AACOM monitors and advocates on federal issues that address or may impact osteopathic medical education. See content below to learn about other legislation issues, related AACOM activity and additional resources.
Senate HELP Committee Convenes Final Biomedical Innovation Markup
On April 6, 2016, the Senate Committee on Health, Education, Labor, and Pensions (HELP) held its final markup for its biomedical innovation package. A complement to the21st Century Cures Act(H.R. 6) that passed in the House last year, this package of bipartisan bills includes measures that authorize the National Institutes of Health (NIH) and the Food and Drug Administration to expand their pools of research talent via recruitment through academic institutions and non-governmental recruitment or placement agencies, authorizes implementation of the President’s Precision Medicine Initiative, cuts down on administrative requirements for NIH employees, increases diversity in clinical trials, and speeds the regulatory approval of antibiotics for serious infections in limited populations.
Assemblage of the aforementioned and related bills into a final Cures package is underway as debate continues on specific mechanisms to fund these initiatives. Committee Chairman Senator Lamar Alexander (R-TN) indicated that Senate Majority Leader Mitch McConnell (R–KY) has agreed to schedule a floor vote on the bill if the Committee can produce it.
The21st Century Cures Act passed the U.S. House of Representatives on July 10, 2015. This bill aims to accelerate the discovery, development, and delivery of life-saving and life-improving therapies, and transform the quest for faster cures by removing barriers to increased research collaboration; incorporating the patient perspective into the drug development and regulatory review process; measuring success and identifying diseases earlier through personalized medicine; modernizing clinical trials; removing regulatory uncertainty for the development of new medical apps; providing new incentives for the development of drugs for rare diseases; investing in 21st century science and next generation investigators; and helping the entire biomedical ecosystem coordinate more efficiently to find faster cures.
Senate HELP Committee Advances Mental Health Reform Act of 2016
On March 16, 2016, the Senate Health, Education, and Labor Pensions (HELP) Committee approved the Mental Health Reform Act of 2016 (S. 1945), a bipartisan bill that would help address the nation’s mental health and substance abuse crisis through prevention and treatment efforts. Introduced by Senators Bill Cassidy (R-LA) and Chris Murphy (D-CT), the legislation aims to improve issues related to access to care, early intervention, and the behavioral health workforce shortage.
S. 1945 also includes measures to increase the number of substance abuse patients that physicians can treat with buprenorphine, an opioid used to treat addiction. Additionally, the bill allows an increase in physicians’ prescription of naloxone, a remedy for overdoses, as well as a stronger state enforcement plan for children who are born dependent on opioids.
The full Senate is expected to consider this legislation in April.
Veterans to Receive In-State Tuition Under the VACAA
Beginning July 1, 2015, the Veterans Access, Choice, and Accountability Act (VACAA), which was signed into law in August 2014, will allow qualified veterans and their dependents to attend any public college or university while paying in-state tuition, regardless of their state residency status. The U.S. Department of Veterans Affairs will deny benefits payment requests for education courses under the Post-9/11 GI Bill and Montgomery GI Bill-Active Duty at public institutions that charge qualifying veterans and their dependents tuition and fees in excess of in-state rates.
The Education Commission of States (ECS) recently published a report indicating the crucial role states play in incentivizing veterans to enroll in colleges and universities. Specifically, it illustrates that states that fail to ensure colleges and universities offer in-state tuition per the VACAA will create a disincentive for veterans to enroll, thereby impeding the nation’s goals of college attainment and economic development.
President Signs into Law the Clay Hunt Suicide Prevention for American Veterans Act
On 2/12/2015, the President signed into law the Clay Hunt Suicide Prevention for American Veterans Act (Clay Hunt SAV Act). Previously, the mandate was unanimously passed by the Senate, by a vote of 99-0. The veteran suicide prevention law is designed to improve the U.S. Department of Veterans Affairs (VA) mental health support services and to reduce the tragic number of veteran suicides. The law was specifically crafted considering the growing unique needs of Iraq and Afghanistan veterans within the VA. Specifically, the Clay Hunt SAV Act creates an online source of information for VA mental health services. It also addresses the shortage of mental health care experts by creating a pilot program that repays student loans for psychiatry students who agree to work for the VA after graduation.
President Signs Into Law Tax Extenders Legislation
On 12/19/2014, the President signed into law the Tax Increase Prevention Act of 2014, which retroactively extended a package of temporary tax credits for individuals and businesses through 12/31/2014 to prevent tax hikes; most of the approximately 50 tax credits expired at the end of 2013. Previously, on 12/16/2014, the Senate approved the law in a 76-16 vote, with Finance Committee Chair Ron Wyden (D-OR) rejecting the measure. On 12/3/2014, the U.S. House of Representatives approved it by a vote of 378-46.
