2012 Federal Relations Issues
I. Important Federal Issues for the 112th Congress:
National Institutes of Health (NIH) Funding
As the primary federal agency for supporting medical research, the NIH is the source of more than 80% of UNMC’s total federal research funding. Annual funding for NIH has lagged behind the rate of biomedical inflation, resulting in fewer research proposals being funded. The Administration has announced a funding NIH at $30.6 billion in FY2013, essentially the same level as FY2012. UNMC supports the $30.6 billion request.
NIH’s Institutional Development Award Program (IDeA) provides opportunities for Nebraska to develop research infrastructure to improve UNMC's ability to compete for NIH funds. In 2011 NIH reorganized its institutes which moved the IDeA program under the Institute of General Medicine. The IDeA program provides about $15 million annually to Nebraska for research centers and workforce development. For FY2013, NIH is proposing to reduce the IDeA budget from its FY2012 level of $276 million by $51 million. Reports indicate NIH would use the $51 million to add funds to the new institute called the National Center for Advancing Translational Sciences (NCAST). UNMC supports the IDeA program at its FY2012 level of $276 million.
Health Professions Education and Training (Title VII and VIII)
UNMC relies on Title VII (health professionals) and Title VIII (nursing) funding from the Public Health Service Act to support educational programs that train professionals in fields with workforce shortages and provide quality cost-effective care in areas of Nebraska in need of health care services. In FY2011 Nebraska received more than $2.3 million in Title VII funds plus $2.5 million in Title VIII funds. UNMC opposes this in light of the existing shortages of healthcare workers, particularly in nursing. The Administration FY2013 budget proposes a 15% cut in Title VII and an 8% increase in Title VIII funding. UNMC supports the Title VIII increase and believes due to the growing workforce shortages in both categories, Title VII should be increased by a similar percentage in FY2013.
Graduate Medical Education (GME)
The Administration's FY2013 Budget calls for a 10% cut in GME through reducing the indirect payments. At a time when it is universally acknowledged that there is a shortage of physicians, the nation should be not cut the medical residency programs by 10%. UNMC opposes the decreasing the indirect payment of GME because it will reduce payments to NMC by at least $1 million annually and likely reduce the number of residencies available to graduating medical students by 10%. A negative consequence of fewer residencies in the state means more graduates will need to leave the state which reduces the chance they will return to work in Nebraska after their residency. In addition, the Administration's FY2013 budget proposes to reduce GME indirect payments to children's hospitals by 67%.
Ag Health Centers
In 2011, UNMC won a competitive award from the Centers for Disease Control, National Institute of Occupational Safety & Health agency to create the Central States Center for Agricultural Safety & Health to serve a 7 state region. There are 10 centers in the nation that conduct research, education, and prevention projects to address the nation’s pressing agricultural health and safety problems. The UNMC center focuses on projects that include identifying ways to reduce asthma and respiratory diseases in farmers caused by constant exposure to dust and products used in farming. Other programs include coordinating farm safety programs for kids and pilot projects to reduce the chance of hearing loss caused by working with loud equipment. The Administration’s FY2013 budget proposed eliminating funding for the ten centers. UNMC advocates for continuation of the program at the FY2012 funded level.
Medicare and Medicaid
In February 2012, the Medicare physician reimbursement rate was extended to the end of the year. This action blocked the scheduled 27% cut in Medicare reimbursement payments that were scheduled for March 1, 2012. Congress continues to look for a permanent replacement payment system that reimburses physicians fairly for their costs to treat Medicare patients that does not reduce services for Medicare patients. UNMC will advocate payments at their current levels until an equitable reimbursement as a permanent fix.
Health Care Reform
Implementation of health care reform continues in 2012. In 2011, the House of Representatives voted multiple times to repeal the Health Care Reform law. Repeal efforts in the Senate have not advanced. The President has said he is willing to improve the law, but will veto outright repeal. In March the U.S. Supreme Court heard the case based on whether the individual mandate is Constitutional. A decision is expected this summer. At the same time, most states are preparing to implement state insurance exchanges. With popular consumer provisions already in force, it is anticipated that implementation will continue unless halted by the court. UNMC will advocate to state officials for state implementation that increases the number of insured citizens and improves delivery of health services.