ), but requests $334 million for AHRQ’s base, discretionary budget, which represents a $35 million (9.5 percent cut), in base funding from last year. 
      • The budget proposes to sustain the maximum Pell Grant award of $5,635 through academic year 2014-2015.
      • Finally, it provides $8 billion to the Departments of Labor and Education for state and community college partnerships with businesses.

    FY 2012 Administration Budget Request

    Updated 4/20/2011

    • House Passes FY12 Budget Resolution 
      On 4/15/11, the U.S. House of Representatives passed a $1.019 trillion fiscal year (FY) 2012 budget resolution along party lines, 235-193, with no Democrats backing the bill and only four Republicans opposing it. The legislation, which is below the $1.121 trillion discretionary request included in the president’s FY12 budget request, was approved following the rejection of a number of alternative budget resolutions. Sponsored by House Budget Chairman Paul D. Ryan (R-WI), the spending measure also calls for an overhaul of Medicare and sets forth budgetary levels through FY21. The U.S. Senate’s Budget Committee is expected to release its FY12 budget resolution in May.
    • On 2/14/11, President Obama proposed his administration’s fiscal year (FY) 2012 budget that would provide $3.7 trillion in discretionary spending, not including military operations. President Obama is proposing a five-year “freeze” on spending for non-security programs, limiting it to levels as provided in fiscal 2010. Some agencies and programs will see spending increases under the plan, while others are frozen or cut.

      The President’s budget proposes $79.9 billion in discretionary spending for the Department of Health and Human Services (HHS), a slight increase over FY10.  The administration increased the health professions programs - Title VII funding increased by $19 million (76%) to $449.5 million - the Training for Primary Care Medicine and Dentistry Program was level funded at $140 million, a 259 percent increase over FY2010; and the Centers of Excellence and Health Careers Opportunity Program were level funded at $25 million and $22 million, unchanged from fiscal 2010.  The National Health Service Corps benefited from an increase in funding with the President allocating a total of $418 million (+$249 million) through both the ACA and budgetary expansions; Community Health Centers received $2.1 million in additional funding to total $4.3 billiondollars distributed over 2011 and 2012; and the National Institutes of Health received a $745 million increase to $32 billionwith the National Center for Complementary and Alternative Medicine receiving $131 million, a $2.16 million increase.  In order to maintain a $5,550 maximum Pell award, the FY2012 budget cuts Pell “year-round” grants and eliminates subsidized Stafford loans, which currently provide students with non-accruing interest loans. At the same time, $2.5 billion is budgeted for Perkins loans.  In addition, the President requested $10 million for the Teaching Health Center Development Grants; $78 million, an increase of $17 million from FY10, for the Office of the National Coordinator for Health Information Technology as well as a 2 year patch through 2014 to the Medicare sustainable growth rate (SGR), the formula that determines physician payment on the Medicare fee schedule.

    FY 2012 Appropriations

    Updated 1/10/12

    • President Signs Payroll Tax, Includes Temporary SGR Fix
      On 12/ 23/11, President Obama signed into law the Temporary Payroll Tax Cut Continuation Act of 2011 (PL 112-078) which extends the SGR, along with the payroll tax holiday and unemployment compensation through 2/29/12. The two-month SGR extension freezes Medicare physician payment rates at 2011 levels and avoids a 27.4 percent cut, which would have gone into effect 1/1/12.  The president signed the measure after the House and Senate approved it by unanimous consent 12/23/11.  The law provides only temporary relief for physicians as they are now faced with another looming deadline in which their Medicare payments could be reduced. 

