Politics and the Future of Public Health Science and Biomedical … · 2017. 1. 10. · Politics...
Transcript of Politics and the Future of Public Health Science and Biomedical … · 2017. 1. 10. · Politics...
Politics and the Future of Public Health Science and Biomedical Research
Public Health Grand Rounds
University of Oklahoma
Tony Mazzaschi, ASPPH Senior Director for Policy and Research Mike Stephens, Cornerstone Government Affairs Senior Consultant
April 23, 2014
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ASPPH Policy and Advocacy Team
• Tony Mazzaschi Senior Director for Policy & Research
• Mike Zwolinski Policy & Legislative Analyst
Cornerstone has represented ASPPH interests on the Hill and Executive Branch since 2004
Cornerstone Government Affairs
Mark Mioduski Founding Partner
Amy Ford Souders Founding Partner
Erik Fatemi Vice President
Max Kanner Legislative Assistant
Mike Stephens Senior Consultant
ASPPH Legislative Committee Membership
Steve Wyatt, Chair (Kentucky) Mike Klag (Johns Hopkins)
Marjorie Aelion (UMass) Bill Mase (Cincinnati)
Rob Amler (NYMC) Bob Meenan (BU)
Paul Brandt-Rauf (UIC) Max Michael (UAB)
Jim Curran (Emory) Martin Philbert (Michigan)
Sue Curry (Iowa) Gary Raskob (Oklahoma)
John Finnegan (Minnesota) Laura Rudkin (UTMB)
Linda Fried (Columbia) Ed Trevathan (St. Louis)
Howie Frumkin (Washington) Phil Williams (UGA)
Lynn Goldman (GWU) Liana Winett (Oregon MPH)
Jody Heymann (UCLA)
*in thousands
NIH $864,351
CDC $213,639
HRSA $109,186
AHRQ $14,407
EPA $12,134
USAID $52,589
Department of Defense $19,387
Other Federal $147,099
Total $1,1432,792
Why Is Policy & Advocacy Important? Grants Account for a Very Large Portion of School & Program Operating Budgets
Preliminary 2013 School Data; Program Data Not Yet Available
Strategic Priorities, 2014-2015
• Provide timely strategic intelligence.
• Strengthen analytic case for Association policy positions.
• Manage relationships with federal agency partners.
• Advocate for schools and programs directly and through contract lobbyists.
Strategic Priorities, 2014-2015
• Manage relationships with public health advocacy partners.
• Protect and expand funding.
• Raise public awareness of schools and programs.
• Follow ACA implementation issues.
Strategic Priorities, 2014-2015
ASPPH Federal Funding Priorities, FY 2015
(Dollars in thousands, includes funding from Prevention and Public Health Fund)
FY 2012
Final
FY 2013
Final (Post Sequester)
FY 2014
Final
FY 2015
President’s Budget
FY 2015 ASPPH
Recommendations
HRSA Public Health Training Centers
25,000,000 (37)
4,029,000 (37)
9,864,000 (11)
13,064,000 (11)
$23,000,000 (increase number of PHTCs)
HRSA Public Health Traineeships
862,000 0 2,500,000 0 $5,000,000
(increase number and size of traineeships) CDC Prevention Research
Centers
27,869,000 (37)
23,424,000 (37)
25,000,000 (26)
25,000,000 (26)
$35,000,000 (increase number of PRCs)
CDC Centers for Public Health Preparedness
7,564,000 8,000,000 8,000,000 0 $8,000,000
(restore to FY 2014)
NIOSH Education and Research Centers
24,268,000 23,005,000 27,000,000 0 $27,000,000
(restore to FY 2014)
NIOSH Agricultural Forestry and Fishing Centers
25,681,000 24,365,000 24,000,000 0 $24,000,000
(restore to FY 2014)
NIH - Total 30,623,259,000 28,926,000,000 29,926,000,000 30,126,000,000 $32,000,000,000
(+ 6.9% over FY 2014)
(NIH Prevention Research Implementation)
- - - -
(Allocate $5 million within NIH total for implementation of new NIH Strategic Plan for
Prevention Research)
Tobacco-Free College Campus Initiative
Following the example of schools like Oklahoma, ASPPH has partnered with HHS to move our campuses to become tobacco-free.
You can watch the recorded webinar here.
The Political and Policy Environment
National Health Expenditures and the GDP 2012-2021 (dollars in billions)
$2,809 $2,915 $3,130 $3,308
$3,514 $3,723 $3,952
$4,207 $4,487
$4,781
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
17.9% 17.8% 18.2% 18.2% 18.3% 18.4% 18.6% 18.9% 19.2% 19.6%
SOURCE: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Projected; NHE Historical and projections, 1965-2021, file nhe65-21.zip).
