1. Learn Serve Lead 2014 AAMC Annual Meeting Atul Grover, M.D., Ph.D. Chief Advocacy and Public Policy Officer Agrover@aamc.org @AtulGroverMD Federal LegislativeUpdate: Good News, Bad News, 2015 Forecast

2. 3 © 2014 AAMC. May not be reproduced without permission. 1.Sustain funding for NIH research and GME 2.Minimize “sequestration” cuts 3.Fix the “SGR” – Physician pay cuts 4.Preserve ability to provide high-quality care to all populations 5.Implement the ACA AAMC Advocacy Priorities 2014

3. The Context:Deficit politics still reign supreme; All of our “asks” have big price tags CBO adds $1 trillion to deficit forecast for next decade  Although deficit is declining, debt is still historically high  CBO projects deficit to rise from FY 2015 – 2023 Sequester, caps on spending still in effect  Reduce total federal spending over 8 years by $1.1 trillion  Medicare cut 2% annually Appropriation process trapped in CR politics  Adjusted for inflation, NIH spending power is less than FY2001 Our “asks” are critical but big:  $ billions more for NIH, GME, VA, Ebola….when there’s no room in the federal budget for more spending © 2014 AAMC. May not be reproduced without permission.

4. The Big Priorities of 2014: NIH – A glimmer of hope or a mass food fight? The Good News:NIH continues to earn strong support  Strong bipartisan support in Congress – e.g., Rep. DeLauro (D-CT) and Sen. Moran (R-KS)  Strong public support – research, business community, patients  Strong prospects of breakthrough research – Ebola treatments, vaccines  Strong NIH leadership – Director Frances Collins The Bad News:Persistent budget pressures  FY 2014 CR = level funding again, at best  Questions about NIH priority-setting: e.g., Coburn’s “Waste Book”  Issues involving duplication vs. reproducibility affect NIH credibility 2015:The year of “Cures Initiative” legislation?  Or NIH vs. AHRQ vs PCORI…food fight? © 2014 AAMC. May not be reproduced without permission.

5. The Big Priorities of 2014: GME – The fight of our lives! © 2014 AAMC. May not be reproduced without permission. The Good News:Rays of hope in 2014  GME spared by 2014 SGR package  Bipartisan support for bills to lift GME cap, define GME accountability continues after election The Bad News:Threats to GME = mounting  IOM committee calls for 34% average cut in GME per hospital  Family physicians recommend end to GME $ for specialists  Osteopathic physicians support Murray bill to give 2% of IME to THCs  In 2015, budget fights could make IME everyone’s favorite offset 2015:We need to make our whole message heard - loudly  We’re for both: more physicians and more reform  New advocacy strategies and new analysis  New politics:Budget reconciliation?

6. The Big Surprises of 2014: VA Physician Shortage – Chance to tell our story? © 2014 AAMC. May not be reproduced without permission. The Bad News:Vets’ lives at risk  Out of the blue?  VA bureaucracy continues to be slow, AAMC continues to pursue  VA continues to be under attack on Hill The Good News:VA has new resources - $17 B, new leaders  AAMC team has built bridges to VA, new secretary  AMCs ready to help – key to any effective, long term strategy  Issue makes case for physician shortage, AMC standby capacity, and need for research 2015:Year of breakthrough or year of inertia?  Can AMCs partner with VA nationally as well as locally?  Can VA get ahead of its problem – at home, in Congress?

7. The Big Surprises of 2014: Ebola – Again, opportunity to tell our story? © 2014 AAMC. May not be reproduced without permission. The Bad News:Inter’l. crisis shows holes in US infrastructure  Both the world and U.S. appear unprepared, playing catch-up  Public fear drives U.S. debate – fear ahead of policy?  Again, AMCs at center, but more resources needed The Good News:AMCs are central to U.S. response  Nebraska, Emory = case studies in AMC standby capacity  Issue makes the case for AMC standby capacity, research  AAMC team working directly with top federal officials 2015:Balancing act  Quantify AMCs’ need for federal support; budget politics tough  Juggle AAMC asks for long-term readiness, VA, GME, NIH, more  We risk being poster child for the hand held out

8. The Big Surprises in 2015: Who knows? – “We don’t know what we don’t know” © 2014 AAMC. May not be reproduced without permission. The only guarantees:  We will be surprised  We won’t know it until we see it  It will come when it’s least opportune We have to have “advocacy” standby capacity, not just medical standby capacity  Our GR and advocacy teams need to be stronger than ever  Our capacity for grassroots, grasstops, and direct advocacy as well as media advocacy needs to be stronger than ever

9. © 2014 AAMC. May not be reproduced without permission. Elections 2016: What’s the Overall Impact? Republicans again take time to repeal ACA  White House will veto. Congress can’t override. Next, Republicans try bipartisan amendments to ACA  Eliminate individual or employer mandates?  Remove medical device tax? White House still vetoes  Congress still lacks override votes. More attempts to repeal or amend ACA

10. © 2014 AAMC. May not be reproduced without permission. Elections 2016: What’s the Impact on US? Return to budget politics due to Republican majority, need for budget res., debt ceiling New pressure on NIH supporters  Tough to get increase in this budget environment  Risk of pitting NIH vs. AHRQ vs. PCORI, etc. New pressure on Medicare IME  $6 billion pot of untapped funds  A big target for off-sets for other initiatives Strong, strategic advocacy needed more than ever  Direct, grassroots, grass tops, media advocacy Renewed budget politics affect NIH, GME