House Appropriations Committee moves on HHS funding
The House Appropriations Committee Subcommittee on Labor, Health and Human Services, and Education (Labor-HHS) released and passed their FY23 spending bill to the full committee for consideration. You can find a summary of the House FY23 Labor-HHS bill HERE and the bill text HERE. The Committee has not yet released a list of the “community project funding requests” (informally known as “earmarks) or report language with more detailed funding information but is expected to do so shortly before the Full Committee markup.
The Senate has not publicly released a timeline for when they will produce their own bills. If Congress does not pass and the president does not sign all 12 appropriations bills by October 1, the government will either shut down or require a continuing resolution (CR) to continue operating. At this point, we expect FY22 to begin with a CR, which requires level funding and no new programs, with full appropriations being approved closer to the end of the calendar year. As such, the appropriations process is still very “live” and negotiations and changes in final appropriated levels and policies are expected to continue until then.
There is currently no bipartisan agreement on total levels of defense or nondefense funding, which makes any legislation moved by the House preliminary. Although Democrats control the House, Senate, and White House, they need bipartisan support to pass any appropriations bill through the Senate. Notably, the LHHS bill has a robust total funding level in it (13 percent increase over FY22), indicating that accounts will likely be negotiated down significantly during conferencing with the Senate.
The House Majority intends on AHRQ receiving $385 million in discretionary funding, $35 million (10 percent) increase over FY22, but $30 million below the President’s Budget Request.
Other notable proposals in this bill include:
- The Department of Health and Human Services would be funded at $124.2 billion, an increase of $15.6 billion over FY22.
- The National Institutes of Health would be funded at $47.5 billion, an increase of $2.5 billion over FY22.
- The Advanced Research Projects Agency for Health (ARPA-H) would be funded at $2.75 billion, an increase of $1.75 billion over FY22.
- The Centers for Disease Control (CDC) would be funded $10.5 billion, an increase of $2 billion above FY22.
- The Health Resources and Services Administration (HRSA) would be funded at $9.6 billion, an increase of $683 million above FY22.
Surgeon General Murthy sounds the alarm on health worker burnout
Surgeon General Vivek Murthy released an advisor on building a thriving health workforce that notes that physicians, nurses, and other health workers have been experiencing crisis-level burnout even before the pandemic, and that the pandemic has pushed them even further. The advisory notes that in addition to the toll burnout takes on the health workers themselves – including stress, exhaustion, anxiety, and depression - it also poses a severe risk to the nation’s public health infrastructure as these workers leave the workforce.
The Surgeon General discussed this report and his recommendations at the 2022 AcademyHealth Annual Research Meeting.
President Biden Nominated Dr. Arati Prabhakar to Lead OSTP
The White House announced that Dr. Arati Prabhakar was nominated to serve as the Director of the Office of Science and Technology Policy (OSTP). In this capacity, Dr. Prabhakar will be the President’s Chief Advisor for Science and Technology, a co-chair of the President’s Council of Advisors on Science and Technology, and a member of the President’s Cabinet. The role of science adviser to the President does not require Senate confirmation however the role as head of the OSTP does — and that could take months. She was previously the Director of the National Institute of Standards and Technology (NIST) and Director of the Defense Advanced Research Projects Agency (DARPA). If confirmed by the Senate, she would be the first woman, immigrant, or person of color nominated to serve as director.
HHS announced a new environmental justice office
The Department of Health and Human Services (HHS) is establishing an Office of Environmental Justice to address environmental health issues among "disadvantaged communities and vulnerable populations on the frontlines of pollution" and other climate impacts, the Biden administration announced. The new HHS office will form and implement a department-wide strategy on environmental justice and health and lead initiatives that integrate environmental justice into the agency's mission to improve health outcomes for high-risk communities.
A recent survey discussed in Nature found that most Americans do not think Black people are more likely to be affected by pollution than white people, despite clear evidence to the contrary. Respondents were twice as likely to identify poverty as the main cause of environmental inequalities, instead of blaming structural racism. This is despite scientific evidence clearly demonstrating that race, rather than poverty, is the primary factor behind environmental inequality.
