A $1.5 Billion Federal Training Program
Today the House will vote on S. 1557, which would reauthorize the Children’s Hospital Graduate Medical Education (CHGME) program for five years. The bill passed the Senate under unanimous consent on November 12th, and it is coming to the House floor under suspension of the rules – an expedited process generally reserved for noncontroversial measures.
But should reauthorizing this program be considered noncontroversial?
The program is intended to help support children’s hospitals that train pediatricians. It provides these hospitals with assistance for both the direct costs (such as resident stipends and supervisory physician salaries) and indirect costs (such as reduced productivity of hospital staff) of these training programs. Taxpayer support for indirect costs (also known as “indirect medical education,” or “IME” expenses) is nearly double that of the support for direct costs.
S. 1557 would authorize $300 million a year for the CHGME program for each of the next 5 years, totaling $1.5 billion of taxpayer money. While the goal of the program is laudable, there are, at the very least, considerable questions about whether or not taxpayer dollars are being used effectively and efficiently on this program.
In fact, in his Fiscal Year 2014 budget, President Obama recommended slashing the Children’s Hospital GME program by 67%. The President’s budget cited a report by outside Medicare experts at the Medicare Payment Advisory Commission (MedPAC), which stated the formula for calculating indirect medical education (IME) costs “is set at more than twice what can be empirically justified.” As the President’s budget puts it, somewhat more guardedly, “IME costs are not well-documented and studies indicate that they may be overstated”.
So despite calls from a big-spending President to cut the program, and despite warnings from outside experts (experts that Congress itself commissioned for advice on health care spending), the program appears on track for reauthorization. What has Congress done to reevaluate this program since its last reauthorization to ensure that taxpayer dollars are being well-spent? The answer appears to be “little-to-nothing.”
There have been no hearings on this legislation or the program itself in the 113th Congress. The Committee markups for the legislation reauthorizing the program could best be described as pro forma rubber stampings of current policy. And, as stated earlier, the bills have been considered in front of the full House and Senate chambers with little debate and under expedited procedures that have allowed no room for amendments.
Despite the little attention given to this program, 50 Members voted against similar legislation when it came before the House last year. That alone should have led to a more robust vetting process before Congress decided to have another go at it. But it has not, and that is a shame for taxpayers and good governance. Congress needs to be less concerned about simply “getting things done” and should instead work harder at making sure they’re getting things done right.