Washington Insider AACOM
Washington Insider

July 5, 2018

What You Need to Know

Amid many notable changes taking place in Washington, U.S. Supreme Court Justice Anthony Kennedy’s retirement, effective July 31, will have a major impact on national politics and policies. It remains to be seen how Justice Kennedy’s replacement proceedings will affect voter turnout in November’s midterm elections, depending on when a nominee is brought in front of the U.S. Senate for a vote.

Once appointed, the lasting implications of Kennedy’s replacement cannot be overstated, as the new justice will have the power to swing the Court’s balance. The shifting priorities of the bench could also affect the osteopathic medical education community. With the upcoming congressional reauthorization of the Higher Education Act (HEA) and court rulings slated that will impact education and health care, AACOM remains steadfast in advocating for its priorities to strongly support the future physician workforce.

Pamela Murphy
Senior Vice President of Government Relations

 
Legislative Update

On The Hill

AACOM-Endorsed Opioid Legislation Heads to Senate

On June 22, after a nearly two-week voting marathon, the House passed H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, a massive package comprised of over 50 individual pieces of legislation. H.R. 6 includes AACOM-endorsed legislation, the Substance Use Disorder Workforce Loan Repayment Act of 2018, which aims to increase the number of qualified health professionals working in substance use disorder roles in communities that have the highest number of opioid deaths. Other provisions include allowing Medicaid to pay for treatment in certain inpatient facilities that treat mental illness, and providing more flexibility with respect to medication treatment for opioid use disorders.

Endorsed by the Administration, H.R. 6 has been sent to the Senate, which has been working on its own legislative package to address the opioid crisis. The Senate and House are expected to negotiate a compromise in conference committee before sending a final bill to the White House.

FY19 Appropriations Update

On June 28, the Senate Appropriations Committee approved its fiscal year (FY) 2019 Labor, Health and Human Services, Education, and Related Agencies (LHHS) funding bill by a vote of 30-1, with Senator James Lankford (R-OK) the sole member to reject the legislation. The $179.3 billion package provides a $2.2 billion increase from the FY18 enacted level, as well as an increase from the President’s budget request. Included are a $2.3 billion increase for the U.S. Department of Health and Human Services, a $2 billion increase to the National Institutes of Health (NIH), and a $541 million increase for the U.S. Department of Education (USDE). The bill also continues funding and authority provided by the Consolidated Appropriations Act of 2018, specifically $350 million toward the implementation of a technical fix to allow borrowers who would have otherwise been eligible for the Public Service Loan Forgiveness (PSLF) Program, but are currently enrolled in an unqualifying loan repayment plan, to qualify for PSLF.

Following a few delays, the House Appropriations Committee is expected to take up its funding bill next week. Highlights of the FY19 Senate LHHS spending bill can be viewed here.

AACOM Endorses Health Care Workforce Bill

AACOM endorsed the Building a Health Care Workforce for the Future Act (H.R. 2574, S. 3095), introduced by Representative Raul Ruiz (D-CA) and Senators Jack Reed (D-RI) and Roy Blunt (R-MO). This bill would address the health professions workforce shortage by awarding grants to states to implement scholarship programs in exchange for service in health professional shortage areas. AACOM previously supported this measure in the last Congress.

VA Secretary Nominee Testifies to Senate VA Committee

On June 27, the Senate Committee on Veterans’ Affairs (VA) held a confirmation hearing for Robert Wilke, President Trump’s nominee for Secretary of the U.S. Department of Veterans’ Affairs. Mr. Wilke is an attorney who was previously confirmed in December 2017 as the Under Secretary of Defense for Personnel and Readiness at the U.S. Department of Defense. The Senate VA Committee plans to vote on Mr. Wilke’s nomination on July 10.

AACOM-Supported EMPOWER Act Passes Subcommittee

On June 27, the House Energy and Commerce Health Subcommittee passed, by a voice vote, H.R. 3728, the Education Medical Professionals and Optimizing Workforce Efficiency Readiness Act of 2017, which would reauthorize Title VII health professions training programs. This includes the Health Resources and Services Administration (HRSA)’s Centers of Excellence, Primary Care Training and Enhancement Grants, Area Health Education Centers, and the Geriatric Health Professional Grant Program. It will advance to the full House Energy and Commerce Committee for consideration. AACOM previously joined a letter to Committee Chair Michael Burgess (R-TX), alongside other national health care organizations, in support of this legislation.