The tax provisions, known as extenders, must be periodically reauthorized. Although the extenders were renewed with little controversy in prior years, recent heightened battles over federal spending and tax increases contained in the American Taxpayer Relief Act of 2012 have turned the extenders into a contentious subject for members of Congress.
House Passes Bi-Partisan Competency-Based Education Bill and Other HEA Legislation
Congressional leaders in both the U.S. House of Representatives and Senate released proposals for an upcoming reauthorization of the Higher Education Act (HEA). House Republicans recently released a proposal detailing their priorities for an update on the legislation, passing several bills as part of their larger HEA platform. Additionally, Senator Harkin (D-IA), Chair of the Health, Education, Labor, and Pension (HELP) Committee, offered outlines to reauthorize the HEA in a draft proposal that would overhaul the legislation.
On 7/23/2014, HR 3136, the Advancing Competency-Based Education Demonstration Project Act of 2013, passed in the House by a vote of 414-0, and was sent to the Senate where it now sits in the HELP Committee. The bipartisan bill directs the U.S. Department of Education (USDE) to issue waivers for institutions of higher education to develop competency-based education demonstration projects that provide easier, more cost-efficient ways for students to obtain degrees. Please view AACOM’s letter of support for HR 3136.
Concurrently, House Republicans passed by voice vote HR 5134, a bill that would extend for one year the USDE National Advisory Committee on Institutional Quality and Integrity (NACIQI) and the Advisory Committee on Student Financial Assistance (ACSFA). NACIQI advises the USDE Secretary on matters related to higher education accreditation and the eligibility and certification process for higher education institutions to participate in the Federal student aid program, and ACSFA advises on and provides the USDE Secretary technical assistance on matters related to Federal student aid and institutions of higher education. This bill now sits in the Senate HELP Committee. Additionally, several other bills as part of the Republicans HEA platform were passed by the House and now face an uncertain future in the Senate.
On the Senate side, Senator Harkin introduced a discussion draft for comment of the Higher Education Affordability Act, which would reauthorize the HEA and contains nearly two dozen policy goals to address educational debt, strengthen accountability measures, and increase transparency. The bill also aims to tighten financial aid regulations and accountability of for-profit schools. AACOM will be submitting comments highlighting policy priorities of importance to its membership.
AACOM Supports Physician Reentry Demonstration Program Legislation
U.S. Representative John Sarbanes (D-MD) has introduced the Physician Reentry Demonstration Program Act (HR 5888). The legislation would provide training and financial assistance to physicians returning to medical practice in exchange for their service at certain public medical facilities. The bill creates a grant program, which would provide funding for the creation or expansion of physician re-entry programs for qualified medical training institutions, such as allopathic and osteopathic medical schools, hospitals, and non-profit organizations that assist with credentialing and continuing medical education (CME). AACOM sent a letter of support for the legislation to Rep. John Sarbanes.
Congress Approves Sequestration Accountability Bill
Congress has passed the Sequestration Transparency Act, which requires the President to provide a report detailing the sequester required by the Budget Control Act of 2011. The legislation would instruct the Obama administration to report on how agencies would implement the $109 billion in automatic cuts scheduled for Jan. 2, 2013. The House passed the bill — introduced by Representative Jeb Hensarling (R-TX) and amended by Budget Chairman Paul Ryan — by a vote of 414-2 on July 17. The Senate previously backed a similar proposal in the form of an amendment to its farm bill in June, which called for more detailed reporting. Both Republicans and Democrats are in agreement on avoiding cuts, but are in disagreement on alternatives for reducing the deficit.
Under the Budget Control Act of 2011, which passed into law last August, Congress must enact a plan to reduce the national debt by $1.2 trillion. The legislation put into place caps on the amount of money that could be spent through the annual appropriations process for the next 10 years. A joint committee proposal cutting the deficit by at least $1.2 trillion failed to put forth recommendations to Congress, and as a result, an automatic spending reduction process - sequestration - will go into effect by January 2013.
Senate Leadership Offers Student Loan Proposal Offsets, Negotiations Continue
U.S. Senate Majority Leader Harry Reid (D-NV) recently put forward offsets to pay for legislation to prevent an increase in student loan interest rates. Senator Reid’s first proposal would expand a change to employer pension funding contributions that the Senate approved in March as a way to offset part of the cost of its surface transportation bill. The second proposal would increase the premiums paid by employers for the insurance provided by the Pension Benefit Guaranty Corp. Reid stated that the combination of these two proposals will provide sufficient resources to fund both a one-year extension of the current student loan interest rate and reauthorization of the nation’s surface transportation programs.
Republicans have recently offered various proposals to deal with the student loan interest hike. One of the proposals would change the structure for new federal student loans disbursed after July 1 to become a fixed-variable rate. The second proposal would pay for a year-long extension of the 3.4 percent interest rate by increasing federal employee retirement contributions. The third option combines three funding streams: limiting the duration of borrowers’ in-school interest subsidy for Stafford loans; revising the Medicaid provider tax threshold; and improving state and local pension collection information.
