Volume 14, No. 8, September 2016

Transcription

1 Volume 14, No. 8, September 2016 IN THIS ISSUE WHITE HOUSE President Obama Pens Article on U.S. Health Care in JAMA Obama Administration Authorizes Additional Zika Virus Funding CONGRESS Congress Considers Rolling Back Some Sunshine Act Reporting Requirements Senators Urge Executive Action on CDC Opioid Guidelines CBO Releases Latest Analysis of Sequestration s Impact

2 FEDERAL AGENCIES Pediatric Stand-Alone Dental Plans Cost to be Considered when Figuring Tax Credits Next Gainful Employment Reporting Due Oct. 1 Surgeon General Launches Website to Provide Tools for Opioid Prescribers CONGRESSIONAL RESOURCES ADEA Advocacy Website ADEA/AGR Twitter and Congressional Websites ADEA Day Book FEDERAL GRANT OPPORTUNITIES *** WHITE HOUSE President Obama Pens Article on U.S. Health Care in JAMA President Obama wrote an article titled, United States Health Care Reform: Progress to Date and Next Steps, published in the July edition of JAMA, the Journal of the American Medical Association. The article assesses ways the Affordable Care Act (ACA) has expanded and impacted health care and the health care delivery system in the United States. The article documents that since the enactment of the ACA, health care coverage has exponentially increased. With the enactment of the ACA, the uninsured rate has fallen by 43%, from 16.0% in 2010 to 9.1% in In raw numbers, uninsured individuals in the United States declined from 49 million in 2010 to 29 million in 2015, leading to the largest decline in the uninsured rate since the enactment of Medicare and Medicaid five decades ago. The following chart illustrates the decline in uninsured after the ACA took effect. ADEA Washington Update Volume 14, No. 8, September 2016 Page 2

3 Interestingly, in instances where states have not adopted Medicaid expansion, those states have seen a reduction in their uninsured rates, which appears to indicate that the ACA s other reforms are contributing to increasing insurance coverage. President Obama made policy recommendations to further improve the health care system from enhancing competition in the Health Insurance Marketplace to addressing the cost of prescription drugs. In concluding, President Obama stated: I will repeat what I said 4 years ago when the Supreme Court upheld the ACA: I am as confident as ever that looking back 20 years from now, the nation will be better off because of having the courage to pass this law and persevere. Obama Administration Authorizes Additional Zika Virus Funding Despite repeated requests from President Obama for $1.9 billion to combat the Zika virus, Congress adjourned for its August recess without approving emergency funding. As a result, $81 million in existing funding is being reallocated for this purpose, Department of Health and Human Services (HHS) Secretary Sylvia Burwell announced. The directive reallocates $34 million from existing programs at the National Institutes of Health (NIH) and $47 million from the Biomedical Advanced Research and Development Authority budget to address the Zika virus. Prior to last month s announcement, HHS had already transferred $347 million from programs that targeted the Ebola virus to help fight Zika. Burwell noted in a letter to Congress that the money is needed for critical vaccine development work. She also expressed frustration that a congressional funding agreement had not passed and that the $81 million would originate from raiding other worthy government programs. The announcement comes as Washington remains in gridlock over how to further fund anti- Zika efforts. Democrats rejected Republican-sponsored legislation, which included more than $1 billion to fight Zika, over two concerns. The bill included additional provisions that loosened various pesticide regulations and restricted Zika-related funds from going to Planned Parenthood. House Republicans have criticized Democrat lawmakers for not passing the Republicansponsored bill, while Democrats, in turn, criticized Republicans for not sponsoring a politically neutral bill that meets the President s funding requirements. NIH officials have warned that if Congress cannot pass an agreement to deliver additional funds, urgent work to prevent the spread of Zika from vaccine development to hospital renovations will be delayed. ADEA Washington Update Volume 14, No. 8, September 2016 Page 3