      A House-Senate bipartisan conference committee has been established to negotiate a package that would extend the payroll tax cut, including the physician payment provision, through the end of 2012.  The committee is scheduled to begin its work this month.  House Ways and Means Committee Chairman Dave Camp (R-MI) will chair the committee.  On the Senate side, conferees appointed include, Sens. Kyl (R-AZ), Crapo (R-ID), and Barrasso (R-WY.), Finance Committee Chairman Baucus (D-MT.), Cardin (D-MD.), Reed (D-RI), and Casey (D-PA).  On the House side, Reps. Levin (D-MI.), Becerra (D-CA), Van Hollen (D-MD), Waxman (D-CA), Schwartz (D-PA), Brady (R-TX), Ellmers (R-NC), Hayworth (R-NY), Price (R-GA.), Reed (R-NY), Upton (R-MI), and Walden (R-OR).
    • President Signs Stopgap Bill into Law to Avoid Shutdown
      On 10/4/11, President Obama signed into law a stopgap bill which funds the federal government through November 18. Earlier that day, the U.S. House of Representatives approved the bill, by a vote of 352-66. This was the second measure the House voted on – the first vote took place on 9/29/11, funding the government through 10/4/11, giving the chamber time to vote the following week on the longer-term measure.

    FY 2011 Administration Budget Request

    Posted 2/16/2010

    • On 2/1/10, President Obama proposed his administration’s fiscal year 2011 budget that would provide $1.16 trillion in discretionary spending, not including military operations in Iraq and Afghanistan.  President Obama is proposing a three-year “freeze” on spending for non-security programs, limiting it to the $446.3 billion provided in fiscal 2010. However, some agencies and programs will still see spending increases under the plan, while others are frozen or cut.
    • The President’s budget proposes $911 billion for the Department of Health and Human Services (HHS), a $51 billion increase over FY10.  The administration increased the health professions programs by $33 million to $995 million - the Training for Primary Care Medicine and Dentistry Program was level funded at $54 million; and the Centers of Excellence and Health Careers Opportunity Program were level funded at $25 million and $22 million.  The National Health Service Corps benefited from an increase in funding with the President allocating $169 million (+$27 million); Community Health Centers received a $290 million increase to $2.48 billion dollars; and NIH received a $1 billion increase to $32.2 billion with NCCAM receiving $132 million, a $3 million increase.  The budget also includes $371 billion for physician payment over the next 10 years, an estimate based on past Congressional actions.