NHE as a Share of GDP:
Source: Congressional Budget Office.
Analysis • The CBO’s latest projections claim that the net 2013-2023 cost of the ACA will amount to $1.2 trillion, $0.1 trillion below the $1.3
net ten-year cost projected in May 2013 • Experts continue to debate why the law is proving less expensive than projected; the ACA’s new regulations may decrease the cost of
healthcare, or the law may simply benefit from a secular trend towards lower premium growth
Projected Net Cost of the Affordable Care Act (Net of Offsetting Receipts, in Billions)
Projected Cost of the ACA Continues to Decline
Health Care Spending
The Federal Budget
Outlays – CBO (2/14)
Federal Deficit – CBO (2/14)
The Congressional Line-Up
113th Congress November 4 Election
SENATE • Democrats 53 20 • Republicans 45 13 • Independents 2
HOUSE • Democrats 199 199 • Republicans 233 233 • Vacant 3 3
Research Champions
Rep. Nita M. Lowey (D-NY)
Rep. Hal Rogers (R-KY)
Majority (R) (29) Minority (D) (22)
Harold Rogers, Ky. - Chairman Nita M. Lowey, N.Y. - Ranking Member Frank R. Wolf, Va. Marcy Kaptur, Ohio Jack Kingston, Ga. Peter J. Visclosky, Ind. Rodney Frelinghuysen, N.J. José E. Serrano, N.Y. Tom Latham, Iowa Rosa DeLauro, Conn. Robert B. Aderholt, Ala. James P. Moran, Va. Kay Granger, Texas Ed Pastor, Ariz. Mike Simpson, Idaho David E. Price, N.C. John Culberson, Texas Lucille Roybal-Allard, Calif. Ander Crenshaw, Fla. Sam Farr, Calif. John Carter, Texas Chaka Fattah, Pa. Ken Calvert, Calif. Sanford D. Bishop Jr., Ga. Tom Cole, Okla. Barbara Lee, Calif. Mario Diaz-Balart, Fla. Adam B. Schiff, Calif. Charlie Dent, Pa. Michael M. Honda, Calif. Tom Graves, Ga. Betty McCollum, Minn. Kevin Yoder, Kan. Tim Ryan, Ohio Steve Womack, Ark. Debbie Wasserman Schultz, Fla. Alan Nunnelee, Miss. Henry Cuellar, Texas Jeff Fortenberry, Neb. Chellie Pingree, Maine Tom Rooney, Fla. Mike Quigley, Ill. Chuck Fleischmann, Tenn. Bill Owens, N.Y.
Jaime Herrera Beutler, Wash. David Joyce, Ohio David Valadao, Calif. Andy Harris, Md. Mark Amodei, Nev. Martha Roby, Ala. Running for Other Office Chris Stewart, Utah Announced Retirement
House Committee on Appropriations
Rep. Henry Waxman (D-CA)
Rep. Fred Upton (R-MI)
Majority (R ) (30) Minority (D) (23) Rep Fred Upton (MI) Rep Henry Waxman (CA) Rep Joe Barton (TX) Rep John Dingell (MI) Rep Ed Whitfield (KY) Rep Frank Pallone (NJ) Rep John Shimkus (IL) Rep Bobby Rush (IL) Rep Joe Pitts (PA) Rep Anna Eshoo (CA) Rep Greg Walden (OR) Rep Eliot Engel (NY) Rep Lee Terry (NE) Rep Gene Green (TX) Rep Mike Rogers (MI) Rep Diana DeGette (CO) Rep Tim Murphy (PA) Rep Lois Capps (CA) Rep Michael Burgess (TX) Rep Mike Doyle (PA) Rep Marsha Blackburn (TN) Rep Jan Schakowsky (IL) Rep Steve Scalise (LA) Rep Jim Matheson (UT) Rep Bob Latta (OH) Rep G.K. Butterfield (NC) Rep Cathy McMorris Rodgers (WA) Rep John Barrow (GA) Rep Gregg Harper (MS) Rep Doris Matsui (CA) Rep Leonard Lance (NJ) Rep Donna Christensen (VI) Rep Bill Cassidy (LA) Rep Kathy Castor (FL) Rep Brett Guthrie (KY) Rep John Sarbanes (MD) Rep Pete Olson (TX) Rep Jerry McNerney (CA) Rep David McKinley (WV) Rep Bruce Braley (IA) Rep Cory Gardner (CO) Rep Peter Welch (VT) Rep Mike Pompeo (KS) Rep Ben Ray Luján (NM) Rep Adam Kinzinger (IL) Rep Paul Tonko (NY) Rep Morgan Griffith (VA) Rep Ralph Hall (TX) Rep Phil Gingrey (GA) Rep Gus Bilirakis (FL) Rep Bill Johnson (OH) Rep Billy Long (MO) Running for Other Office Rep Renee Ellmers (NC) Announced Retirement
