At a Glance…
- Full year appropriations were signed into law…but a COVID-19 supplemental is stuck
- Dr. Ashish Jha replaces Jeff Zients as COVID-19 Czar
- Prevent PANDEMICS Act passes Senate HELP 20-2
- And more…
FY22 negotiations finally end with the signing of the Omnibus spending bill
Congress passed and the president signed the $1.5 trillion FY22 Omnibus, which provided appropriations for the rest of the fiscal year. This bill provided the Department of Health and Human Services (HHS) with $108 billion, an increase of $11.3 billion over FY21. Notable in this bill is:
- ARPA-H. The bill included $1 billion to establish ARPA-H within HHS. We have been active directly with members of Congress and their staff in advocating for a strong focus on health services research, implementation, and health equity in ARPA-H. If you missed our earlier blog on this, here it is.
- NIH. The bill included $45 billion for NIH, an increase of $2.25 billion above FY21. This includes $6.9 billion for the National Cancer Institute, $3.5 billion for Alzheimer’s disease, $3.2 billion for HIV/AIDS research, $50 million for health disparities research, and much more.
- CDC. The bill included $8.5 billion for CDC, an increase of $582 million for CDC. This includes $200 million in new flexible funding for public health infrastructure and capacity, $100 million to modernize public health data surveillance and analytics, $180 million for the National Center for Health Statistics, and more.
- HRSA. The bill included $8.9 billion for HRSA, an increase of $1.4 billion. This includes $1.7 billion for health centers, $1.3 billion for the Bureau of Health Professions, $366 million for the Rural Health Programs, and more.
- NSF. The bill included $8.84 billion, an increase of $351 million.
- FDA. The bill included $3.3 billion, an increase of $102 million. This includes a targeted increase of $29 million to address the opioid crisis, medical supply chain surveillance, and rare cancers.
Learn more about the health programs here.
The omnibus funded AHRQ at $350.4 million in discretionary funding, $12.4 million (3.5 percent) increase over FY21. This is below what the President’s Budget and the House and Senate Appropriations Committees Majorities had called for, indicating that cuts in nondefense discretionary (NDD) proposals were necessary for bipartisan support out of the Senate. Congressional Republicans have consistently in the last year attacked the appropriations bills drafted by the Majorities as having too high of spending in NDD and were nonstarters, and we have been prepared for any final bill to be signed into law to be a bit lower than proposals for that reason. Although this is lower than we would have preferred, this is the first year in over a decade that AHRQ has had year-over-year increases in funding.
The Omnibus calls for several specific reports and research endeavors from AHRQ, in addition to AHRQ’s normal activities:
- $2,000,000 to establish the Center for Primary Care Research
- $10,000,000, an increase of $8,000,000, for researching diagnostic error and associated risks to patient safety.
- Supports heart disease research, calling on AHRQ to be studying and assessing the current evidence for lipid control and cardiovascular event reduction, quality measures for the improvement of clinical outcomes, and development and dissemination of educational resources and materials about improving cardiovascular clinical outcomes for coronary heart disease death, myocardial infarction, ischemic stroke, and urgent coronary revascularization procedure.
- Urges AHRQ to evaluate innovative approaches to enhance the availability of organs, otherwise encourage donation, and further improve the organ transplantation process, including through consultation with other Federal agencies.
- The bill encourages AHRQ to continue supporting research on health equity, health system innovations responding to COVID-19, improving maternal morbidity and mortality State and local data, opioids research, research on the use of natural products such as kratom to treat pain, and prenatal care for pregnant individuals.
With the end of FY22 negotiations, FY23 advocacy is in full swing. The Friends of AHRQ sent the House and Senate letters calling for AHRQ to be fully funded at $500 million for the upcoming fiscal year. Over 135 organizations, representing every corner of health policy and the health system – form hospitals to doctors to nurses to patients to researchers to universities, and more, signed on. To learn more about the Friends of AHRQ, email Advocacy@AcademyHealth.org.
Additional needed COVID-19 funding faces an uncertain path
In a last minute decision, Congress dropped a $15.6 billion pandemic aid package from the $1.5 trillion Omnibus due to concerns about the cost being paid by cuts to existing state economic aid drawing opposition from governors. The absence of this funding has left the federal response to the ongoing pandemic in a state of uncertainty. The Biden Administration is beginning to look to wind down federal programs that would no longer be funded, including halting government coverage for certain expensive COVID-19 therapeutics and reimbursing providers that care for uninsured patients. Congressional Republicans have indicated that they will not support a plan that is not fully offset and that they did not see an urgent need for additional funding.