    FY 2011 Appropriations

    Updated 4/19/2011

    • President Signs Continuing Resolution for Remainder of FY11
      On 4/15/11, President Obama signed into law a continuing resolution (CR), H.R. 1473, to fund the government for the remainder of fiscal year (FY) 2011.  The legislation, which includes cuts of approximately $40 billion from current spending levels, passed the U.S. House of Representatives 260-167.  Shortly thereafter, the U.S. Senate passed the bill 81-19.  This spending measure, which is the eighth CR passed in the current FY to continue federal funding, reduces funding for community health care centers by $600 million to $1.6 billion and includes some additional cuts to health-related programs.
    • President Signs Stopgap Measure to Avert Government Shutdown
      On 4/9/11, the President signed into law a one-week continuing resolution (CR), narrowly averting a government shutdown on April 9th.  The CR will extend federal funding through April 15th, allowing time for a spending measure to be drafted for the remainder of FY11.  The spending measure is expected to be taken up this week.  The legislation, which includes cuts of an additional $2 billion from current spending levels but continues funding for most federal programs at FY 2010 levels, was cleared by the U.S. Senate on 4/9/11 and approved by the U.S. House of Representatives shortly after.  This spending measure is the seventh CR passed in the current fiscal year to continue federal funding.
    • President Signs Three-Week Continuing Resolution
      On 3/18/11, the President signed into law a three-week continuing resolution (CR) to avert an impending government shutdown on March 18.  The CR will extend federal funding through April 8.  The legislation, which includes cuts of an additional $6 billion from current spending levels but continues funding for most federal programs at FY 2010 levels, was cleared by the U.S. Senate on 3/17/11 and approved by the U.S. House of Representatives a couple of days prior.  This spending measure is the sixth CR passed in the current fiscal year to continue federal funding due to Congress’ failure to pass the 12 regular appropriations bills for FY 2011.
    • Senate Rejects Two Spending Measures to Continue Funding for Federal Government 
      On 3/9/11, the U.S. Senate rejected two proposals to fund the government through the rest of the fiscal year.  The Senate first defeated H.R. 1, which was passed by the Republican-controlled House of Representatives, by a vote of 44-56.  This bill would have cut more than $60 billion from current government spending.  Then the Senate rejected a substitute amendment, cutting $4.7 billion, offered by Senate Appropriations Chairman Daniel K. Inouye (D-HI) by a vote of 42-58.  Each measure required 60 votes to pass.  The current continuing resolution extending federal funding for FY 2011 will expire on March 18.
    • Congress Passes Two-Week Continuing Resolution
      On 3/2/11, the President signed into law a two-week continuing resolution (CR) to avert an impending government shutdown on March 4 which will extend federal funding through March 18.  The legislation, which includes cuts of more than $4 billion from current spending levels but continues funding for most federal programs at FY 2010 levels, was cleared by the U.S. Senate earlier in the day and approved by the U.S. House of Representatives on 3/1/11.  This spending measure is the fifth CR passed in the current fiscal year to continue federal funding due to Congress’ failure to pass the 12 regular appropriations bills for FY 2011. 
    • House Approves FY11 Spending Measure 
      On 2/19/11, the U.S. House of Representatives approved a measure, by a vote of 235-189, to fund the federal government for the rest of the current fiscal year, cutting more than $60 billion in spending from FY 2010 levels for numerous federal programs and agencies. The bill also prohibits some federal spending for implementation for the health care reform law. In addition, the measure includes an amendment that would temporarily bar the U.S. Education Department from enforcing a rule, which would prohibit the department from using federal funds to enforce its proposed "gainful employment rule" in the 2011 fiscal year, which ends September 30. There were over 500 amendments offered, in which the House voted on nearly 70 amendments and rejected just over 50. The Senate is expected to consider the measure the first week of March. Funding for the federal government is scheduled to end on March 4.