House Committee on Energy & Commerce
Sen. Barbara Mikulski (D-MD)
Sen. Richard Shelby (R-AL)
Majority (D) (16) Minority (R) (14) Mikulski, Barbara A. (MD) , Chairman
Shelby, Richard C. (AL), Ranking Member
Leahy, Patrick J. (VT) Cochran, Thad (MS) Harkin, Tom (IA) McConnell, Mitch (KY) Murray, Patty (WA) Alexander, Lamar (TN) Feinstein, Dianne (CA) Collins, Susan M. (ME) Durbin, Richard J. (IL) Murkowski, Lisa (AK) Johnson, Tim (SD) Graham, Lindsey (SC) Landrieu, Mary L. (LA) Kirk, Mark (IL) Reed, Jack (RI) Coats, Daniel (IN) Pryor, Mark L. (AR) Blunt, Roy (MO) Tester, Jon (MT) Moran, Jerry (KS) Udall, Tom (NM) Hoeven, John (ND) Shaheen, Jeanne (NH) Johanns, Mike (NE) Merkley, Jeff (OR) Boozman, John (AR) Begich, Mark (AK) Coons, Christopher A. (DE) Announced Retirement
Senate Committee on Appropriations
Sen. Tom Harkin (D-IA)
Sen. Lamar Alexander (R-TN)
Majority (D) (12) Minority (R) (10) Harkin, Tom (IA), Chairman Alexander, Lamar (TN), Ranking Member
Mikulski, Barbara A. (MD) Enzi, Michael B. (WY)
Murray, Patty (WA) Burr, Richard (NC)
Sanders, Bernard (VT) Isakson, Johnny (GA)
Casey, Robert P. (PA) Paul, Rand (KY)
Hagan, Kay R. (NC) Hatch, Orrin G. (UT)
Franken, Al (MN) Roberts, Pat (KS)
Bennet, Michael F. (CO) Murkowski, Lisa (AK)
Whitehouse, Sheldon (RI) Kirk, Mark (IL)
Baldwin, Tammy (WI) Scott, Tim (SC)
Murphy, Christopher (CT)
Warren, Elizabeth (MA) Announced Retirement
Senate HELP Committee
Regular Order
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In Practice, Continuing Resolutions Now Common
Analysis •A continuing resolution (CR) is a stopgap measure that authorizes continued government funding for federal agencies or specific programs at, above, or below current funding levels when Congress and the president do not pass a regular appropriations bills before the fiscal year begins •CRs can be attractive vehicles for other substantive legislation because they are considered “must-pass” measures, but passing a CR in lieu of a budget resolution also produces budget uncertainty, making it difficult to act on other legislative priorities
Source: Kenneth Chamberlain, “Congress’ Use of Continuing Resolutions Is a Common Practice,” National Journal, Sept. 11, 2013; “Continuing Resolutions: CRs in a Nutshell,” Department of the Treasury, 2012.
Average number of CRs
per year: 4
Omnibus Budget Agreement
Federal Funds to Schools of Public Health: FY11, FY12, and FY13 (Dollars in millions)
798.3
276.9
124.2
13.4
20.1 82.3
15.4
101.2
855.2
271.6
119.2
16.2 14.6 93.1
9.3
142.2
864.3
213.6
109.2
14.4 12.1 52.6
6.1
175.1
NIH CDC HRSA AHRQ EPA USAID State OtherFederal
FY 11 FY 12 FY 13
Preliminary 2013 School Data
Only.
Program Data Not Yet
Available.
