AADR’s 2017 Advocacy Year in Review: Where We’ve Been and Where We Go from Here

In 2017, the American Association for Dental Research (AADR) was presented with myriad opportunities to weigh in on issues with the potential to affect dental, oral and craniofacial research. In each instance – whether a partner coalition’s sign-on letter opportunity, a federal agency’s Request for Information or a federal policy or trend –AADR considered how its members, patients and public health could be affected and sought to provide comments reflective of our field’s values.

Over the year, some of our work mirrored advocacy efforts of years past (e.g., championing the highest possible funding for the National Institute of Dental and Craniofacial Research), but our efforts also expanded into newer territory (e.g., tax reform and the executive order suspending entry of certain foreign nationals into the United States).

Highlights of AADR’s advocacy in 2017 included:

 
 
 
 
For more information about each of these activities, view our one pager.

As we shift our focus to 2018, we don’t want to miss the opportunity to thank our AADR members and community for their partnership in advocacy in 2017. Advocacy makes a difference, and looking ahead, as we advocate for funding for NIH and NIDCR in an environment already wrought with fiscal austerity, we need your voice now more than ever!

In the coming weeks, Congress will work to tackle its already packed legislative agenda, which includes a deal to raise the spending caps, the January 19 deadline to fund the government and the need to find a long-term solution for the Children’s Health Insurance Program.The deadline for the release president’s fiscal year 2019 budget, which signals the administration’s priorities, is also on the horizon.

As in 2017, AADR remains committed to our government affairs and advocacy portfolio, and we will continue to carry the torch for this work and dental, oral and craniofacial research in 2018.

 

In Lead-Up to Holidays, Congress Pushes Tax Reform and a New CR

With one day remaining before the current continuing resolution (CR) – the stopgap spending measure that keeps the government funded in the absence of regular appropriations – expires, Congress has been knee-deep in tax reform, health program funding and fiscal year 2018 spending discussions. Congress has now moved tax reform forward, but other issues still loom large.

Congress on Wednesday passed the sweeping Tax Cuts and Jobs Act to overhaul the U.S. tax code. The $1.5 trillion bill narrowly passed the Senate in a 51-48 vote and passed the House (for the second time to fix technical problems with the legislation) in a 224-201 vote. The bill is now with the president, who may sign the bill into law as early as today but will likely push enacting the bill until early January to postpone the automatic cuts it would trigger. (Read more on the statutory Pay-As-You-Go rule from Politico here.)

AADR remains concerned about how the net $1.5 trillion this bill is expected to add to the federal deficit over 10 years could undermine – and even jeopardize – non-defense discretionary programs, which encompass virtually everything outside of national defense and entitlement programs (education, scientific research, public health programs, infrastructure, etc.). Yet, in a positive move for the research community, the House and Senate during conference committee removed the House bill’s initial provision to treat as taxable income the tuition waivers provided to graduate students by universities in exchange for their teaching courses or conducting research while seeking graduate degrees. In the new bill tuition waivers, which benefit graduate students but are never received by the student as income, will not to be taxed and treated as income – as is current practice.

AADR was troubled about how that provision, among others, could impact higher education and our nation’s scientific advancement by burdening students pursuing or wishing to one day pursue advanced degrees. AADR spoke out against the bill’s potential implications for research, and so did our members. We would like to thank those of you who responded to our call to action and reached out to your elected officials, whether through our action alert or other mechanisms. Through AADR’s action alert portal alone, roughly 80 messages were sent to members of Congress. Your voice matters; the public outcry resulting in the removal of the graduate waiver tax provision in the final bill proves that.

With the tax bill now more or less off its agenda, Congress shifts its attention to reaching an agreement that will keep the government funded beyond tomorrow’s deadline.

Last night House Republicans released the text of a new CR, H.R. 1370, to keep the government funded through January 19, 2018. The bill, which replaces the previously proposed H.J. Res 124, would also extend funding for the Children’s Health Insurance Program (CHIP), the National Health Service Corps and Community Health Centers, and it would waive statutory PAYGO requirements to prevent the automatic spending cuts triggered by the tax legislation’s enactment. However, as a way to pay for the public health program extensions, the CR also contains a provision to cut $750 million from the Prevention and Public Health Fund through fiscal year 2022. As a reminder, the Prevention Fund, which is regularly targeted in spending negotiations, accounts for roughly 12 percent of the Centers for Disease Control and Prevention budget.