Rescissions Package Fails in Senate

On June 20, the Senate rejected the House-passed rescissions package on a 48-50 vote, dooming its advancement. Two Republican members, Senators Richard Burr (NC) and Susan Collins (ME), opposed the legislation. The spending package, requested by President Trump, would have reduced $15.4 billion dollars in the federal budget authority from past years’ unused spending, including $7 billion from the Children’s Health Insurance Program and $800 million from the Centers for Medicare & Medicaid Services (CMS) Innovation Fund.

House Budget Resolution Passes Committee

The House Budget Committee recently passed its FY19 budget resolution by a vote of 21-13. This proposal seeks to balance the budget in nine years by cutting non-defense discretionary spending caps by more than half a trillion dollars and requiring congressional committees to cut, over a ten-year period, $302 billion in spending across a range of programs. However, it is unlikely that this budget resolution will advance, as neither the House nor Senate GOP leadership have agreed to take up a budget this year. A two-year bipartisan budget deal was already signed into law earlier this year.

Congressional Budget and Appropriations Process Reform Committee Update

On June 27, the Joint Budget and Appropriations Process Reform Committee held a Members’ Day full committee hearing, “How to Significantly Reform the Budget and Appropriations Process,” during which Members of Congress shared their perspectives on how to accomplish the committee’s goals. Witnesses included House Speaker Paul Ryan (R-WI) and House Minority Leader Nancy Pelosi (D-CA).

Established by the Bipartisan Budget Act of 2018, this temporary bipartisan committee comprised of 16 Members from both chambers is charged with developing recommendations on overhauling the federal budget and appropriations process. The Committee is expected to produce its recommendations by November 30.

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Advocacy Update  Advocacy

ED to MED Highlights 4 Ways to Declare Your Financial Independence

To celebrate Independence Day, ED to MED highlights four tips and tools to help health professions students plan their financial futures. From the AACOM Financial Aid Modules to the #SaveGradPLUS initiative, learn how you can declare your financial independence this summer.

Urge Congress to Protect the Future Health Care Workforce

As Congress continues negotiations on the reauthorization of the HEA, student financial aid programs like Grad PLUS and PSLF are under threat. AACOM’s ED to MED campaign makes it easy to reach out to your Members of Congress urging them to consider the needs of medical students as they negotiate the HEA. Take action today!

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Regulatory Update

Administration and Federal Agencies

AACOM Comments on CMS FY19 IPPS Proposed Rule

AACOM recently submitted comments to the CMS regarding its FY19 Medicare Hospital Inpatient Prospective Payment System and Long Term Acute Care Hospital Prospective Payment System Proposed Rule. AACOM’s comments focused on the CMS proposal that would enable new urban teaching hospitals to loan medical residency slots to other new urban teaching hospitals beginning July 1, 2019 through June 30, 2020. CMS is expected to issue a final rule later this year.

Administration Unveils Plan to Restructure Federal Government

In accordance with an Executive Order (EO) issued in March 2017, the Administration recently published a proposal to overhaul the structure of the federal government. Among the recommendations in “Delivering Government Solutions in the 21st Century: Reform Plan and Reorganization Recommendations” is a proposal that would merge the USDE and U.S. Department of Labor into one single agency, the Department of Education and the Workforce (DEW). Also under the plan, the U.S. Public Health Service Commissioned Corps would be reduced, and a Reserve Corps would be established to respond to public health emergencies. The plan faces an uphill battle in Congress, with Democrats’ outward rejection of the proposal and with some GOP members, including Senate Appropriations LHHS Subcommittee Chair Roy Blunt (R-MO), publicly expressing support for certain provisions of the plan to include the creation of DEW, but highlighting the overall plan’s current lack of votes to pass the Senate.

USDE Delays GE Disclosure Requirements Again

The USDE announced on June 18 that it will allow additional time, until July 1, 2019, for institutions to comply with certain disclosure requirements in its gainful employment (GE) regulations. Institutions subject to GE regulations have until July 1, 2019 to include in (or provide a link to) their GE program promotional materials a disclosure template with information specified by the USDE and ensure this information is directly distributed to prospective students. This requirement was scheduled to go into effect on July 1. The delay also allows the USDE to issue revised GE regulations following the negotiated rulemaking sessions that concluded earlier this year without consensus. AACOM continues to weigh in with the USDE and has submitted comments urging the Department to recognize the unique characteristics of medical education and exempt all U.S. graduate terminal degree medical education programs from any GE-related requirements.

