In his early years at the Academy, R. Michael Miller, JD, spent part of each day reading the Congressional Record and copies of bills sent to him by a legislative reporting service. He searched the documents for activities the Academy might want to support or protest. While reading the bills one day in 1970, he stumbled across one that would trigger a turbulent series of events eventually leading to federal funding for family practice training programs.
Good news. Mr. Miller, now deputy executive vice president, says he remembers being surprised to discover the Family Practice of Medicine Act in his stack of papers. "To find a diamond in the rough like that was kind of exciting," he says.
The bill, introduced by Rep. Fred Rooney, D-PA, was the first piece of legislation to specifically authorize funding for family practice training programs as a way to increase the country's supply of family physicians. "We didn't even know the bill was going to be introduced until it came across my desk that day," Mr. Miller recalls.
The Academy contacted Rep. Rooney and discovered he wasn't a major player on any congressional health committees or subcommittees. In fact, he introduced the bill at the encouragement of his administrative assistant, Ray Huber. Mr. Huber moved to Washington when the congressman was elected, but he couldn't find a family physician in the area. Suddenly, the shortage of FPs in the United States was an issue worthy of consideration by Congress.
Amos Johnson, MD, a past president of the Academy, used his contacts on Capitol Hill to get identical legislation introduced in the Senate. Sen. Ralph Yarborough, D-TX, who chaired the influential Committee on Labor and Public Welfare, became the Senate sponsor of the Family Practice of Medicine Act.
Following several months of heavy lobbying by the Academy, Congress passed the legislation with only one dissenting vote. Congress then adjourned for the Christmas holiday and sent the bill to President Richard Nixon for signing.
Bad news. Mr. Miller provides a brief lesson in constitutional law to explain what happened next:
"The Constitution says if you send a bill to the president, the president's got 10 days to sign it. If the president doesn't sign the bill in 10 days, it becomes law unless Congress, by its adjournment, prevents the president from returning the bill to Congress with a veto.
"The Nixon White House took the position that since Congress was recessed for Christmas--although they were coming back into session before the term ended--the president was prevented from vetoing the bill and returning it to Congress. Therefore, a 'pocket veto' existed. A veto certainly would have been overridden. So, despite the fact that the bill passed with just one dissenting vote, the president felt he found a nifty way to veto it in his pocket."
More good news. Legal scholars hotly debated the validity of President Nixon's use of the pocket veto in this circumstance, and a hearing was held before a Senate subcommittee to determine the constitutionality of the president's pocket veto power. Sen. Ted Kennedy, D-MA, sued the president in what was reportedly the only case he ever argued in court. In 1974, the US Supreme Court finally proclaimed Nixon's pocket veto to be an unconstitutional use of the power.
More bad news. The Family Practice of Medicine Act would have authorized funding for three years, but the time expired before the pocket veto issue was resolved in court. So, although the veto was invalidated, so was the practical effect of the bill.
The best news. Mr. Miller explains that members of Congress interested in funding family practice training didn't give up. In 1971, President Nixon signed the Health Manpower Training Act, which authorized $100 million over three years to support family practice educational programs. It also authorized more than $410 million for projects such as FP preceptorships and the creation or expansion of family medicine programs.
Every year since the act was passed, family practice has received line item funding. "For many years, family practice was the only medical specialty that received line item funding," Mr. Miller says. "At some point along the way, general dentistry and then internal medicine and pediatrics started receiving line item support, but the bulk of money available has gone to family practice."
The 1997 budget--signed into law by President Bill Clinton in September--includes $49.3 million in Title VII funds for family practice, a $5.2 million increase over the 1996 funding level.