POLICY BRIEFINGS


Republicans Unveil Budget Resolutions


Last week, Republican Budget Committee Chairmen released their budgetary proposals for fiscal year (FY) 2016. While both budgets propose to eliminate the deficit within 10 years without increasing taxes, there are notable differences between the two documents. House Budget Committee Chairman Tom Price’s (R-Ga.) plan, entitled “A Balanced Budget for a Stronger America,” would balance the federal budget in nine years through $5.5 trillion in spending reductions. The blueprint proposes to partially privatize Medicare through a premium support voucher system starting in 2024, similar to past proposals by Rep. Paul Ryan (R-Wis.). It would also convert Medicaid into a block grant program. In total, the Senate budget would cut $4.3 trillion in mandatory spending and $97 billion in discretionary programs over the next decade. The proposal would also convert the Medicaid program to one that is similar to CHIP and based largely on block grants to the states. The budget directs $430 billion in savings from Medicare to be found by individual committees. The resolution includes language that would repeal the 2.3 percent medical device tax enacted as a part of the Affordable Care Act (ACA), and as well as proposals to help keep rural hospitals open and help seniors receive care from pharmacists. Both the Senate Budget Committee and the House Budget Committee adopted their respective resolutions by party-line votes. Both budget proposals rely on the reconciliation process to repeal the ACA. Reconciliation allows committees to write bills which can pass the Senate with only 51 votes, instead of the 60 normally required to overcome a filibuster. The House budget would make it possible to use reconciliation to restructure the Medicare and Medicaid programs while also overhauling the tax code. 13 committees are charged with creating reconciliation bills by July 15. The Senate budget, however, contained very limited reconciliation instructions, allowing for two committees to draft legislation to repeal the ACA. The budget calls for the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee to each find at least $1 billion in deficit reduction savings from the health care law by July 31. Reconciliation could aid Republicans in creating a health care reform replacement plan should the Administration lose the King v. Burwell case. If the Supreme Court rules in the plaintiff’s favor, 7.5 million people in the health care exchange could lose $28 billion worth of subsidies. A Supreme Court decision is expected by the end of June. In order to successfully use reconciliation, Republicans in the House and Senate will need to agree upon a budget blueprint. The biggest challenge to a compromise budget will be agreeing on funding for the war spending account known as the overseas contingency operations (OCO) fund. The Senate will begin consideration of the fiscal 2016 budget resolution early this week, and voting on amendments could begin as early as Monday night. Both chambers are expected to hold floor votes on their budget resolutions by the end of the week. If both resolutions are passed, Senate Budget Committee Chairman Mike Enzi (R-Wyo.) has expressed hopes to reach a conference agreement by April 15.


Match Day 2015 Sees Increase in Medical Residency Spots


The National Resident Matching Program filled 30,212 positions this year, an increase of 541 spots over last year and an all-time high for the program. Sixty percent of the growth in first-year positions is attributable to primary care specialties. The number of registered applicants also rose this year to 41,224 applicants, up by 940 people. Stakeholders, however, continue to urge Congress to provide more federal funding for graduate medical education. The Association of American Medical Colleges (AAMC) noted that the increase in residency spots had not risen as fast as the number of medical school students. This year, of the 18,025 U.S. allopathic seniors who participated in the 2015 match, 93.9 percent were matched with first-year positions. The AAMC projects a shortage of up to 90,000 physicians in the U.S. by 2025.



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