Physicians protest health cuts in HHS spending bill

Washington A House spending bill that would fund health, education and labor programs for fiscal year 2013 received a barrage of criticism from physician organizations and others for proposing major cuts to health research and physician education programs while eliminating a federal agency that supports patient safety.

The legislation would appropriate $150 billion in discretionary funds for the Dept. of Health and Human Services and other programs, a $6.3 billion reduction from fiscal 2012 levels and $8.8 billion below President Obama’s budget request. HHS alone would receive $68.3 billion, $1.3 billion less than in fiscal 2012. The Republican legislation was approved by the House Appropriations Labor/HHS subcommittee by a party-line vote on July 18. The full committee did not immediately set a date to consider the bill.

House GOP appropriators said they wanted to reduce spending for unnecessary or ineffective programs in an effort to promote fiscal responsibility. In line with Republican policy on the Affordable Care Act, the legislation would prohibit the use of new discretionary funding to implement the law as well as rescind prior-year mandatory funds.

The health system reform law “is driving up health costs and making it harder for small businesses to hire workers,” said Rep. Denny Rehberg (R, Mont.), the subcommittee’s chair. Defunding these provisions would save taxpayers $123 billion over the next five years, according to a GOP summary.

Rep. Rosa DeLauro (D, Conn.), the subcommittee’s top Democrat, called the bill a “reckless document” for trying to stop key reform law provisions that would provide coverage for children with preexisting conditions, extend preventive services to women and families, and close Medicare’s prescription drug coverage gap.

The bill also includes funding reductions that would limit the ability of medical schools and teaching hospitals to conduct important health research and improve the health care work force, said Darrell Kirch, MD, president and CEO of the Assn. of American Medical Colleges.

Dr. Kirch criticized the bill’s “rigid requirements” for awarding research grants through the National Institutes of Health. This, “coupled with a freeze of that agency’s budget, would undermine NIH’s ability to support the most promising, scientifically driven research proposals at medical schools and teaching hospitals nationwide,” he said. The legislation would set aside $30.6 billion for NIH, the same as the 2012 level and the president’s request.

The bill’s proposal to eliminate the Agency for Healthcare Research and Quality was of particular concern to physician organizations. AHRQ supports efforts to improve patient safety and eliminate health disparities, Dr. Kirch said.

In a July 18 letter to Rehberg, Roland Goertz, MD, board chair of the American Academy of Family Physicians, urged that the subcommittee reconsider its proposal to eliminate AHRQ and that it provide at least $400 million for the agency in fiscal 2013.

The bill also would eliminate funding for the reform law’s Prevention and Public Health Fund, “which has already helped modernize vaccine systems, support breastfeeding, reduce tobacco use and address the childhood obesity epidemic, among other initiatives,” said Robert Block, MD, president of the American Academy of Pediatrics.

The AAP was pleased, however, that the bill included $275 million to support the Children’s Hospital Graduate Medical Education program, a $10 million increase from the previous fiscal year, Dr. Block said. Funding under this program is provided to children’s hospitals to train pediatricians and pediatric subspecialists.