4 CONGRESS Congress Considers Rolling Back Some Sunshine Act Reporting Requirements Congress is continuing its efforts to roll back some of the reporting requirements mandated by the 2010 Physician Payments Sunshine Act (Sunshine Act or Open Payments). Sen. John Barrasso (R-WY), one of three physicians in the Senate, has introduced legislation that would remove the reporting requirement for drug and device makers who pay for continuing medical education (CME) or send physicians copies of research studies. A similar exemption was passed as part of the House of Representatives version of 21 st Century Cures Act in The Sunshine Act was designed to track the financial relationships between physicians and teaching hospitals and drug and medical device makers. Data about these relationships have been available since 2014 at the government s Open Payments web page. A 2016 analysis by the investigative journalism site ProPublica looked at physician payments records from 2014 and found that doctors who received more than $5,000 from drug companies prescribed brand name drugs at an average rate of about 30%, compared with 20% for internists who received no money. The Centers for Medicare and Medicaid Services (CMS), which runs Open Payments, has provided inconsistent advice over the years about the need to report continuing medical education (CME) payments, typically made to companies that organize CME courses. The fear among regulators is that through its funding of CME programs, big pharma has too much control over the medical curriculum. A 2015 report by the Accreditation Council for Continuing Medical Education found that the industry spent nearly $700 million on CME, up 2% from the year before. A June 29 letter to Barrasso signed by more than 100 state and national medical societies, including the American Medical Association, said passage of the bill was urgently needed to fix what it called the law s onerous and burdensome reporting obligations. A rebuttal to the Barrasso bill, written by a former Senate staffer who helped draft the original legislation, notes that an investigation by the Senate Finance Committee concluded that corporate funding was turning both medical education and scientific publishing into marketing and public relations vehicles. The Barrasso bill was introduced on May 25 and is now awaiting a hearing in the Senate Finance Committee. ADEA Washington Update Volume 14, No. 8, September 2016 Page 4

5 Senators Urge Executive Action on CDC Opioid Guidelines Senators Kirsten Gillibrand (D-NY) and Shelley Capito (R-WV) sent a letter to President Obama urging the Centers for Disease Control and Prevention (CDC) to develop and publish comprehensive prescribing guidelines focused on the use of opioids to treat acute pain. The senators urge the change because current CDC guidelines focus mostly on opioid prescriptions for chronic pain despite the fact that opioid treatment for acute pain following a wisdom tooth extraction, for example can also lead to addiction. Prevention of overprescribing or inappropriate prescribing of opioids is a key component to combating the opioid epidemic, write the senators, who note that less-addictive drugs and shorter courses of opioid treatment can be effective in treating much acute pain. The letter comes on the heels of the senators introduction of S.2567, the Preventing Overprescribing for Pain Act, part of the Mental Health Reform Act of 2016, which the Senate Committee on Health, Education, Labor and Pensions passed in March. The Senators urge the President to use his administrative authority to encourage the CDC to create the envisioned guidelines whether or not Congress passes their bill. CBO Releases Latest Analysis of Sequestration s Impact In its latest sequestration update, the Congressional Budget Office (CBO) says that appropriations for discretionary funding through the middle of 2016 have not exceeded the mandatory budget caps. That means that sequestration the automatic, across-the-board budget cuts that started in 2013 will not be necessary this year. This reprieve resulted in part because the 2016 caps on discretionary budget authority were raised by $83.3 billion, most of which will go to overseas contingency operations. The CBO stressed, however, that only the White House Office of Management and Budget has the statutory authority to determine whether sequestration is required from one year to the next. By law, the CBO must issue a report by Aug. 15 each year estimating the caps on the government s discretionary budget authority through The office s most recent report notes that the total limit on discretionary budget authority for fiscal 2018 will drop to $1,064 billion from $1,070 billion in FY17, which begins Oct. 1. Federal taxpayer dollars are used for two types of funding: 1) mandatory, which includes programs that the government has to fund, such as Social Security, Medicare and Medicaid, and 2) discretionary spending, which is funding set by the two Congressional appropriations ADEA Washington Update Volume 14, No. 8, September 2016 Page 5