At this point, House Democrats say they will vote against the CR unless they get assurances that a final spending bill for fiscal year 2018 will provide parity between defense and non-defense spending and include a solution for Dreamers. Senate Democrats’ standing is unclear.

In sum, there is still much to negotiate in advance of tomorrow’s CR deadline. Continue to check AADR’s blog for updates.

UPDATE: On January 18, Congress voted to approve a CR to fund government operations through January 19 and includes a waiver of the PAYGO spending cuts. The bill provides temporary funding for CHIP and $550 million for community health centers that will is intended to last through March 31. The extension was partly paid for by the previously mentioned $750 million cut to the Prevention Fund, which will begin with a $100 million cut in FY 2019. 

Continuing Resolutions Will Likely Take Spending Talks into 2018

Last week, Congress approved and the president signed H.J. Res 123, a continuing resolution (CR) to fund the government through December 22. The CR, which avoids a shutdown and keeps federal programs operating at current levels, modified the expiration date of the previous CR set to expire on December 8. All of the previous CR provisions carry forward through December 22. After this date, another funding measure – either another CR or a spending bill funding the government for the remainder of fiscal year 2018 – will be needed. Despite the two-week buffer, there is already an expectation that a second CR into January will need to be passed to give lawmakers more time to complete their work.

These funding measures have implications for research and come into play as Republicans and Democrats negotiate longer-term deals over government funding, which include raising the defense and non-defense budget caps and passing an omnibus spending package for fiscal year 2018 appropriations.

By way of background, at the beginning of the fiscal year, October 1, 2017, spending limits on military and domestic programs came into effect as a result of 2011’s Budget Control Act. Consequently, if Congress wants to increase funding for defense and non-defense programs, lawmakers first need to pass a budget deal to lift the caps and then pass a spending bill containing the actual appropriations for fiscal year 2018 (e.g., funding for the Department of Health and Human Services, Education and Related Agencies). Importantly for the dental, oral and craniofacial research community, it is important to note that for the Senate’s proposed increases for the National Institutes of Health (NIH) and the National Institute of Dental and Craniofacial Research (NIDCR) to be realized, Congress will need to make a deal to raise the caps.

Congressional negotiators are currently considering a two-year budget deal to do just that – potentially raising the caps by more than $200 billion. However, Republicans and Democrats are working under different priorities. Republicans are looking to increase the defense budget – initially seeking a deal that would raise defense by $54 billion and non-defense by $37 billion in both fiscal 2018 and 2019 – and Democrats are seeking parity, proposing increasing defense and non-defense equally by $54 billion, a move that would raise the two-year cost above $200 billion.

In addition reaching consensus on top-line numbers and finding a solution for Democrats’ demand for parity, a number of challenges remain for the budget deal as negotiators look to it as a vehicle to pass other legislation, such as the reauthorization of the Children’s Health Insurance Program and a third emergency supplemental for communities affected by this year’s natural disasters.

According to CQ Roll Call, a GOP aide speculates that a budget agreement will be announced December 18, just a few days before the December 22 deadline to pass another funding measure.

AADR will be closely monitoring these developments over the coming weeks given their implications for research funding. Under a CR, NIH will be paying out grants at a lower rate than they would under regular appropriations (see a previous NIH CR notice here). Therefore, it is critical that Congress pass regular appropriations through the end of the year to provide stability for medical research.

If you have questions, please contact AADR’s Assistant Director of Government Affairs Lindsey Horan or continue to check the AADR Government Affairs and Science Policy Blog for updates.

What the Tax Reform Legislation Means for Research

The GOP’s move to overhaul the tax system is moving quickly, with the House and Senate working in parallel on tax reform legislation. Before diving into the respective bills’ potential implications for scientific research, let’s first look at where we stand in the legislative process.

