Speak Out on Draft Bill That Would Gut Critical Training Programs

House Appropriations Measure Zeroes Out NHSC Funding, Eliminates AHRQ

June 20, 2015 12:18 pm News Staff

The AAFP moved swiftly to rebuke House leaders for proposing drastic funding cuts in a draft appropriations bill(appropriations.house.gov) released this week by the House Appropriations Subcommittee on Labor, HHS, Education and Related Agencies.

[AAFP Advocacy]

In a June 17 letter(2 page PDF) to Subcommittee Chair Tom Cole, R-Okla., and Ranking Member Rosa DeLauro, D-Conn., AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., offered a litany of "serious concerns" with several provisions in the draft measure.

"In particular," Blackwelder wrote, "we are very troubled that the subcommittee bill does not invest adequately in physician workforce training grants or in the National Health Service Corps (NHSC). We also oppose the proposals to terminate the Agency for Healthcare Research and Quality (AHRQ) and to defund the implementation of the (Patient Protection and) Affordable Care Act."

Training Short-Shrifted

At a time when the United States faces a shortage of family physicians that, by all accounts, will only worsen in the coming years, Blackwelder pointed to lawmakers' failure to heed recommendations the Academy made in written testimony(5 page PDF) to the subcommittee in April.

Story Highlights
  • The AAFP has rebuked House leaders for proposing drastic funding cuts in a draft appropriations bill released this week by the House Appropriations Subcommittee on Labor, HHS, Education and Related Agencies.
  • In a June 17 letter, AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., offered a litany of "serious concerns" with several provisions in the draft measure.
  • The bill would strip funding from the National Health Service Corps and the Agency for Healthcare Research and Quality and cut funding to other key programs and agencies.

For example, rather than boost discretionary funding for the Health Resources and Services Administration (HRSA) in fiscal year 2016, which oversees health professions training programs authorized under Title VII of the Public Health Service Act, the draft bill would actually cut the agency's funding by $299 million from the FY 2015 level.

In its testimony, the Academy had specifically urged the subcommittee to provide $71 million for the Title VII, Section 747 of the Public Health Service Act, Primary Care Training and Enhancement program, which supports family physician education and training. Similarly, the AAFP had called for $4 million for Rural Physician Training Grants.

"Failure to invest in these important programs makes no sense and will further erode the needed primary care workforce that is essential to delivering better care at lower cost," declared Blackwelder in his letter.

Unraveling the Safety Net

Noting that the Government Accountability Office has described the NHSC as "one safety-net program that directly places primary care physicians and other health professionals in … medically needy areas," Blackwelder also decried the subcommittee's failure to include discretionary funds for that agency in its proposal.

The NHSC offers scholarships to students who choose family medicine or some other primary care specialty and agree to work between two and four years in a federally designated health professional shortage area (HPSA). In 2014, more than 9,000 health care professionals were placed in HPSAs all over the country, serving nearly 10 million patients coast to coast.

Now's the Time to Speak Your Mind

It's a real possibility that the draft appropriations bill considered June 17 by the House Appropriations Subcommittee on Labor, HHS, Education and Related Agencies will go to the full committee next week. That makes it all the more urgent that you contact your representatives to object to the proposal and the threats it poses to evidence-based research, the primary care workforce and patients' access to care.

The AAFP has made it easy for you to do just that via its Speak Out system. Start by entering some basic contact information (required for officials to accept your message), access the message template the Academy has provided, and then you'll have a chance to tailor your remarks.

"The AAFP believes that Congress must re-establish annual appropriations for the NHSC to address the nation's HPSAs and mounting medical student debt," said Blackwelder. "Again, this funding is vital to building a strong primary care physician workforce that our nation desperately needs."

AHRQ Dismantled

Another big-ticket item completely ignored in the draft appropriations measure was funding for AHRQ, which supports the yeoman's share of research to "improve clinical decision-making, advance patient safety, decrease medical errors and enhance health care quality and access," according to the letter.

Terminating the agency, as the draft proposes, would directly contradict efforts to reduce costs to the U.S. health care system, Blackwelder argued. Moreover, he added, "The AAFP relies on research developed by AHRQ to answer key clinical questions based on the agency's Effective Health Care Program to help clinicians make better treatment choices. AHRQ provides the critical evidence reviews needed to answer questions on the common acute, chronic, and comorbid conditions that family physicians see on a daily basis."

Reversing Course on Coverage

The AAFP has long called for health care coverage for all "through a primary care-based system built on the patient-centered medical home," Blackwelder reminded the subcommittee leaders. Thus, he said, "We oppose the provisions in this draft which seek to bar the use of appropriated funds to support the Affordable Care Act and thus would restrict health care coverage."

#SaveAHRQ

Join your fellow family physicians in using this hashtag in your social media posts to rally support for the Agency for Healthcare Research and Quality.

On top of that, the draft measure has cut funding for CMS, which, in addition to administering its usual roster of federal programs, will now be saddled with additional responsibilities tied to implementing the recent changes to Medicare enacted in the Medicare Access and CHIP (Children's Health Insurance Program) Act.

"The AAFP is concerned that $3.3 billion for CMS management and operations, which is $344 million below the FY 2015 level and $919 million below the (president's) budget request, will not be adequate to serve the physicians and their patients covered by Medicare, Medicaid and CHIP," Blackwelder said.