Research Rebate

CUMC stands up for the Affordable Care Act and research funding

by Virginia Ambeliotis

Six weeks into a presidency that has rejected the science behind climate change and announced plans to overhaul the current healthcare system, morale in the medical community might appear to be low.

At Columbia University Medical Center (CUMC), that assessment is largely sound. News of a potential repeal of the Affordable Care Act (ACA) has garnered pushback from the New York- Presbyterian Hospital and students, faculty and staff at CUMC, who have organized events to discuss the consequences that a repeal could have on themselves and their patients.

In an email sent out to colleagues in January, the deans of the four schools at CUMC stated “…as healthcare providers ourselves, we strongly believe that all U.S. residents should have access to high quality, affordable health care and be able to obtain health insurance that enables them to pay for it. The Affordable Care Act (ACA), while not without its problems, has been highly effective in moving the country in that direction. Any effort to repeal and replace the ACA should maintain or enhance health care coverage for all. We are prepared to work with any and all elected officials to ensure that any proposed plan achieves this goal. We are, however, opposed to any plan that does not.”

On March 8th, the Association of American Medical Colleges (AAMC), of which CUMC is a member, criticized the alternative bill the G.O.P. has drafted to replace the ACA, which received the approval of two House committees the following day. The open letter to Congress expressed concern that the proposed American Health Care Act “could lead to tremendous instability for those seeking afford- able coverage” and that the changes to Medicaid it calls for could “result in both the loss of coverage for current enrollees as well as cuts to a program that provides health care services for our most vulnerable populations, including children, the elderly and disabled.”

“I’m always nervous about what Washington is going to do,” Ross A. Frommer, Vice President for Government and Community Affairs and Associate Dean at CUMC. He describes the future of the ACA as “precarious” but emphasizes that CUMC is taking steps to prepare for whatever happens. “We’re certainly hanging on, paying close attention to it. [We’re] certainly working through the AAMC, our trade association, spending a lot of time on what effect [a repeal] could have on the medical centers, on the health-teaching hospitals, on our physicians, on our patients.”

I’m always nervous about what Washington is going to do,” Ross A. Frommer, Vice President for Government and Community Affairs and Associate Dean at CUMC. He describes the future of the ACA as “precarious” but emphasizes that CUMC is taking steps to prepare for whatever happens.

Despite the President’s known contempt for Obamacare and the House and Senate having Republican majorities, the future of the ACA and other policies that affect the biomedical research community remain unclear. The path ahead for CUMC faculty who do advocacy work, then, will center on the same objective it has prioritized for decades past: supporting and securing funding for research.

Before the passage of the ACA, lobbying efforts for the CUMC centered mostly on securing funding for agencies that conduct research but also pushing back on legislative efforts to curtail certain programs. “This goes way back a little bit, but certainly we were opposed to any restrictions on stem cell research,” Frommer says. “We’re very concerned about any restrictions that could come about on fetal tissue research. We want the opportunity for our scientists to do the best possible research they can, and any efforts which would put a crimp in that…we’d likely, can’t speak to every specific example, be very concerned about.”

For policy matters, Frommer’s team adopts a lobbying strategy “usually in the form of letters to members of Congress or the administration [that] we will sign ourselves, or co-sign with a large group.” When CUMC issues statements, they “tend to focus more on the research itself.”

Columbia, like other research universities, funds much of its work through governmental avenues. Support for some programs, like its research on spinal cords and stem cells, comes from New York state, but is “not on the same level in terms of dollar amount” as federally funded programs, Frommer explains.

A substantial source of federal funding for biomedical research at CUMC comes from the National Institutes of Health. Frommer characterizes the agency’s importance to research institutions as so great that CUMC’s advocacy work revolves around promoting the NIH’s interests, even though Columbia researchers only obtain grants from them after completing a “rigorous application process”. The agency distributes grants using a “merit-based and peer review” system where researchers, sometimes in conjunction with faculty from other universities, submit extensive applications for funding. Says Frommer, “[t]he payline, which is basically success rate, is very low, depending on who you talk to, anywhere from 10 to 20 percent success rate in terms of grant applications.

As lobbying for NIH funding is, for Frommer, “one of the most important if not the most important issue [he deals] with” in his job, he monitors activity in Washington closely to track proposed cuts to the agency’s budget, which has oscillated over the past few decades. During the five-year period from 1998 to 2003, NIH funding doubled from roughly $13 billion to $26 billion. In the 16 years that followed, “funding was essentially at” and “the buying power of the NIH actually fell”, most painfully during the budget sequester of 2013, forcing the agency to eliminate hundreds of research grants. The tables turned in December 2015, when Congress passed a budget for the 2016 financial year that would increase NIH funding by $2 billion, or six percent.

While the budget increase is not enough to bring agency funding back to the level it occupied before the recession, the NIH and their supporters celebrated the measure. Getting funding for research is a tricky endeavor, as advocates have to contend with politicians who promise leaner budgets but also more funding for schools and other infrastructure projects. In November 2016, the biomedical research community had its purpose validated again when Congress passed the the 21st Century Cures Act, which allocates funds supplemental to the NIH bud- get for cancer research, the BRAIN Initiative, precision medicine and other broad areas.

Whether similar developments will occur in the future remains to be seen, and Frommer says he doesn’t expect his office will shift focus from lobbying for the NIH any- time soon, explaining “[t] here is great bipartisan sup- port, bicameral support for the NIH…[b]ut obviously given the current budget and the current picture and the current stated plans of the administration, there is cause for concern, so we are monitoring it, we are talking to our delegation about it.”

Indeed, the presidential administration’s forthcoming fiscal year (FY) 2018 budget is expected to offset increases in spending on defense and national security by reducing funding for other federal programs; biomedical research seems a likely candidate for cuts.

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