6 committees every year. Discretionary funding is divided between defense spending and nondefense discretionary (NDD) spending, which includes everything from funding federal agencies to basic scientific research. According to the public interest group NDD United, NDD s share of the federal budget has been shrinking, particularly since the passage of the 2011 Budget Control Act, which set funding caps for non-discretionary spending over the next 10 years. The 2011 Act also set sequestration in motion, with the intent of yielding $1.2 trillion in deficit reduction by If the 2011 Budget Control Act remains unchanged, NDD spending will represent an estimated 2.6% of GDP by 2021 or some 11% of federal spending the lowest level since FEDERAL AGENCIES Pediatric Stand-Alone Dental Plans Cost to be Considered when Figuring Tax Credits In a major victory for dental health advocates, the Internal Revenue Service (IRS) says it will take into account the cost of stand-alone pediatric dental health plans when calculating tax credits for health insurance premiums purchased under the Affordable Care Act. Although pediatric dental health benefits are part of the ACA s ten essential health care benefits, these benefits are not included in most health plans and must be purchased separately using stand-alone dental insurance. The IRS, however, has not been including the cost of dental plans when figuring the tax credits, it provides to families or individuals buying coverage under the ACA. Under a proposed rule issued on July 8, the cost of children s dental plans will be included in the IRS subsidy calculation starting in The IRS will accept comments on its proposed rule until Sept. 6. For years, a coalition of dental groups has been asking the IRS to change its calculation procedure and include the cost of stand-alone dental plans. This is particularly important because only about one-third of exchange health plans include pediatric dental benefits, and in some cases, the only pediatric dental plans on the market are stand-alone. Sen. Debbie Stabenow (D-MI) co-wrote the section of the ACA permitting stand-alone dental plans, and she has been trying for several years to convince the IRS to include this cost in its premium subsidy calculations. A May 17 letter to Treasury Secretary Jack Lew, signed by Stabenow and 19 other senators, urged Lew to use his rulemaking authority to clarify that the advance premium tax credit is calculated based upon all essential health benefits, including pediatric dental care, for all families. ADEA Washington Update Volume 14, No. 8, September 2016 Page 6

7 Next Gainful Employment Reporting Due Oct. 1 The Department of Education s Gainful Employment program has announced that its deadline for the award year is Oct. 1. The gainful employment regulations were designed to ensure that for-profit schools teach students skills that will earn them sufficient income to pay back their student loans a condition the Department of Education s 2015 fact sheet calls gainful employment in a recognized occupation. The idea is to provide federal financial aid only to those for-profit schools that provide affordable training that leads to well-paying jobs. The regulations, the latest version of which went into effect in July 2015, require graduates to have annual loan payments of either less than 8% of their gross income or less than 20% of their discretionary income. Only students who finish a program are counted in the school s statistics. Schools whose measurements are between 8% and 12% of gross income or between 20 and 30% of discretionary income are given a warning, and schools that receive a warning four years in a row or miss the 12% and 30% figures two out of three years in a row lose federal student aid for at least three years. Schools at risk of not meeting the gainful employment requirements must inform students of this risk before they enroll. According to the Department of Education, the gainful employment statistics focus on the forprofit education sector because students at for-profit schools pay more up-front for their education, borrow more frequently than students who attend public institutions and have a disproportionately high default rate. Surgeon General Launches Website to Provide Tools for Opioid Prescribers In August, U.S. Surgeon General Vivek Murthy launched turnthetiderx.org, a digital component of the Turn the Tide Rx campaign, which is engaging prescribers in the battle against opioid abuse. The website was created in partnership with Public Health Foundation Enterprises and the 100 Million Healthier Lives collaboration, convened by the Institute for Healthcare Improvement. There are many tools available on the site to aid potential opiate prescribers. Handy oneand two-page guides detailing prescription criteria and alternative treatment options are ADEA Washington Update Volume 14, No. 8, September 2016 Page 7

