Congress is in the midst of its summer recess, but the public's attention remains fixed on what will happen when our elected officials return to Capitol Hill on September 8. And with agenda items including the Iran Nuclear Deal and a number of looming fiscal deadlines--namely the funding of the federal government--the items on Congress's fall agenda are significant.
I recently spoke with Emily Holubowich, senior vice president at CRD Associates and director of the Coalition for Health Funding to get her insights on Congress's agenda and what it could mean for the health research community. Here's what she had to say:
Congress will reconvene after a roughly month-long recess next week. What can we expect to see when they return to town?
Lawmakers have a busy fall ahead. First up, they'll consider the Iran Nuclear deal. Shortly thereafter, they'll need to address government funding before the fiscal year ends on September 30th since Congress failed to finalize any fiscal year 2016 spending bills before leaving for August recess. Consideration of the funding bills that support health services research and public health stopped at the committee level in both the House and Senate in June; neither chamber brought their respective bills to the floor, nor will they.
Clearly all eyes are on a government shutdown, with House Budget Committee Ranking Member Rep. Chris Van Hollen recently saying that it's a "real danger." How likely do you think a shutdown is at this point?
Anything is possible, and I would never say never when it comes to a shutdown.
Congressional leadership has made it clear that they want to avoid a government shutdown. Then again, congressional leadership didn't want a shutdown in 2013, and it happened nonetheless. In 2013, we saw the main point of contention was funding for the Affordable Care Act; this year, it's funding for Planned Parenthood in the wake of undercover videos about the acquisition of fetal tissue for medical research.
A shutdown could occur if Republicans cannot garner enough support for a "clean" short-term, stop-gap funding bill that keeps the government (and Planned Parenthood) running at current levels. If Republicans in Congress put forward a stop-gap spending bill that defunds Planned Parenthood--as more and more conservatives insist--the president will certainly veto it. This highly-politicized, election cycle debate around whether or not to ban all federal funding for Planned Parenthood and the women's health services it provides may prove too difficult for cooler heads to overcome.
What about sequestration? How do you think those conversations will play out this fall?
Sequestration returns in fiscal year 2016 after a two-year, partial reprieve granted under the "Murray-Ryan" Bipartisan Budget Act of 2013. There is bipartisan agreement that sequestration is bad policy, and there is bipartisan interest in avoiding sequestration's cuts, but the path to enacting a "Murray-Ryan 2.0" deal is unclear.
Replacing sequestration for defense and non-defense activities, including health services research, will cost nearly $75 billion for just one year. Most of the "low-hanging fruit" to offset such an expense has already been picked to pay for other priorities like the Medicare physician payment fix, or will be needed to pay for other high-ticket priorities this fall, such as the Highway Trust Fund. The cost of avoiding these cuts may be insurmountable despite the widespread recognition that this no-growth fiscal environment is not sustainable to meet current and emerging priorities and needs.
The Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid Innovation (CMMI), and the Patient-Centered Outcomes Research Trust Fund were all targeted in the House and, to a lesser extent, the Senate Appropriations Committees' spending bills for FY16. Any of these measures pose a real threat to the health research enterprise. How do you see the discussions surrounding these provisions unfolding?
My sense is that members of Congress have been taken aback by the public outcry against the cuts and outpouring of support from our field. As a result, they are interested in making AHRQ and other health research initiatives whole in fiscal year 2016. But that will only be possible with more funding--funding that would come from sequestration relief. (*Note: Emily is also founding co-chair of NDD United, which advocates for sequestration relief.) In this regard, the fate of these agencies and their activities in the near-term is inextricably linked to Congress's ability to pay for a "Murray-Ryan 2.0" budget deal.
If Congress is unable to reach a deal to patch sequestration, we might expect lawmakers to enact a year-long continuing resolution, a stop-gap spending bill that will hold funding for all government agencies, programs, and activities at current levels--essentially maintaining the status quo. But even then, current funding levels for non-defense programs like health services research exceed the funding allowable under the sequestered spending caps for the next fiscal year. So, if Congress enacts a year-long continuing resolution at current levels, all non-defense programs will take a 1.5 percent spending cut.
Either way, we should expect some level of cut for AHRQ. Obviously these cuts are not equal!
A lot of what we're talking about here relates to the near future. What about looking beyond the short-term? What does our community need to know?
In the long-term, our community should be very concerned with the anti-health services research language in the proposed spending bills. The threat to the health services research enterprise is real, and depending on the outcome of the 2016 election, could become a reality is the community is not vigilant in its advocacy for and promotion of health services research. AcademyHealth is developing tools to help producers and users of health services research raise awareness about our field among lawmakers, the media, and the public. Joining AcademyHealth's Advocacy Interest Group is also a great way to stay abreast of developments in Washington and learn effective strategies for engagement.
If you would like more information about AcademyHealth's advocacy activities or would like any additional information, please contact AcademyHealth's advocacy staff.