ASPPH Federal Funding Priorities, FY 2015
(Dollars in thousands, includes funding from Prevention and Public Health Fund)
FY 2012
Final
FY 2013
Final (Post Sequester)
FY 2014
Final
FY 2015
President’s Budget
FY 2015 ASPPH
Recommendations
HRSA Public Health Training Centers
25,000,000 (37)
4,029,000 (37)
9,864,000 (11)
13,064,000 (11)
$23,000,000 (increase number of PHTCs)
HRSA Public Health Traineeships
862,000 0 2,500,000 0 $5,000,000
(increase number and size of traineeships) CDC Prevention Research
Centers
27,869,000 (37)
23,424,000 (37)
25,000,000 (26)
25,000,000 (26)
$35,000,000 (increase number of PRCs)
CDC Centers for Public Health Preparedness
7,564,000 8,000,000 8,000,000 0 $8,000,000
(restore to FY 2014)
NIOSH Education and Research Centers
24,268,000 23,005,000 27,000,000 0 $27,000,000
(restore to FY 2014)
NIOSH Agricultural Forestry and Fishing Centers
25,681,000 24,365,000 24,000,000 0 $24,000,000
(restore to FY 2014)
NIH - Total 30,623,259,000 28,926,000,000 29,926,000,000 30,126,000,000 $32,000,000,000
(+ 6.9% over FY 2014)
(NIH Prevention Research Implementation)
- - - -
(Allocate $5 million within NIH total for implementation of new NIH Strategic Plan for
Prevention Research)
STRATEGIC PRIORITY I Systematically monitor NIH investments in prevention research and assess the progress and results of that research. STRATEGIC PRIORITY II Identify prevention research areas for investment or expanded effort by the NIH. STRATEGIC PRIORITY III Promote the use of the best available methods in prevention research and support the development of better methods. STRATEGIC PRIORITY IV Promote collaborative prevention research projects and facilitate coordination of such projects across the NIH and with other public and private entities. STRATEGIC PRIORITY V Identify and promote the use of evidence-based interventions and promote the conduct of implementation and dissemination research in prevention. STRATEGIC PRIORITY VI Increase the visibility of prevention research at the NIH and across the country.
NIH Strategic Plan for Prevention
NIH and Oklahoma
NIH and Oklahoma
$35,745 $36,438
$16,406
$30,362 $27,167
$30,861
$29,151
$30,165
$11,300
$21,080
$17,699
$16,405 $16,651
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Dol
lars
(Mill
ions
)
With SupplementalAppropriation (ARRA)Current $ (Millions)
President's Budget
Source: NIH Office of the Director, Office of Budget: http://officeofbudget.od.nih.gov/
NIH Appropriations in Current and Constant Dollars
Success Rates (Excluding ARRA)
Source: NIH Data Book http://report.nih.gov/nihdatabook/index.aspx and supplemental tables available in RePORT
26.8% 31.5%
29.9%
20.0%
17.6% 16.8%
25.9%
32.0%
30.2%
20.7%
18.3% 17.5%
0%
5%
10%
15%
20%
25%
30%
35%
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Succ
ess
Rat
e
Research Project Grants (RPG)
R01 Equivalent Awards
Summary of Trends in NIH Funding FY1995-FY2013
FY1995 FY2003 FY2013 % Change since 1995
% Change since 2003
NIH Budget (in millions) $11,300 $27,067 $29,151 158.0% 7.7%
NIH Budget (constant 1995 $ millions) $11,300 $21,003 $16,309 44.3% -22.4%
R01 Equivalent Funding ($ millions) $4,718 $10,102 $10,175 115.7% 0.7%
Total # R01 Equivalent Grants 21,680 29,626 25,069 15.6% -15.4%
R01 Equivalent Applications 22,542 24,634 28,044 24.4% 13.8%
# of R01 Equivalent Awards 5,849 7,430 4,902 -16.2% -34.0%
R01 Equivalent Success Rates 25.9% 30.2% 17.5% -32.4% -42.0%
Changes in the NIH Portfolio - NINDS
Affordable Care Act
Research that benefits persons in “real world settings.” Outcomes that matter to patients, populations, Congress. Faster dissemination of evidence to practice.
Designated appropriations: FY 2012 - FY2019 $150M annually
PCORI Trust FUND: Funding tied to health expenditures
PLUS: Contributions from Medicare Trust Funds, private health insurers and self-insured health plans:
• FY 2013 $1 per capita • FY 2014 $2 per capita • FY 2015 - FY 2019 Indexed by the % increase in the projected per capita
amount of National Health Expenditures • FY 2014 ~ $650 million/year
Challenges
Challenges
Challenges
Challenges
• Proposals for major system changes • Culture change to focus on quality rather than growth • Evaluation metrics that measure impacts and
outcomes that matter to the public • Fierce competition among advocates • Cost shifting efforts • Evidence to drive policy and advocacy
How You Can Help
Faculty, Staff and Students: Be Advocates
• Stay informed • Inform your friends and relatives about the role of federal
funding in your mission activities • Visit your representatives (and their staff) in Washington • Participate in candidate forums – ask questions about your
concerns • Hold the candidates accountable • Vote
Questions?