No Rest for the Weary: Congress Returns to face Health Care Reform, Appropriations, and More 

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By Lyle B. Dennis

The traditional August congressional recess has come and gone – with both a bang and whimper – and Congress has returned to Washington to face a raft of issues that promise to keep them in session into December. Below are just a few of the things that AASLD members will be watching in the fall.

Health Care Reform

After an August recess in which town hall meetings were filled with less than spontaneous outbursts of indignation over health care reform – replete with charges of death panels, euthanasia, government takeovers, socialism, fascism and communism – Congress has returned to deal with the actual legislation that is before them.

There are a number of issues in health care reform that directly impact AASLD members.  While research is not a major component of the pending proposals, research into the outcomes of various treatment modalities is squarely on the table. With increasing treatment options available for various liver diseases, including viral hepatitis, this emerging field of research could be of particular and growing importance to hepatologists.

Payment issues under Medicare are also of importance. First and foremost, Congress needs to address the planned 21 percent reduction in Medicare reimbursement rates that will take effect on January 1, 2010, if nothing is done. This reduction, which results from a faulty Sustainable Growth Rate (SGR) formula in the existing Medicare law, must be addressed – with or without health care reform. To not do so will create a Medicare access issue of unprecedented proportions.

Beyond the SGR fix, the health care reform proposals address how Medicare rates for individual codes are set. On the one hand, there is pressure to realign reimbursement to put more money into primary care. However, there are also pressures to put more money into cognitive care and less into procedures. This is a mixed bag for AASLD members and will merit careful analysis as the bills crystallize this fall.

In addition, health care reform legislation as currently written contains a number of provisions and incentives related to the provision of quality care. Quality care measures are an important factor in healthcare reform and the exact nature of the provisions and – perhaps more importantly – their eventual implementation will be critical to the future of hepatology.

Appropriations

In last month’s report, we detailed the recommended funding levels for some of the key programs of interest to AASLD members, among them the National Institutes of Health, the Division of Viral Hepatitis at the CDC, the Division of Transplantation in HRSA, the research component of the Department of Veterans Affairs.

The House has passed its appropriations legislation for FY2010, the fiscal year that begins on October 1. The Senate may consider its bill during the month of September. If it does, an effort will be made to “conference” the bills quickly and produce a single version, known as a Conference Report, for both houses to consider before or close to the October 1 deadline.

If the legislation is not completed by October 1, a Continuing Resolution (CR) will have to be passed by Congress to assure the continued operation of the federal government in the new fiscal year. Unfortunately, CRs often have the effect of slowing down the grant-making process as NIH, in particular, tends to operate at a reduced level until its annual appropriation is finalized.

SMRB

Earlier this year, we wrote about the NIH’s Scientific Management Review Board (SMRB), which is looking at, among other things, the issue of whether the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) should be merged into a single unit.  AASLD has actively opposed the merger, citing the dearth of end-organ damage research at NIDA and the potential impact such a merger could have on the amount of research currently being funded at NIAAA.

A working group of the SMRB will be meeting on September 23 to address the scientific impact of such a merger.  AASLD president, Dr. Scott Friedman, has been invited to participate as an expert advisor to the working group. It is expected that the working group will complete its consideration at this meeting and draft a recommendation for consideration by the entire SMRB, at its meeting in November.

This electronic newsletter is a bi-weekly publication of AASLD and replaces the former bi-monthly print newsletter and weekly e-news. Members are welcome to submit articles and may send suggestions to atracy@aasld.org