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Proposed GME Budget Cuts Questioned at House Hearing

WASHINGTON — Graduate medical education (GME) needs more funding from the Trump administration, a House member told Health and Human Services (HHS) Secretary Alex Azar Thursday.

“The Trump budget proposal cuts the GME program by $52 billion over the next 10 years,” Rep. Steven Horsford (D-Nev.) said to Azar, the lone witness at a House Ways & Means Committee hearing on the Trump administration’s proposed HHS budget for fiscal year 2021. “This does not work for my home state of Nevada; we need more doctors, not cuts to the very program that trains them. Nevada ranks 48th in the nation for primary care doctors — there are just 180 full-time doctors for every 100,000 residents, compared to 303 per 100,000 on average.”

In addition, “I literally have parts of my district in rural areas that don’t have ob/gyn services available, and there are only 259 ob/gyns in the entire state of Nevada,” said Horsford. “So how does the administration justify to Nevadans who desperately need to see a doctor the cuts to the GME program?”

Azar said he hoped Horsford would re-examine the budget proposal. “What we propose doing is taking Medicare, Medicaid, and children’s GME and putting it all in the general fund and creating a more flexible fund,” Azar said.

“Does that add money to the GME program?” Horsford asked.

“It would pull down overall but would allow re-focusing on primary care and rural” healthcare, Azar said. “Your state might actually benefit from those changes.”

Rep. Steven Horsford (D-Nev.) said cuts to graduate medical education funding would hurt his state. (Photo courtesy House Ways & Means Committee livestream)

“No, we won’t, because we need more resources and not less,” said Horsford. He also questioned the budget’s elimination of the Health Profession Opportunity Grants (HPOG) program, which provides education and training to Temporary Assistance for Needy Families recipients and other low-income individuals for healthcare occupations that pay well and are in high demand. “We have huge growth and demand for home health aides, medical insurance coders, and medical assistants … Do you believe that eliminating the HPOG training program will help the existing healthcare workforce shortage?” he asked.

“The health professions program funds institutions; we believe in the National Health Service Corps — which actually gets us healthcare providers going to rural underserved areas — which is a tuition reimbursement program,” Azar responded. As for HPOG, “we don’t believe it provides discernible results in terms of the shortages, unlike the National Health Service Corps, which we’re very committed to.”

The administration’s actions related to the Affordable Care Act (ACA) also came under criticism during the hearing, particularly a lawsuit filed by a group of Republican attorneys general and supported by the administration that would invalidate the law. In addition to getting rid of an ACA provision barring insurers from discriminating against people with preexisting conditions, “it would preclude people from being able to keep their kids on their plan, it would end healthcare for 20 million Americans, and it would affect how we deal with people with mental illness,” said Rep. Mike Thompson (D-Calif.). “To sue, to do away with this and, at the same time, propose a budget with $866 billion in cuts … I find it hard to believe it will do anything but worsen our healthcare problems.”

Thompson asked Azar whether there was any written plan in place to replace the ACA in case the lawsuit was successful; a federal district court ruled in favor of the plaintiffs but that decision is being appealed to the Supreme Court. “We put in the budget the $844 billion allowance to work with Congress in a flexible way,” said Azar. “We’re trying not to stake out a firm demand around the approach to replace the Affordable Care Act … But frankly right now it’s so far off [before] we’d see any Supreme Court decision and how it would rule — any notion like that would be so hypothetical and distant it would be meaningless.”

Health and Human Services Secretary Alex Azar expressed concern about infection control in rural hospitals which may not see some types of infections as often as other places. (Photo courtesy House Ways & Means livestream)
Health and Human Services Secretary Alex Azar expressed concern about infection control in rural hospitals which may not see some types of infections as often as other places. (Photo courtesy House Ways & Means livestream)

The ACA lawsuit also factored into Wednesday’s Energy & Commerce Health Subcommittee hearing on the proposed HHS budget. “I continue to be upset by the Trump administration’s decision to ask the court to strike down the ACA,” said Rep. Frank Pallone (D-N.J.), chairman of the full Energy & Commerce Committee. “If the district court’s ruling is upheld, the administration would be responsible for the largest coverage loss in U.S. history” as well as the adverse impacts to the Medicaid program. Pallone said he had sent HHS three letters over almost a 2-year period asking to see any contingency plans if the ruling is upheld, “and only last week I received a 1½-page response that answers none of my questions.”

Of course, the coronavirus outbreak — the focus of Wednesday night’s White House press conference — was, not surprisingly, a hot topic at both hearings. Rep. Ron Kind (D-Wis.) said he had held a telephone Town Hall Wednesday night, “and one out of every three calls into it was talking about the coronavirus. Certainly the concern, if not the fear, is starting to permeate throughout our communities,” especially in rural areas, he said. He asked Azar how confident he was that rural providers were up to the task, adding, “It’s coming, and I’m concerned whether we’re ready for that.”

“One of the bedrocks of our system is our great hospitals, our great public health infrastructure, and our providers,” Azar said. However, he added, “I worry about infection control protocols in rural facilities, just because they don’t see it as much … I think we have to up the game nationwide around immediate infection control on suspect cases so we don’t get nosocomial infections.”

Committee members also praised Azar for his work in certain areas. Rep. Jason Smith (R-Mo.) thanked Azar for HHS’s work to improve care for kidney disease patients. “Your department’s work to ensure that fewer patients develop kidney failure, to increase the rates of home dialysis, and to increase the number of kidneys available for transplant have not gone unnoticed.”