    • President Proposes Five-Year Spending Freeze
      On 1/25/11, President Obama, during his State of the Union address, proposed a five-year freeze on non-security discretionary spending, which he said would save more than $400 billion over 10 years.  The President vowed to protect major provisions of the health reform law; however, he stated support for minor changes, such as revoking a provision imposing a tax reporting requirement on businesses.  The President is expected to unveil his FY 2012 budget during the week of February 14.
    • House Passes Measure Reducing Non-Security Spending
      On 1/25/11, the U.S. House of Representatives passed a measure, by a vote of 256-165, directing  Budget Chairman Paul Ryan (R-WI) to set a discretionary spending cap for FY 2011 that assumes non-security spending at fiscal year 2008 levels or below.  House Republicans were joined in supporting the measure by 17 Democrats.  The current continuing resolution expires March 4.
    • Congress Passes Continuing Resolution through March 4
      On 12/22/10, the House of Representatives approved, by a vote of 193-165, a continuing resolution (CR) allowing continued government operations at current levels for most programs through 3/4/11.  The Senate approved the measure 79-16 before it passed the House.  It was the fourth CR passed in the current fiscal year to continue federal funding at FY 2010 levels due to Congress’ failure to pass the 12 regular appropriations bills for FY 2011.  The most recent CR does not include increases for most programs under the U.S. Department of Health and Human Services.
    • President Obama Signs Temporary SGR Fix
      On 12/15/10, President Obama signed into law the Medicare and Medicaid Extenders (H.R. 4994) bill delaying a 25% cut in Medicare reimbursement for physicians for one year, which was scheduled to take effect on January 1, 2011. The measure passed the Senate on December 8 and the House of Representatives on December 9.  The act is paid for by modifying policy in the health care affordability tax credit in the health reform law.
    • On 9/29/10, the House of Representatives approved, by a vote of 228-194, a continuing resolution (CR) allowing continued government operations at current levels for most programs through 12/3/10.  The Senate approved the measure 69-30, several hours before it passed the House.  The CR was necessary because Congress had not approved the 12 regular appropriations bills for FY 2011, which began on 10/1/10.  Congress failed to address the impending Pell grant shortfall by denying White House requests to add funding in the CR for the Pell grant program, which helps low-income college students pay for school.
    • On 7/29/10, the Senate Appropriations Committee approved its fiscal year (FY) 2011 Labor-HHS-Education appropriations bill by a vote of 18-12.  The bill includes funding increases for both Title VII and Title VIII programs, with Title VII receiving $356 million and Title VIII receiving $292 million.  Health professions programs received funding increases, including  $90 million, an increase of $51 million for primary care training activities; approximately $48 million for oral health care training, an increase of $15.1 million; and a total of $57.9 million, an increase of $20 million, for public health workforce training.  The bill also provides $32 billion for the National Institutes of Health, $5.1 million to fund a newly authorized Rural Physician Pipeline program to create opportunities for primary care physicians to train in rural areas, and maintains funding for the Agency for Healthcare Research and Quality at the FY 2010 level.  On 7/15/10, the House of Representatives Appropriations Subcommittee on Labor-HHS-Education approved its spending bill; however, the House has taken no further action on the bill.

