Outlook for Research Funding Uncertain as New Fiscal Year Approaches
October 1 marks the beginning of the new fiscal year and the date by which Congressional spending bills are supposed to be completed. But despite bipartisan support for the National Institutes of Health (NIH), it is unclear if the bills funding the agency will be brought to the House and Senate floor for a final vote by that date.
As this issue of The Hematologist went to press, action on the spending bills had stalled in both the House and Senate. In July, the Senate Appropriations Committee approved its draft fiscal year (FY) 2014 Labor, Health, and Human Services and Education (Labor-HHS) spending bill that funds most federal health programs, including NIH. The Senate bill includes $30.955 billion for NIH. That level replaces the funding lost due to sequestration and also includes a small increase over the FY 2012 NIH budget. A vote on the bill by the full Senate has not yet been scheduled.
The House, meanwhile, has not yet taken any action on the FY 2014 Labor-HHS spending bill. However, House leaders established a spending blueprint earlier this spring that sought additional cuts totaling18.6 percent for public health and education programs. Although individual program levels will not be determined until later, an 18.6 percent across-the-board reduction for these programs would equal a loss of $5.4 billion for NIH in FY 2014. Although it is unlikely that NIH would see a cut of that magnitude, the House Labor-HHS spending bill is almost certain to include a reduction in the agency's budget.
Given the wide gap in spending levels, reaching an acceptable compromise between the House and the Senate on their respective proposals will be challenging. If Congress cannot reach a decision about spending bills by October 1, it has two options: pass a temporary continuing resolution that extends federal agency and program funding from the prior year or shut down the government until it can come to an agreement on spending.
What’s the takeaway?
ASH is continuing advocacy, urging Congress to provide NIH with at least $32 billion in funding in FY 2014 – the minimum investment necessary for NIH’s budget to keep pace with biomedical inflation. Senators and representatives need to hear from their constituents about the negative impact that cuts in funding have had (and will continue to have) on hematology research. ASH members, along with ASH staff, have met with numerous congressional offices to discuss the importance of biomedical research and the need to protect NIH from further funding cuts.
You can also have your voice heard in the halls of Congress and back home in congressional districts by participating in the Society’s advocacy efforts. As Congress continues to formulate the FY 2014 budget, the Society encourages you to visit the ASH Advocacy Center and take action in support of funding for NIH in FY 2014. You are also encouraged to let the ASH Government Relations, Practice, and Scientific Affairs Department know when you are in Washington, DC, and available to meet with your congressional delegation. To find the latest information about the FY 2014 budget and its potential impact on NIH, please visit the ASH website.
Congress Moves Forward With Medicare Physician Payment Reform Legislation
Committees in both the House of Representatives and the Senate continue to work on legislation to reform physician payment for Medicare services.
On July 31, the House Energy and Commerce Committee approved the Medicare Patient Access and Quality Improvement Act of 2013 (H.R. 2810) by a unanimous vote. The legislation would repeal the current payment formula known as the Sustainable Growth Rate (SGR), provide for a five-year period of annual payment increases, and initiate a quality performance system in 2019. The legislation builds on proposals that House Republican leadership released earlier this year, and it provides for an initial five years of payment increases at 0.5 percent per year. Beginning in 2019, physicians would have the opportunity to earn an additional 1 percent for successful participation in an expanded Physician Quality and Reporting System (PQRS) program. Physicians who score poorly in the program, however, would be subject to a cut of 1 percent (net -0.5%).
The House Ways and Means Committee and the Senate will also likely consider legislation on the SGR this fall and, unlike previous years when only short-term patches were passed, policy analysts expect that legislation to reform Medicare payment is likely to be completed this year. Two factors have influenced this position shift: the cost estimate for repealing the SGR has been reduced significantly, and Members of Congress have finally come to understand that the current system, which has scheduled significant payment cuts each year, is not sustainable. The remaining challenge for Congress will be to identify a way to pay for the approximately $138 billion cost of repealing the SGR.
What’s the takeaway?
Because the cost estimate of repealing the SGR has been reduced significantly, and among legislators there is a shared frustration with the current system, Congress seems poised to finally pass legislation to reform Medicare’s physician payment system. You are encouraged to join the Society’s online advocacy campaign urging Congress to repeal the current payment formula and replace it with a predictable and stable payment system.
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