Institute of Medicine Changes Name, Releases Report on Core Health Measures

The membership of the National Academy of Sciences has voted to change the name of the Institute of Medicine (IOM) to the National Academy of Medicine. The change is effective July 1, 2015, and is part of an effort to integrate the work of the National Academies of Sciences, Engineering, and Medicine. IOM activities will continue uninterrupted. The IOM released a new report last week titled Vital Signs: Core Metrics for Health and Health Care Progress. The report proposes a streamlined set of 15 standardized measures aimed at improving outcomes and providing consistent benchmarks for health progress across the country. The 15 measures are life expectancy, well-being, overweight and obesity, addictive behavior, unintended pregnancy, healthy communities, preventive services, care access, patient safety, evidence-based care, care match with patient goals, personal spending burden, population spending burden, individual engagement, and community engagement. The report also includes priority areas related to each measure and recommendations for measure application across the health care system.

House Passes Joint Budget Conference Agreement

Following release of the budget conference committee report, the House passed the Republican fiscal year 2016 conference budget resolution, S. Con. Res. 11, by a vote of 226-197. Fourteen Republicans joined every Democrat in opposition to the bill. Dissenting Republicans included Reps. Justin Amach (Mich.), Rick Crawford (Ark.), John Duncan (Tenn.), Chris Gibson (N.Y.), David Jolly (Fla.), Walter Jones (N.C.), John Katko (N.Y.), Raul Labrador (Idaho), Frank LoBiondo (N.J.), Thomas Massie (Ky.), Martha McSally (Ariz.), Mick Mulvaney (S.C.), David Schweikert (Ariz.), and Ryan Zinke (Mont.). The deal reconciles the separate budget blueprints passed by the House and Senate earlier this year, and is the result of negotiations between Budget Committee chairmen Rep. Tom Price (R-Ga.) and Sen. Mike Enzi (R-Wyo.). The plan cuts more than $5 trillion in spending and balances the budget within the decade without raising taxes. It retains the $1.017 trillion budget ceiling for fiscal year 2016 that was created by the 2011 deal to raise the debt ceiling. Eighty percent of the spending cuts included in the budget come from mandatory spending programs. The budget includes cuts to Medicaid as well as $430 billion in cuts to the Medicare program. The joint resolution, however, removes a provision from House Ways and Means Committee Chairman Paul Ryan (R-Wis.) to transition the Medicare program to a premium support model by 2024. There was much debate in the conference committee regarding the use of reconciliation to repeal the Affordable Care Act (ACA). Reconciliation is a budgetary process requiring only 51 votes in the Senate for passage, in contrast to the usual 60 votes required to overcome a filibuster. The conference agreement retained the Senate’s proposal for narrow use of budget reconciliation solely for the purpose of making revisions to or repealing the ACA. The House’s budget would have given reconciliation instructions to 13 different authorizing committees, allowing reconciliation to be used to make a wider range of changes, such as an overhaul of the tax code. Committees with jurisdiction over health care – House Energy and Commerce, Ways and Means, and Education and the Workforce, and Senate Finance and Health, Education, Labor and Pensions (HELP) – have until July 24 to draft legislation to repeal the law. The President has already promised to veto any attempts to scale back the ACA. The budget resolution also includes language in preparation for the King v. Burwell ruling. If the Supreme Court should rule against the administration and the federal government’s authority to provide subsidies to people who purchase insurance in a federally facilitated exchange, the Congressional Budget Office (CBO) would update its spending estimates to align with the financial implications resulting from the ruling. However, the conference budget agreement contains a special procedure that would allow the House Budget Committee to utilize pre-King v. Burwell spending and tax baselines in subsequent reconciliation legislation. This means that any legislation in response to the Supreme Court ruling – such as a temporary transition program for subsidy recipients or a temporary extension of subsidies – would not be scored as a spending increase adding to the deficit. The Senate is expected to pass the budget this week. If adopted, it will be the first Republican budget agreement in a decade. The joint budget resolution guides appropriators with limits on taxes and spending as they continue work on individual spending bills. The House passed the first of its 12 annual appropriations measures, the Veterans’ Affairs and military construction spending bill, last week. The vote fell largely along party lines. The bill adheres to the statutory sequester level spending caps, allocating $48.6 billion for the Veterans Health Administration (VHA) medical services and including an amendment to help bring attention to the health care needs of female veterans. In an effort to spur negotiations for a bipartisan budget deal, Democratic leaders are saying that their party will not vote for appropriations bills that preserve sequestration spending levels. The White House has also threatened to veto appropriations measures that keep the spending caps in place. Additionally, Director of the Office of Management and Budget (OMB) Shaun Donovan sent a letter to House Appropriations Chairman Harold Rogers (R-Ky.) urging Congress to replace the sequester. The Senate Appropriations Committee is expected to begin marking up their spending bills in the near future.

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