8 featured, alongside longer guides such as the Opioid Overdose Toolkit, published by the Substance Abuse and Mental Health Services Administration The site also features helpful patient education tools. Information about the risks and side effects of various medications accompanies guidelines for the taking, storing and disposing of opiates. A pledge featured on the site urges health care providers to, Educate [themselves] to treat pain safely and effectively, screen [their] patients for opioid use disorder and provide or connect them with evidence-based treatment, and talk about and treat addiction as a chronic illness, not a moral failing. According to the Surgeon General s website, the campaign includes three additional steps: Sending a letter to 2.3 million health care providers, including dentists, encouraging them to be leaders in combating the opioid epidemic while still treating their patients pain appropriately. Embarking on a nationwide tour to visit communities most affected by opioid abuse and talk with community leaders and residents about ways to address the challenges. Engaging stakeholders in the medical, legal and public policy spheres to gauge how the United States views substance use disorders and addiction. CONGRESSIONAL RESOURCES ADEA Advocacy Website The ADEA Advocacy website is updated daily and contains issues of importance to academic dentistry and dental and craniofacial research. Also, it allows you to communicate with your elected officials by simply entering your zip code or address. You can navigate the website by clicking through the drop-down menus at the top of the page. While there, please subscribe to ADEA Action Alerts to maximize your ability to send messages to your elected officials. ADEA/AGR Twitter and Congressional Websites For the latest information on issues affecting dental education and dental and craniofacial research in Washington and the state legislatures, please follow us on Twitter and find information on congressional proceedings at the U.S. House and U.S. Senate. ADEA Washington Update Volume 14, No. 8, September 2016 Page 8

9 ADEA Day Book FEDERAL GRANT OPPORTUNITIES The ADEA Day Book provides up-to-the-minute information regarding Congressional hearings and briefings, federal agency meetings and webinars and policy conferences that may be of interest. ADEA facilitates your ability to watch, listen or participate in these happenings. Simply click on the link provided next to the event and you are connected. Check back often for the most current listing of events. Below are selected funding opportunities that might be of interest. You can search for additional federal government funding opportunities at grants.gov. HRSA Service Area Competition Health Resources and Services Administration (HRSA) Closes October 17, 2016 HRSA Service Area Competition Additional Area (SAC-AA) Miles City, Montana Health Resources and Services Administration (HRSA) Closes October 17, 2016 HRSA Rural Policy Analysis Program Health Resources and Services Administration (HRSA) Closes November 14, 2016 HRSA Predoctoral Training in General, Pediatric, and Public Health Dentistry and Dental Hygiene Health Resources and Services Administration (HRSA) Closes January 20, 2017 RFA-ES BD2K Research Education Curriculum Development: Data Science Overview for Biomedical Scientists (R25) National Institutes of Health (NIH) Closes December 1, 2017 ADEA Washington Update Volume 14, No. 8, September 2016 Page 9

10 PAR Research Initiative for Scientific Enhancement (RISE) (R25) National Institutes of Health (NIH) Closes May 25, 2018 PAR NIDCR Small Grant Program for New Investigators (R03) National Institute for Dental and Craniofacial Research (NIDCR) Closes September 7, 2019 PAR NIDCR Small Research Grants for Secondary Analysis of FaceBase Data (R03) National Institute for Dental and Craniofacial Research (NIDCR) Closes September 7, 2019 Quotable Looking back, I realize that nurturing curiosity and the instinct to seek solutions are perhaps the most important contributions education can make. Paul Berg The ADEA Washington Update is published monthly when Congress is in session. Its purpose is to keep ADEA members abreast of federal issues and events of interest to the academic dental and research communities American Dental Education Association 655 K Street, NW, Suite 800, Washington, D.C Telephone: , Website: Yvonne Knight, J.D. ADEA Chief Advocacy Officer (KnightY@ADEA.org) Jennifer Thompson Brown, J.D. ADEA Director of State Relations (BrownJ@ADEA.org) B. Timothy Leeth, C.P.A. ADEA Senior Director of Federal Relations (LeethT@ADEA.org) ADEA Washington Update Volume 14, No. 8, September 2016 Page 10