SCOTUS Updates: Travel EO and Kennedy Retirement

Prior to adjourning for summer recess, the Supreme Court of the United States (SCOTUS) issued a 5-4 decision to uphold the third version of the Administration’s EO that restricts travel and immigration from certain countries, including Iran, Libya, Somalia, Syria, and Yemen. SCOTUS generally allowed the EO to go into effect in December while the legal challenge continued. In the majority opinion led by Chief Justice Roberts, the Court ruled that under the Immigration and Nationality Act, the President has “ample power to impose entry restrictions.” The Chief Justice also wrote that the EO does not violate the Establishment Clause, since “the admission and exclusion of foreign nationals is a fundamental sovereign attribute exercised by the Government’s political departments largely immune from judicial control.” Please note: under the EO, there is an exemption for citizens of Iran who have valid student (F and M) and exchange visitor (J) visas, although these individuals are subject to enhanced screening requirements. Lawful permanent residents of the U.S. are not impacted by the proclamation.

Additionally, the longest-serving member of the Court, Justice Anthony Kennedy, is retiring. Nominated by President Ronald Reagan, Justice Kennedy was often considered a potential swing vote on some of the Court’s controversial cases related to gay rights and abortion. Justice Kennedy’s retirement paves the way for President Trump to nominate his second Supreme Court justice, which if confirmed by the U.S. Senate, is expected to further solidify the Court’s conservative majority.

Kathleen Kraninger Nominated as CFPB Director

On June 18, President Trump announced his intent to nominate Kathleen Kraninger to be the Director of the Consumer Financial Protection Bureau (CFPB), an agency charged with protecting consumers from unfair or deceptive practices, which includes issues related to student loans. Currently the Associate Director for General Government at the White House Office of Management and Budget (OMB), Ms. Kraninger previously served as Deputy Assistant Secretary for Policy at the U.S. Department of Homeland Security and worked as staff for both the House and Senate appropriations committees. Ms. Kraninger’s nomination is pending Senate confirmation. In the interim, the OMB Director, Mick Mulvaney, will continue to simultaneously serve as the CFPB’s acting chief.

Featured Federal Resources and COM Engagement 

SAMHSA Grant—Provider’s Clinical Support System – Universities (PCSS-Universities): The Substance Abuse and Mental Health Services Administration is accepting applications for the PCSS-Universities grant program, which will help expand/enhance access to medication-assisted treatment services for people with an opioid use disorder through ensuring the education and training of medical and other health professions students. Applications are due by July 25. Learn more.

HRSA GrantRural Communities Opioid Response-Planning Grant Program (RCORP-Planning): HRSA’s Federal Office of Rural Health Policy is accepting applications for the RCORP-Planning program to support one year of community-level planning to implement opioid use disorder prevention, treatment, and recovery interventions designed to reduce opioid overdoses among rural populations. The lead applicant must be part of a group including at least three other partners that have committed to forming a consortium or are part of an established consortium. The deadline to apply is July 30. Learn more.

NASA Official and Former Dean of DMU-COM Delivers Commencement Keynote: Chief Health Medical Officer of the National Aeronautics and Space Administration and former dean of the Des Moines University College of Osteopathic Medicine J.D. Polk, DO, MS, MMM, CPE, FACOEP, FAsMA, served as keynote speaker for Des Moines University’s graduating class on May 25. Commencement photos and a video recording of the ceremony are available here.

NIH Funding Awarded to WesternU: The NIH awarded a $409,223 grant to Western University of Health Sciences (WesternU) researchers, including co-investigator Cyrus Parsa, DO, of WesternU College of Osteopathic Medicine of the Pacific. The grant will fund a three-year project to study the safety of using the βblocker carvedilol to prevent skin cancer. Learn more.

KCU-COM OMM Fellows Honor U.S. Veterans: Kansas City University of Medicine and Biosciences College of Osteopathic Medicine Osteopathic Manipulative Medicine Fellows raised funding for and contributed to veterans in need after completing clinical rotations at the Kansas City Veterans Administration Hospital. Learn more.

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