February 15, 2008

1. Act Now: Extend the Medicaid Moratorium

2. FY 2009 Budget Decreases Funding for Medicare, Discretionary Programs

1. Act Now: Extend the Medicaid Moratorium

Members of the US House of Representatives and Senate have introduced legislation (HR 3533, S 2460) to extend by one year the moratorium delaying implementation of the proposed regulation that would eliminate federal Medicaid matching funds for the graduate medical education (GME) expenses states incur. The current moratorium is scheduled to end May 23, 2008. The Alliance for Academic Internal Medicine (AAIM) urges members to contact congressional representatives and encourage them to extend the moratorium on cuts to GME Medicaid funding by supporting HR 3533 and S 2460 before the proposed regulation takes effect this May.

Senators Jeff Bingaman (D-NM) and Elizabeth Dole (R-NC) introduced S 2460 December 12, 2007. The legislation, very similar to its House counterpart, the Public and Teaching Hospital Preservation Act, has garnered support from several health care organizations, including AAIM and the Association of American Medical Colleges (AAMC). In a recent letter to Senator Bingaman, AAMC expressed its support of the Senate bill, stating, “by expanding and extending the moratorium for one year, Congress can conduct a careful analysis and thoughtful debate before moving forward.” Observers believe extending the moratorium until a new administration enters the White House will increase the likelihood the proposed regulation is not implemented.

According to AAMC, federal and state funding for GME through the Medicaid program totals more than $3.1 billion annually. If the moratorium is not extended, the burden will fall on state governments to compensate for the loss of federal Medicaid matching funds. However, more than 22 states are already projecting significant financial deficits for at least one of the next two years. Shifting additional financial burdens to states that cannot afford it may cause those states to reduce the amount of money they spend on GME if federal matching funds are not available.

Please contact your congressional representatives and ask them to support the extension of the moratorium on cuts to Medicaid GME funding. To find contact information for your congressional representatives, please visit www.house.gov and www.senate.gov.

2. Congressional Turnover Affects Health Committee Membership

Turnover on Capital Hill continues to increase as more members of the 110th Congress announce plans for retirement. Several retiring members currently serve on committees with jurisdiction over programs relevant to the academic internal medicine community, leaving top committee assignments and important votes at stake.

As of February 13, 2008, 42 congressional representatives have left have announced they will not run since the beginning of the 110th Congress. The largest turnover rate is among Republicans in the House of Representatives. In the Senate, five senators have announced their retirement, all of whom are Republicans.

Representative James Walsh (R-NY), ranking member of the House Appropriations Subcommittee on Labor, Health and Human Services (HHS), and Education, announced in January 2008 that he will retire at the end of his congressional term in 2009. Representative Walsh, a moderate Republican, is among the handful of Republicans to offer bipartisan support of HR 3533, which seeks to extend by one year the moratorium on the final rule that would eliminate federal Medicaid funding for graduate medical education (GME). While serving in Congress, Representative Walsh has also advocated on behalf of rural health issues and veterans health care.

An additional five House Republican appropriators have announced their plans for retirement. Four out of the six appropriators hold seats on the House Appropriations Subcommittee on Labor-HHS-Education, which handles the largest of the domestic spending bills.

Among other retiring House members serving on key health subcommittees are Representative Michael Ferguson (R-NJ) and Kenny Hulshof (R-MO). Representative Ferguson, a member of the House Committee on Energy and Commerce Subcommittee on Health, also co-sponsored HR 3533. Representative Hulshof, a member of the House Committee on Ways and Means Subcommittee on Health, is also a supporter of federal payments for GME. In addition, Representative David Weldon, MD (R-FL), an internist and one of the few physicians serving in Congress, will not seek re-election at the end of his term.

On the Senate side, Senator Wayne Allard (R-CO), a member of both the Senate Committee on Appropriations and Senate Committee on Health, Education, Labor and Pensions (HELP), will retire in January 2009. The HELP Committee has broad jurisdiction over measures relating to health care, research, and educational programs.

The Alliance for Academic Internal Medicine—the nation’s largest academically focused specialty organization—consists of the Association of Professors of Medicine, the Association of Program Directors in Internal Medicine, the Association of Subspecialty Professors, the Clerkship Directors in Internal Medicine, and the Administrators of Internal Medicine.

Please contact AAIM Vice President for Policy Charles P. Clayton (cclayton@im.org), AAIM Policy Associate Nicole V. Baptista (nbaptista@im.org), or AAIM Policy Assistant Allison L. Haupt (ahaupt@im.org) at (202) 861-9351 with questions or comments about this week’s Merlin.