Federal Spending Measure Provides 'Mixed Bag' for Family Medicine

President Bush recently signed an omnibus spending bill that slightly reduces funding for Title VII primary care training programs while providing modest increases for rural health programs and the Agency for Healthcare Research and Quality, or AHRQ, in the fiscal year 2008, or FY '08, budget.

The $555 billion catch-all spending bill reduces the budget for Title VII primary care training programs from nearly $49 million in FY '07 to just under $48 million in FY '08. At the same time, the measure increases funding for AHRQ by $15.6 million over last year's figure, bringing the program's budget to about $334.6 million in the current fiscal year, which is $5 million more than the president requested. It also provides an increase of $7.5 million for rural health programs, elevating the budget for the programs to just more than $136 million in FY '08.

Although Congress passed a spending bill for discretionary domestic programs earlier this year, Bush vetoed the measure, saying it was too costly. He agreed to sign the current measure only after Congress cut $23 billion from the earlier bill, a reduction achieved by slashing all programs funded under the omnibus appropriations bill by 1.75 percent. This resulted in a $6.3 billion reduction in Labor/HHS/Education programs from what was proposed in the earlier spending measure, including a decrease of $853,000 for Title VII primary care training programs.

"There was tremendous pressure," said Teresa Baker, government relations representative in the AAFP Division of Government Relations. "Congress had to basically come down $23 billion in their domestic discretionary spending in order to put this bill together."

Section 747 of Title VII of the Public Health Service Act provides the only federal grants for training family physicians, and the program's survival in the FY '08 budget at roughly the same funding levels as those appropriated for FY '07 represents a "real achievement," said Baker. President Bush had called for the elimination of Title VII's primary care training programs as part of his FY '08 budget proposal, arguing that the programs are ineffective. The Bush administration's proposal, coupled with the tight fiscal environment on Capitol Hill, threatened the very existence of the Title VII training programs.

The AAFP worked diligently to counter the Bush administration's proposal, providing evidence that the Title VII grants are vital to training new primary care physicians and for sustaining the nation's primary health care infrastructure. The Academy submitted written statements to House and Senate committees about the importance of the Title VII programs and met with key leaders in both the House and Senate on the issue. AAFP members also sent e-mails and letters and made phone calls to congressional leaders to explain the critical need for Title VII programs. In the final analysis, both Congress and the Bush administration agreed to preserve the Title VII training programs.

"We did everything we could," said Baker, describing the AAFP's advocacy efforts. "We submitted (written statements) at the onset of the budget process. We met with members of the appropriations committees, and we participated in a number of coalitions."

The AAFP and four academic family medicine organizations sent a joint letter to House Speaker Nancy Pelosi, D-Calif., and other key congressional leaders on Dec. 5, urging support for Title VII health professions programs and explaining that the grants are "vital to the primary care educational infrastructure."

"The Title VII primary care training program has already experienced significant cuts in recent years," said the letter, co-signed by AAFP President Jim King, M.D., of Selmer, Tenn., and the presidents of the Society of Teachers of Family Medicine, the Association of Family Medicine Residency Directors, the Association of Departments of Family Medicine and the North American Primary Care Research Group. "Since FY 2003, when Section 747 was funded at $92.4 million, primary care training programs have struggled," the letter continued. "There is growing recognition of the value of primary care doctors to improved quality and cost-effective care. We must at least maintain our current level of effort to train an adequate supply of primary care physicians."

Other highlights of the appropriations bill include: