Important Federal Issues for the 114th Congress
National Institutes of Health (NIH)
NIH is the primary federal agency that funds medical research and is the source of about 88% of the total federal research funding that the University of Nebraska Medical Center (UNMC) obtained through competitive awards. Annual funding for NIH has lagged behind the rate of biomedical inflation, resulting in fewer research proposals being funded. The FY15 Omnibus bill included $30.7 billion, which does not cover the rate of biomedical inflation. UNMC recommends NIH be funded at $31.3 billion in FY16.
Impact of Sequestration Continues
The 2013 sequestration cuts were felt severely by the Public Health Training Centers which is funded by Health Resource Service Administration (HRSA). With sequestration and the previous partial shutdown of the federal government, UNMC experienced agency delays in reviewing, delays in awarding competitive grants and delays in renewing existing grants. The delays forced UNMC to provide bridge funding with limited university funding for researchers. Continuing annual sequestration cuts could reduce UNMC research funding. The average age of a researcher winning their first major grant from NIH is now 47 years old. Continuing sequestration will further delay the ability of up-and-coming researchers to obtain their first RO-1 grant from NIH and in some cases will deter good scientists from seeking a science research career.
Institutional Development Award Program
The IDeA program helps build more competitive research programs and gives students a better opportunity to become a health professional or scientist. More than 50% of all NIH grant awards go to institutions in 6 states. NIH’s Institutional Development Award Program (IDeA) provides opportunities for Nebraska and 22 other states to create research infrastructure to improve our ability to compete for NIH funds. The IDeA program operates within the Institute of General Medicine at NIH. The IDeA program provides about $15+million annually to Nebraska for research centers and developing a science workforce. Research and student opportunities work together in this unique program. The University of Nebraska and state colleges work together to give Nebraska students a chance to shape their future in healthcare and science careers. The Administration proposed funding IDeA at its current level of $273 million in FY15. UNMC encourages the IDeA program be funded in FY16 at $273 million.
Health Professions Education and Training (Title VII and VIII)
UNMC relies on Title 7 (health professions) and Title 8 (nursing) funding from the Public Health Service Act to support educational programs that train professionals in areas where there are workforce shortages and to provide cost-effective care in underserved rural and some urban areas of Nebraska that lack sufficient health care services.
Title 7 (health professions) funds in Nebraska are used for physician assistant training, pediatric dentistry, public health training, medical assistants, dental assistants, Area Health Education Centers (AHEC) and mental and behavioral health graduate psychology programs. The Title 7 funds to Nebraska have been cut by around 40% from the $3.8 million in FY10 to the $1.6 million received in FY13. For FY16 the Administration budget proposes cutting Title 7 by about $7 million to $238 million. UNMC encourages Title 7 be funded at its current level of $245.4 million in FY16.
Title 8 (nursing) funds to Nebraska have dropped by about 40% from their FY10 level of $2.3 million to $1.4 million in FY13. Title 8 (nursing) funds support nursing education, the nurse faculty loan program and nurse anesthetist traineeships. UNMC urges Title 8 be funded at a minimum level of $232.8 million in FY16.
Graduate Medical Education (GME)
GME has been repeatedly targeted for budget cuts by the federal government. Ironically, this has occurred when it is universally acknowledged that there is a shortage of physicians and GME is the pipeline for our nation’s future physicians. UNMC opposes attempts to decrease the indirect payment of GME because it will reduce payments to our hospital partner Nebraska Medical Center (NM) by at least $1 million annually and more importantly will likely reduce the number of residencies available in Nebraska. UNMC/NM received about $25.9 million in FY14 for GME. Fewer residencies in the state means that more medical graduates will leave Nebraska for residency which reduces the chance that they will return to work in Nebraska after their residency is completed. UNMC has suggestions for alternatives for the future of GME and until changes are adopted supports funding GME at its current levels.
Medicare and Medicaid Provider Reimbursement; Fix the Sustainable Growth Rate (SGR)
The ongoing Sustainable Growth Rate (SGR) problem affects physicians and students. The reimbursement cut to physicians has again been postponed to later this year. The cost of the repeated band aids now exceeds the estimated $140 billion cost of the fix. While the repeated band aids avoid deep cuts in services to Medicare patients, it creates a climate of uncertainty for future physicians about accepting Medicare patients not knowing if they will be reimbursed enough to recoup their costs when they start their practice of medicine. UNMC advocates that an equitable replacement reimbursement plan be adopted this calendar year.