1. Legislative Update Michael J. Dyer, JD Vice President for Government Relations, AACOM OME Conference January 13, 2007

2. Current Environment Themes Control Shift

3. Recurring Themes Cost Accountability Transparency

4. Baseline Deficit Projections [in billions of dollars] Source: OMB, 02/06; House Budget Democratic Staff, 02/06

5. Accountability Benefits to the Public Biggest Bang for Fewest Bucks

6. Transparency Lobby Reform Ethics Reform Earmark Reform

7. Whos In Charge?

8. Meet the New Chairman House Appropriations Committee David Obey (D-Wis.)

9. Meet the New Chairman Senate Appropriations Committee Robert C. Byrd (D-W.Va.)

10. Meet the New Chairman House Energy and Commerce Committee John Dingell (D-Mich.)

11. Whats Up, Doc! and What it Means to OME

12. Labor-HHS-Education Subcommittee Allocation FY 2004 $139.2 billion (+5.2%) FY 2005 $142.7 billion (+2.4%) FY 2006 $141.1 billion (-1.1%) FY 2007 (President) $137.8 billion (-2.3%) FY 2007 (House) $141.9 billion (+0.6%) FY 2007 (Senate) $142.8 billion (+1.1%) Source: House and Senate Appropriations Committees and OMB

13. Title VII Health Professions Diversity Programs (in millions) FY 2005 Final FY 2006 Final Percent Change FY 2007 House Percent Change FY 2007 Senate Percent Change Centers of Excellence $33.6$11.9-64.7%$11.90%$11.90% Health Careers Opportunity Program $35.7$4.0-88.9%$0-100%$4.00% Faculty Loan Repayment $1.3$1.29-1%$0-100%$1.290% Scholarships for Disadvantaged Students $47.1$46.7-1%$46.70%$46.70%

14. Title VII Health Professions Title VII Health Professions (in millions) FY 2005 Final FY 2006 Final Percent Change FY 2007 House Percent Change FY 2007 Senate Percent Change Primary care medicine & dentistry $88.8$40.9- 54%$40.90%$5022.4% AHECs$29.0$28.7- 1%$28.70%$28.70% HETCs$3.8$0- 100%$00%$00% Allied health$11.8$4- 66.3%$40%$40% Geriatric training$31.6$0- 100%$31.5--$00% Rural training$6.1$0- 100%$00%$00% Public health, preventive medicine $9.1$7.9- 12.9%$0-100%$80% Health administration $1.1$0-100%$00%$00% Workforce analysis $0.7$0-100%$00%$00%

15. FY 2007 Appropriations 109 th Congress failed to pass a Departments of Labor, Health and Human Services, and Education Appropriations bill for fiscal year (FY) 2007 Current continuing resolution (CR) continues funding at FY 2006 levels FY 2006 level for Title VII programs – 51.5% cut from FY 2005 level $ eliminated for Geriatrics Training, Health Education and Training Centers and Burdick Rural Training Significant cuts in $ for primary care training Near total elimination for HCOP and COE

16. FY 2007 Appropriations (continued) Current CR expires on February 15 th Seek restoration of some funding for the long-term CR Specter/Harkin Amendment Veterans health care will be a priority

17. FY 2008 Appropriations Presidents Budget - first week of February Proposal likely to include huge Title VII cuts Depending on a Budget Resolution, Title VII may have a better shot

18. Reauthorizations Student Assistance Title VII

19. What About GME?

20. IME Adjustment On Oct. 1, 2007 and beyond: 5.5% Resident Limits

21. Advisory Commissions and Councils Medicare Payment Advisory Commission (MedPAC) IME Recommendation Reduce the IME Adjustment by 1% from 5.5% to 4.5%. The 1% differential should be used to fund implementation of the severity adjustment.

22. MedPAC (continued) 2.7% Empirical Adjustment IME in Appropriations ? Interest in workforce

23. Council on Graduate Medical Education (COGME) Ongoing interest in workforce Flexibility in GME funding New paradigm for physician service in improving access to healthcare

24. Childrens Hospital GME Has been reauthorized (P.L. 109-307) Increasing funding support Possible model ?

25. Other Major GME Issues for the 110 th Congress Caps Non-hospital training

26. Democracy is the theory that the common people know what they want and deserve to get it good and hard. - H.L. Mencken

27. To download this presentation: www.aacom.org On the Government Relations page