Congress' 2020 Spending Package Short-changes Primary Care

Legislation Keeps the Government Open, Delays Crucial Funding Decisions

December 18, 2019 03:31 pm News Staff

Congress appears to have averted a repeat of last year's government shutdown with a $1.4 trillion spending package for 2020 that cleared the House on Dec. 17 and now goes to the Senate, which is expected to vote on it before funding expires on Friday, but the deal appropriates zero new dollars for one of the AAFP's highest legislative priorities and jeopardizes primary care in other ways, as well.

[u.s. capitol in winter]

The Teaching Health Center Graduate Medical Education program, a crucial link in the primary care workforce pipeline that also provides desperately needed health care in rural areas, remains in limbo, with only a brief funding extension that falls far short of what's needed. Congress moved the program's funding deadline to May 22, the latest in a series of extensions for deadlines to lock in two- or four-year funding for an array of public health programs. Other programs left with so-called "health extenders" that do not provide the long-term funding the Academy is advocating for include community health centers and the National Health Service Corps.

Now, with legislators leaving Washington for the holiday recess, the Academy is gearing up to once again start a calendar year with work to secure the future of family medicine.

Previous permanent funding deadlines came and went this fall as Congress passed two continuing resolutions to keep federal offices open while kicking the THCGME can farther down the road.

Meanwhile, the Academy added muscle to its longstanding push to ensure full THCGME funding by marshalling members through a well-supported Speak Out campaign. In October, Board Chair John Cullen, M.D., of Valdez, Alaska, and AAFP President Gary LeRoy, of Dayton, Ohio, took that fight to Capitol Hill.

The facts have always been clear, even as the urgency has grown.

"The THCGME program is, without question, one of the most successful, efficiently run programs in the country," the Academy said in a Sept. 12 letter signed by (then) Board Chair Michael Munger, M.D., of Overland Park, Kan. "It is a mission-focused program that has a proven track record of achieving its legislative mandate of training the next generation of primary care physicians. Since its inception, this program has successfully trained over 1,000 primary care physicians and dentists who, in return, have established practices and provided high-quality care to millions of Americans."

Also left in shadow as the year closes: what had appeared to be broadly supported bipartisan efforts to end surprise medical billing (legislation the Academy also has called for) and rein in prescription drug costs.

The absence of a surprise-billing measure in the spending package has drawn media attention. Stories of patients facing financial pressure -- or even ruin -- due to unexpected medical expenses have become news outlet and social media channel constants. Yet Congress punted that matter, too.

"Although most lawmakers who have written legislation on the issue endorsed the proposal, a few did not," said a Dec. 17 political analysis from The New York Times.(www.nytimes.com) "The bipartisan leaders of the House Ways and Means Committee said last week that they hoped to introduce a competing bill in the future and released a one-page paper(waysandmeans.house.gov) last week describing a framework that is more aligned with the preferences of doctors' groups."

The spending package did align with another Academy advocacy position by including $25 million in funding for gun violence research, a breakthrough after 20 years of inaction.

And the package increases to 21 the minimum age to purchase tobacco, a change that also will apply to e-cigarettes and vaping devices.

But even that provision missed an opportunity to answer loud calls to action from the AAFP by failing to ban the flavored vaping products that have fueled an epidemic of youth nicotine use and that have even drawn fire from the White House.