    Economic Stimulus (ARRA)

    Updated: 3/4/2010

    • HRSA also recently announced competitions for a new grant program -- the Equipment to Enhance Training for Health Professionals (EETHP).  HRSA is making available ARRA grant funds of approximately $50,000,000 to fund approximately 200 grant awards for a one-year project and budget period to support programs in the purchase of health professions training equipment for 21 program areas.  Applications are due March 26, 2010, at 8:00 PM (EDT) via Grants.gov (www.grants.gov); additional information is due April 26, 2010, at 5:00 PM (EDT) via HRSA's EHB (https://grants.hrsa.gov/webexternal/home.asp).  More information
    • For the Training in Primary Care Medicine and Dentistry Grant Program, the Health Resources and Services Administration (HRSA) is making available American Recovery and Reinvestment Act (ARRA) grant funds of approximately $48 million in combination with an additional funding opportunity of $54 million in Fiscal Year (FY) 2010 regular appropriations for two-year projects to support the following six program areas: academic administrative units, residency training, predoctoral training, faculty development training, physician assistant training, and general and pediatric dental residency training. Applications are due March 24, 2010, at 8:00 PM (EDT) via Grants.gov (www.grants.gov); additional information is due on April 9, 2010, at 5:00 PM (EDT) via HRSA's Electronic Handbooks System (EHB) (https://grants.hrsa.gov/webexternal/home.asp).  More information
    • The Secretary of HHS announced on 07/28/09 the availability of $200 million in ARRA funds supporting grants, loans, loan repayment, and scholarships to expand the training of health care professionals.  The funds are expected to train approximately 8,000 students and credentialed health professionals by the end of FY 2010.  The funds are part of the $500 million allotted to HHS’ Health Resources and Services Administration (HRSA) to address workforce shortages under ARRA. The $200 million will be directed to the following program areas:  (1) $80.2 million for scholarships, loans, and loan repayment awards to students, health professionals, and faculty (of those funds, $39 million will be targeted to nurses and nurse faculty, $40 million to disadvantaged students in a wide range of health professions, and $1.2 million to health professions faculty from disadvantaged backgrounds); (2) $50 million in grants to health professions training programs (funds will be used to purchase equipment needed to expand programs and improve the quality of training); (3) $47.6 million to support primary care training programs (funds will support the training of residents, medical students, physician assistants, dentists and individuals, many of whom will practice in underserved areas); (4) $10.5 million to strengthen the public health workforce (funds will support public health traineeships and increase the number of individuals trained through preventive medicine and dental public health residencies); (5) $10.2 million to increase the diversity of the health professions workforce; and (6) $1.5 million to support the efforts of state professional licensing boards in reducing barrier to telemedicine.  HRSA is using a competitive process to award all funds. 
    • On 06/29/09, the Federal Coordinating Council for Comparative Effectiveness Research (FCCCER) released recommendations for how the HHS Office of the Secretary will spend $400 million in funds for CER.  The FCCCER report, mandated by ARRA, is designed to help the HHS Secretary and lawmakers improve the quality of care for patients and provide patients and doctors the best information possible to make decisions about health care.  Congress charged the FCCCER with the task of identifying key areas of CER where funding could make the greatest impact to improve health outcomes for our nation.  The report includes a definition of CER, criteria for determining which research projects should be a priority, and a strategic framework to identify gaps and future priorities.  The report also catalogues current federal activities on CER, which had not been previously inventoried, and is available at: www.hhs.gov/recovery/programs/cer.
    • On 06/05/09, the Secretary of Health and Human Services (HHS) announced the availability of nearly $200 million from ARRA to support student loan repayments for primary care medical, dental, and mental health clinicians who want to work at National Health Service Corps (NHSC) sites.  The new funds are expected to double the number of NHSC clinicians and result in 3,300 awards to clinicians serving in health centers, rural health clinics, and other health care facilities that care for uninsured and underserved people.  Fully trained health professionals who are dedicated to working with the underserved and have qualifying educational loans are encouraged to apply for this opportunity.  In addition to $50,000 for loan repayment, each clinician receives a competitive salary and a chance to have a significant impact on a community.  In exchange for the loan repayments, clinicians serve for two years with the NHSC.  Primary care practitioners interested in applying for loan repayments should visit:  http://nhsc.hrsa.gov.  To see a list of opportunities available by state, go to: http://www.hhs.gov/recovery/programs/nhsc/vacancies.html.
    • Designed to put Americans back to work quickly and revive a moribund economy that has been non-responsive to other stimuli and incentives, the American Recovery and Reinvestment Act of 2009 (ARRA), signed on 02/17/09, by President Obama, included:  Training for Primary Care Physicians and Nurses – $500 million; Construction and Renovation of University Research Facilities – $1.3 billion; National Institutes of Health (NIH) Research Funding – $8.2 billion; Comparative Effectiveness Research (CER) Funding – $1.1 billion; Pell Grants – $15.64 billion; Higher Education Repair and Modernization Funds – approximately $48 billion for elementary, secondary, and higher education, but no specific breakout for higher education; Higher Education Assistance to Expand Health Information Technology Educational Programs – no specific amount designated for competitive grants, with osteopathic medical schools specifically eligible.

    FY'10 Budget Request

    Updated: 8/5/2009

    • Among the highlights in the President’s budget requests are the inclusion of funding for Title VII Health Professions programs.  This is the first presidential budget since the Carter Administration to include Title VII funding in the request.  The budget also includes increases for the National Health Service Corps.  The National Institutes of Health receives a small (1.4 %) increase and the Agency for Healthcare Research and Quality is level funded.
    • The President released the broad parameters of his FY 2010 budget on 02/26/09 and the detailed version on 05/07/09.

    FY'10 Appropriations

    Updated: 08/04/2010

    • On 7/29/10, President Obama signed into law a $58.8 billion emergency supplemental appropriations act (PL 111-212).  The act includes money for war operations, veterans’ programs, and disaster relief.  It does not, however, include the $4.95 billion for the Pell Grant Program that was originally added by the House of Representatives but stripped out by the Senate, leaving a projected Pell Grant shortfall unresolved.  The measure was cleared for the White House when the House approved the Senate version of the stripped-down emergency supplemental appropriations act, by a vote of 308-114, on 7/27/10.
    • On 7/22/10, the Senate voted to return to the House of Representatives an emergency supplemental appropriations bill.  In an earlier vote, the Senate failed, by a vote of 46-51, to approve a procedural motion regarding a $21 billion domestic spending package, including $4.95 billion for the Pell Grant Program, added by the House.
    • On 7/1/10, the House of Representatives approved, by a vote of 239-182, an amended version of the Senate-passed emergency supplemental appropriations bill.  The bill contains war funding as well as appropriations for veterans programs and disaster relief.  The House approved an amendment, offered by Appropriations Committee Chairman Obey (D-WI), for$4.95 billion to cover an impending $5.7 billion Pell Grant Program shortfall.  The House and Senate both previously approved versions of the bill without funding to cover a projected Pell Grant shortfall. 
    • On 12/13/09, the FY 2010 Labor-HHS-Education Appropriations bill was approved by the Senate as part of an omnibus spending bill, which included six other spending bills, by a vote of 57-35 and became public law (PL 111-117) on 12/16/09. The FY 2010 Labor-HHS-Education Appropriations bill provides $163.6 billion in discretionary funding, an $8.5 billion increase over fiscal year 2009, excluding stimulus funds.  The FY 2010 Labor-HHS-Education Appropriations bill funded many key programs under Title VII, including:  Training in Primary Care Medicine and General Dentistry - $54,425,000 (+8,000,000); Centers of Excellence - $24,602,000 (+4,000,000); and Health Careers Opportunities Program - $22,133,000 (+3,000,000) Additionally, the bill funded the National Health Service Corps at $142,000,000, a $7 million increase over fiscal year 2009.   
    • The House and Senate have passed and the President has signed into law a continuing resolution (CR) for FY 2010 that extends funding for key programs at FY 2009 levels through October 31, 2009.  House and Senate subcommittee staffs are working behind the scenes to create a final version of the FY 2010 bill.  Current plans call for the Labor-Health and Human Services-Education appropriations bill to be combined with at least one other bill and brought to the House and Senate floors prior to the expiration of the CR.  While exact funding levels are not yet known, based on the similarities in the bills, it is expected to be at the levels requested by the President.
    • The House of Representatives passed on 7/24/09 and the Senate Appropriations Committee released on 07/30/09 their respective versions of the FY 2010 Labor-HHS-Education Appropriations bills.  Both the House and the Senate have accepted the increases in key Title VII programs sought by the White House, indicating that – if the bill is enacted rather than a continuing resolution – the programs will be funded as follows:  Training in Primary Care Medicine and General Dentistry – $56,425,000 (+$8,000,000); Centers of Excellence – $24,602,000 (+$4,000,000); Health Careers Opportunities Program – $22,133,000 (+$3,000,000).  FY 2010 marks the first time since the Carter administration that any President – Republican or Democrat – has requested funding for all Title VII programs in his budget request to Congress.
    • AACOM signed the NHSC stakeholder letter of 6/17/09, to the House and Senate Appropriations Committees, urging them to appropriate $235 million to the NHSC in FY 2010.  This is $66 million more than the President’s budget request.  The letter, which can be found at http://www.aamc.org/advocacy/library/workforce/corres/2009/061809.pdf, cited the importance of the program in addressing the current workforce shortage.

    Small Business Innovation Research Reauthorization

    • On 7/9/09, AACOM joined other higher education associations, patient advocacy organizations, scientific and professional societies, and research institutions in signing a letter supporting the House version of the reauthorization legislation because it does not include a provision contained in the Senate version that proposed a mandatory increase in the Small Business Innovation Research (SBIR) program allocation across agencies that will necessarily result in funding cuts for the peer-reviewed research conducted by other organizations.  The letter, which can be found at http://opa.faseb.org/pdf/2009/July-December/SBIR_Community_B%207%2007%2009.pdf, expressed support for SBIR research and asked that Congress work with the Obama administration to increase support for all types of research.  AACOM also signed a letter, dated 06/23/09, to the Senate, opposing the increase in SBIR allocation approved by a Senate committee: http://opa.faseb.org/pdf/2009/SBIR_community_final.6.24.09.pdf