Dr. Ashish Jha replaces Jeff Zients as COVID-19 Czar
Jeffrey D. Zients, an entrepreneur and management consultant who steered President Biden’s coronavirus response through successive pandemic waves and the largest vaccination campaign in American history, plans to leave the White House in April. will be replaced as the White House coronavirus coordinator by Dr. Ashish K. Jha, the dean of the Brown University School of Public Health and a practicing internist who has urged an aggressive approach to the pandemic in frequent television appearances. Dr. Jha will coordinate the government’s Covid-19 response from inside the White House.
Dr. Jha spoke at the 2020 Annual Conference on the Science of Dissemination and Implementation in Health on how the pandemic changed approaches to science innovation, the publication process, and data collection. You can watch his presentation here.
Advocacy Opportunity: Comment on AHRQ’s proposed strategic framework
The Agency for Healthcare Research and Quality (AHRQ) is seeking comments on the proposed strategic framework for the Agency’s Patient-Centered Outcomes Research PCOR Trust Fund (PCORTF) investments through fiscal year 2029. AHRQ has developed this strategic framework to guide future planning and evaluation of the PCORTF investments. Learn more about the framework and how to submit your comments here.
Sen. Kaine introduces legislation to study Long Covid after suffering from it
Sen. Tim Kaine got COVID-19 in the spring of 2020, and nearly two years later he still has mild symptoms. Long covid has baffled scientists, and the true scope of how many people it has affected is unknown. High estimates suggest over one-third or even roughly half of the 80 million Americans who have had the virus developed long-term symptoms, and low estimates put that figure in the single-digit percentage range. His legislation, the Comprehensive Access to Resources and Education (CARE) for Long COVID Act, would empower and fund AHRQ and PCORI to improve treatment and health outcomes for patients with Long Covid.
Senate HELP Committee passed the bipartisan PREVENT Pandemics Act
The Senate Health, Education, Labor, and Pensions (HELP) Committee passed nearly unanimously the Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act (PREVENT Pandemics Act). This legislation responds to the pandemic with improved coordination among public health agencies, strengthens medical supply chains, and requires Agency-wide CDC strategic plans. Notably, this legislation would empower AHRQ to develop evidence, tools, and strategies regarding the delivery of high-quality, high-value health care for individuals with Long Covid. The legislation also calls for the creation of a 9/11-style commission to investigate what went wrong in the coronavirus response and make recommendations to the president and Congress. The legislation also provides a vehicle for the initial authorization of the Advanced Research Projects Authority for Health (ARPA-H), with this version being housed in NIH. Of note, ARPA-H is also being authorized in CURES 2.0 as an agency in HHS.
Digital health system for veterans plagued by patient safety risks
More than a year after a disastrous deployment at its first hospital, the $16 billion effort to modernize veterans’ medical records still poses grave safety risks to patients, from medication errors to failures to safeguard patients at high danger of suicide, the Department of Veterans Affairs’ internal watchdog has reported. Three reports on the project’s rollout in Spokane, Wash., cast doubt on how smoothly it will expand next week, when VA plans to bring its digital health records system to a second Washington hospital in Walla Walla, then accelerate implementation at other hospitals and clinics in the Pacific Northwest and elsewhere by December. Medical appointments took months to schedule, investigators found. Veterans could not log in to the secure website that gives them personal health information and lets them communicate with their doctors. The system gave bad computer links for telehealth appointments. Many tickets from the medical staff asking the contractor to troubleshoot problems — almost 40,000 were filed from October 2020 through the end of March 2021 alone — went unanswered.
What I’m reading
Due to the massive investments and success of the mRNA vaccines for COVID-19, researchers are generating medical and scientific breakthroughs on numerous other diseases that have plagued patients. Researchers are now investigating mRNA treatments for diseases from cystic fibrosis to influenza, and cancers such as pancreatic, colorectal, and melanoma. As this exciting new era begins, it is critical that this research is undertaken with an equity-focused lens.
One of the most critical challenges facing patient care is the growing workforce shortages, especially among nurses. Buerhaus et al wrote in Health Affairs that Current Population Survey data suggests a tightening labor market for registered nurses, licensed practical nurses, and nursing assistants, marked by falling employment and rising wages.
As the current Omicron spike falls, the desire to “return to normal” is on our minds. As we approach the two year anniversary of country-wide lockdowns, Gostin writes in JAMA about what life after a pandemic looks like. There will not be a single moment, but rather a gradual shift to COVID-19 as a background risk and occasional shifts back to precautions as new variants arise.
The journal Health Affairs devoted their most recent volume on Racism and Health. It’s difficult to pick just one or two articles to highlight, but I especially appreciated the work of Harderman et al on how antiracist health policy research requires methodological innovation that creates equity-centered solutions that are centered on the complexities of structural racism. Their work provides thought-provoking methodological approaches to help us move our field forward in being able to validly measure structural racism to achieve health equity. I also found the work of Yearby et al on the historical context and accounting of modern structural racism in health care policy to be illuminating. Barriers to equitable access to high-quality care do not exist in a vacuum, and identifying structural racism is a first step in dismantling it.