Stalemate or Innovate: What Will the Future of Federal Legislation Bring?

Hope Wittenberg

Hope Wittenberg, MA
Director, Government Relations

This past session of Congress was frustrating. Seemingly no movement was made on spending levels for health programs, GME reform, and on broader national issues such as gun control or immigration reform. Brinksmanship over the national debt led to a 16-day government shutdown that cost the government money.

In the aftermath of the shutdown, however, key lawmakers sat down and worked out a budget.

This budget set the overall spending levels for the Fiscal Year 2014 (Oct 1, 2013–Sept 30, 2014) enabling the appropriations committees, which are in charge of discretionary spending, to move forward and craft a spending bill. When Congress returned in January from their winter recess, appropriators were hard at work on the Consolidated Appropriations Act of 2014, which culminated in some success for some of our key health programs.

Historically, both AHRQ and Title VII primary care programs have limited support in the House. Both programs have been zeroed out in the House version of the spending bill in recent years.

However, the spending bill kept them intact, with Title VII primary care support growing to $39.6 million (only a 1% increase). Unfortunately, the current amount of Title VII funding, while enough to fund continuing grants, isn’t large enough to allow for a competitive cycle again this year. AHRQ’s total spending, including trust fund transfers, grew to $471 million (9% increase). AHRQ’s increase was mainly due to expanded funding from the Patient-Centered Outcome Research Trust Fund as mandated in the Affordable Care Act.

With much effort on the part of the family of family medicine and a coalition of interested groups, late November brought about the introduction in the Senate of a bill, S. 1759, to reauthorize the Teaching Health Center program—one of our key programs that we are working hard to make sustainable. More effort and action is needed to gain momentum for a reauthorization to happen, given the cost and its origin in the Affordable Care Act. Its provenance makes it an anathema to most House Republicans as well as many Senate Republicans. Currently there are 10 bill cosponsors—all Democrats and one independent.

The post-shutdown timeframe also brought about advancement of interim, and hopefully final, solutions to the Sustainable Growth Rate (SGR) problems. A 3-month patch for SGR issues passed in December prevented the 20.1% cut in Medicare physician reimbursement that was due on January 1, 2014, and replaced it with a 0.5% increase until April 1, 2014. This so-called patch is a way to continue positive updates to physician reimbursement until a full repeal and replacement of SGR is put into place. Similar, but not identical, bills to repeal the problematic SGR passed both the Senate Finance Committee and the House Ways and Means committee in December. Leaders of both parties have expressed interest in achieving the repeal before the end of February.

What can we expect as we move forward in this session of Congress? Innovation or another session of stalemate? Will Congress be able to complete its work on SGR before Senator Baucus (D-MT) leaves to take on a new role as Ambassador to China? Easily foreseen is a short legislative year due to elections in November.

Less clear is how a new Finance Committee, with Senator Wyden (D-OR) at the helm, will operate. Will the committee address key programs such as Medicare graduate medical education—either for the purposes of deficit reduction, increasing resident slot positions, or reforming the program? If they move forward, will the House Ways and Means Committee move forward as well with similar changes?

Our list of key issues, including funding for Title VII primary care training, AHRQ funding, Teaching Health Center reauthorization, and our GME pilot reform bill all require action on the part of additional committees—Appropriations Committees in both houses and the Senate Help and House Energy and Commerce Committees.

How can we make progress? Collectively, we all need to overcome our cynicism and frustration and buckle down to the work of creating momentum behind our issues and concerns. The old truism—if you aren’t at the table, you are on the menu—applies here.

As I write this, it’s January, the traditional time for New Year’s resolutions. Mine is for the grace to cope with the weariness and disappointment of inertia, stalemate, and downright opposition and the courage to fight for what we believe is right for the nation.

I encourage all of you to make a similar resolution—fight for the changes you believe are important and encourage your local and national representatives to seek innovation instead of opposition.

For our members whose day-to-day lives aren’t geared toward federal advocacy, I’d offer the same recommendation many of you probably give your patients to encourage exercise. “Start small, but start. It takes a while to develop a habit.”

There are many small steps you can take to keep your resolution:

  • STFM has an online advocacy course that takes the mystery out of a congressional visit and contacting your legislators.
  • You can join the CAFM Advocacy Network to learn about our legislative issues and get tips on advocating.
  • Our annual legislative conference, the Family Medicine Congressional Conference, gives you the advocacy skills you need and an opportunity to try out those skills with your colleagues. This year’s conference is April 7-8 in Washington, DC. Early bird registration ends February 14.

Lastly, make the resolution to spur innovation in your representative. Nothing is more powerful than personal stories of real situations related by you. Your strength and importance to a legislator is your true-to-life stories of the impact of the current health system and health laws on your patients and students.

We can teach you how best to craft and communicate those stories. I’m happy to coach anyone who wants to become more active in advocacy. Contact me at

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