The interest rate break, which Congress is trying to extend, applied only to new federal student loans issued during the past four academic years. Graduates who are repaying older student loans do not benefit from this interest rate break. Congress has until July 1, 2012 to intervene to prevent the increase in student loan interest rates.
For more information, see below.
Reps. Schwartz and Heck Introduce SGR Repeal Bill
On 5/9/12, Representative Schwartz (D-PA) and Representative Heck, DO (R-NV) introduced the Medicare Physician Payment Innovation Act of 2012, which would repeal Medicare's physician payment system and provide the transition to a new system.The bill would repeal the sustainable growth rate (SGR) formula, which dictates how much Medicare reimburses physicians; create positive incentives for undervalued primary, preventive, and coordinated care services; and would set up a five-year transition period, during which the Centers for Medicare & Medicaid Services would develop and test new payment models to replace the formula. The cost of repeal — an estimated $316 billion over 10 years, according to the Congressional Budget Office — would be offset by using savings from the Overseas Contingency Operations funds. In February, Congress passed a temporary fix, which will expire 1/1/13, and leave physicians facing a 32 percent cut in Medicare reimbursement.
House Passes Republican Student Loan Bill, Fight Continues in Senate
On 5/8/12, the U.S. Senate, by a vote of 52-45, rejected a cloture motion to proceed to debate on the Democrats’ student loan bill, S. 2343, introduced by Senator Harry Reid (D-NV), which fell short of the 60 votes needed to prevent a GOP filibuster. The Democratic alternative bill’s offset would eliminate a tax break for S corporations - companies that pass their income, losses, deductions and credits through to shareholders for federal tax purposes. While republicans agree with democrats on extending the current 3.4 percent interest rate for one year, they object to the Democrats’ proposed offset. The GOP alternative, S. 2366, was introduced by Senator Lamar Alexander (R-TN) and proposes to eliminate the Prevention and Public Health Fund, created in the Affordable Care Act, as an offset.
On 4/27/12, the U.S. House of Representatives passed its bill, H.R. 4628, the Interest Rate Reduction Act, by a vote of 215-195. The measure was introduced by Representative Judy Biggert (R-IL) and would prevent government-subsidized student loan interest rates from increasing to 6.8 percent from 3.4 percent on 7/1/12. The measure offsets the hike in interest rates by eliminating the Prevention and Public Health Fund. The prevention fund expands and sustains funding for prevention and public health programs. These funds may be used for programs authorized by the Public Health Service Act for prevention, wellness, and public health activities, including prevention research and health screenings, such as the Community Transformation Grant Program, the Education and Outreach Campaign for Preventive Benefits, and immunization programs. The White House has threatened a veto over how the bill would be financed.
AACOM supports the Student Loan Affordability Act (S. 2051/H.R. 3826
), which was introduced in January 2012, by Senator Jack Reed (D-RI) and Representative Joe Courtney (D-CT), which would amend the Higher Education Act of 1965 to extend the reduced interest rate for federal Direct Stafford Loans and would permanently cap Stafford Loan interest rates for low and moderate income students.
On behalf of our nation’s osteopathic medical students and graduates, AACOM supports the efforts in Congress to stop the interest rate increase, which will take place on July 1, 2012 if Congress doesn't intervene; however, AACOM does not support legislative proposals that utilize the Prevention and Public Health Fund as an offset.
President Signs Law, Delays Physician Cut for Remainder of 2012
On 2/22/12, President Obama signed into law the Middle Class Tax Relief & Job Creation Act of 2012 (PL 112-96), which extends the payroll tax break, continues unemployment insurance benefits, and is expected to add approximately $100 billion to the federal deficit. The law delayed a scheduled March 1 cut to Medicare physician payments and delays this cut until January 1, 2013 where physicians will be facing a 32% cut. The measure would reduce Medicare and Medicaid reimbursement for several provider groups to help pay for the Sustainable Growth Rate, as well as cuts spending in the Affordable Care Act (ACA) by $11.6 billion. Some of the measure’s offsets include $5 billion from the Prevention and Public Health Fund, created in the ACA, and other funding including reducing the amount of patient bad debt that Medicare providers, including hospitals and nursing homes, can recover from Medicare.
President Signs the Patent Reform into Law
On 9/16/11, President Obama signed into law the Leahy-Smith America Invents Act, also referred to as the patent reform bill (P.L.: 112-29), which changes the U.S. patent application system from one that awards patents to the first person to invent something, to a system that awards the first person to file a patent application on an invention. The law allows a new review of patents and gives the U.S. Patent and Trademark Office more flexibility to set and spend fees paid for by inventors to get patents and businesses to register trademarks.