NIH launching grant programs aimed ad the funding gap between Black and white investigators
The National Institutes of Health (NIH) is launching a new class of R01 research grants designed to encourage a more diverse pool of principle investigators. The program could award up to $20 million a year to neuroscience, drug abuse, and mental health investigators from minority groups. NIH Chief Officer for Scientific Workforce Diversity Marie Bernard published a blog discussing research project grant funding rates and principle investigator race and ethnicity, which she noted that in the 2021 fiscal year, a Black applicant’s odds of receiving at least one new R01 was 24.4 percent, or 2.2 percentage points lower than for a white applicant–compared with a gap of about seven to nine points from 2013 to 2019
HHS approved Colorado’s public option
HHS announced approval of Colorado's Section 1332 State Innovation Waiver amendment request to create the "Colorado Option," a state-specific health coverage plan that increases health coverage enrollment and lowers health care costs, making insurance more affordable and accessible for nearly 10,000 Coloradans starting in 2023. It is designed to reduce racial and ethnic health disparities by providing new coverage options for Coloradans. This public option would be available on the ACA Marketplace. Colorado is the first in the nation to adopt this waiver to introduce a new and more affordable state-based health insurance option, and leverage federal savings to support state subsidies to improve affordability and coverage initiatives. Colorado projects that approximately 32,000 Coloradans will gain health insurance under the amended waiver by 2027, which would be an increase of approximately 15 percent in the individual market.
Federal monkeypox response may echo early COVID-19 missteps
Public health experts, including within the Biden administration, are increasingly concerned that the federal government’s handling of the largest-ever U.S. monkeypox outbreak is mirroring its cumbersome response to the coronavirus pandemic 2½ years ago, with potentially dire consequences. The rapidly rising global case counts have prompted the World Health Organization to convene an emergency committee to assess whether the monkeypox outbreak represents a public health emergency of international concern — the agency’s highest-level warning, which currently applies only to the coronavirus and polio. But as other nations have ramped up their efforts to track and prevent the spread of infection, experts say the United States has moved too slowly to expand access to monkeypox testing and vaccinate people at highest risk. The government’s failure to clearly and urgently communicate the symptoms and risks associated with monkeypox, a disease spread by close contact that can lead to fever, pain and a visible rash, has left gay and bisexual men, who are disproportionately contracting the virus, especially vulnerable, public health experts say.
AHRQ published the Common Formats for Event Reporting—Diagnostic Safety (CFER-DS) Version 1.0
AHRQ has released Common Formats for Event Reporting—Diagnostic Safety (CFER-DS) Version 1.0 as the first AHRQ Common Formats for Event Reporting (CFER) that can be used across health care settings. It is designed to capture standardized, structured data to facilitate the reporting of diagnostic safety events for the purpose of learning about how to improve diagnostic safety and better support the diagnostic process. AHRQ has previously developed and maintains Common Formats for three settings of care—acute care hospitals, skilled nursing facilities, and community pharmacies—for use by health care providers and PSOs. AHRQ-listed PSOs are required to collect patient safety work product in a standardized manner to the extent practical and appropriate, a requirement the PSO can meet by collecting such information using Common Formats.
What I’m reading
NPR wrote about the risk of over testing a patient can create a cascade of low value care. Research has shown that low-value care is costly, with one study estimating that the U.S. health care system spends $75 billion to $100 billion annually on these services. AcademyHealth led a research community on low value care in partnership with the ABIM Foundation for eight years, helping to spur more research on the scope and impact of such care. Cascades of care are common and dangerous, with one study finding that nearly 9 in 10 physicians had seen a cascade harm a patient, either physically or financially. Software that notifies physicians of potentially low-value care only leads to a 10-13% reduction in low value care. Major barriers to reducing cascades include a medical culture of more is better, doctors fearful of missing something, patients pushing for more, and hospitals making money based on the number of services provided.
The American Medical Association responded to the growing threat of over-policing and surveillance of reproductive health services, the nation’s physicians and medical students at the AMA Annual Meeting adopted a policy recognizing that it is a violation of human rights when government intrudes into medicine and impedes access to safe, evidence-based reproductive health services, including abortion and contraception.
A new study in Nature studied the well-documented gap in the number of scientific works produced by women and men, and found that women in research teams are less likely to be credited with authorship than men. The study found that women are 13% less likely to be credited with authorship than men on a paper and 58 percent less likely to receive credit on a patent. The research team found that women on a research team are significantly less likely to be named on any given article than a man, and that their work is often not known, appreciated, or is ignored.
President Biden’s COVID-19 advisor, Dr. Ashish Jha, gave an interview with the New Yorker about his philosophy on the pandemic and how we will know that we have gotten to the endemic stage. Notably, he discussed the importance of translating research into action, and how he saw publishing research as one step that would then lead to affecting policy.
Nature has an article highlighting the “Great Resignation” that is hitting academia as waves of departures amongst mid-career scientists calls attention to the discontent many are feeling in universities. Experts noted that grievances include lack of support, increased workloads, micromanagement, increasing right-wing hostility towards academics, fewer tenure-track positions for greater numbers of applicants, and salaries that have not kept up with cost of living, with the pandemic being the last straw for many.