On Thursday, November 16, House Republicans passed their tax bill (H.R. 1) along party lines, 227-205, completing the first step in the budget reconciliation process. The bill, which passed with no Democratic support and 13 Republicans in opposition, will now go to the Senate for its consideration. The budget reconciliation instructions are significant because they will allow the Senate to pass the bill without Democratic support, if needed. (If you want to dive deeper, see this article from The New York Times.)

In the other chamber, the Senate is concurrently working on its own bill, one that greatly differs from that of the House. The Senate’s bill, after four days in markup, passed the Senate Finance Committee on Thursday via a party-line vote of 14-12. The full Senate is expected to take up the bill after Thanksgiving. (Read more from POLITICO.)

While the bills vary in terms of their provisions, which will need to be resolved during conference, both have consequences for research:

At the highest level, the first thing to note about both the House and Senate bills is that they are each expected to add roughly $1.5 trillion to the federal debt over the next 10 years. While the provisions within the bills are likely to shift as negotiations continue among and between the two chambers, this figure is unlikely to change. So, what does this have to do with research specifically? Recent history has shown that when there is an increase in the deficit, the subsequent move from Congress is to take steps to cut discretionary spending. Non-defense discretionary spending, which includes health care and health research, would likely take the bulk of that cut.  Continue reading

AADR Provides Input on Trans-NIH Strategic Plan for Women’s Health Research

In September, the Office of Research on Women’s Health (ORWH) at the National Institutes of Health (NIH) released a Request for Information to solicit input from scientists and advocacy and patient communities on the trans-NIH Strategic Plan for Women’s Health Research. Specifically, ORWH was seeking feedback on three proposed cross-cutting themes and goals under consideration for the next iteration of the plan that is intended to promote allocation of NIH resources for conducting and support women’s health research across NIH Institutes and Centers.

For this reason, AADR wanted to stress to the ORWH that the cross-cutting themes and goals can and should be readily applied to oral and craniofacial health and disease research supported by NIH, and specifically by the National Institute of Dental and Craniofacial Research and submitted a set of comments to this effect:

The American Association for Dental Research (AADR) appreciates the opportunity to provide input on the trans-NIH Strategic Plan for Women’s Health Research. We commend the Office of Research on Women’s Health (ORWH) for putting forth the important cross-cutting themes in the Request for Information and believe they are an imperative step in ensuring that women’s health research is conducted and supported across NIH Institutes and Centers.

As such, we would note that the proposed themes and goals can and should be readily applied to oral and craniofacial health and disease research supported by NIH and specifically, the National Institute of Dental and Craniofacial Research. In addition to the manifestations of sex-based differences in dental, oral and craniofacial diseases and conditions, which may be affected by hormonal changes, genetic variations and more, contextual factors and life experiences also play an important role in oral health – an integral component of overall health.

Additionally, as ORWH deliberates its approach to the science of women’s health, we would encourage ORWH to consider that, while the biologic implications of sex are both justified and important in basic or translational disease models, there is also opportunity for clinical investigators – particularly in the multi-dimensional approach to the science of women’s health – to highlight the socioeconomic and behavioral aspects of gender as well as biological sex. As noted by Ioannidou(1), “economic inequality and hardship for women have resulted in limited access to oral care. As a result, gender emerged as a complex socioeconomic and behavioral factor in influencing oral health and outcomes.” Expanding the strategic plan to encompass gender may lead to a greater understanding of the life-course and psychosocial dimensions sought after by ORWH as well as equip our system for better care by considering health disparities, gender bias and therapeutic interventions.

 

(1) Ioannidou, E.: The sex and gender intersection in chronic periodontitis. Frontiers in Public Health 2017 Aug 4;5:189.

AADR Showcases NIDCR-Funded Research at Second Annual Public Health Fair

For the second year, the American Association for Dental Research (AADR) was a proud co-sponsor and exhibitor at the Coalition for Health Funding’s (CHF) Public Health Fair, an event aimed at educating members of Congress and their staff about the value and importance of public health, including federally-funded public health research and programs. Representative Rob Wittman (R-VA) kicked off the event, stressing the importance of public health research in our society and sharing his belief that prevention efforts are the wisest way to use public health dollars.

  

During this event, held in the Rayburn House Office Building Foyer on November 8, organizations – ranging from professional associations to federal agencies – convened on Capitol Hill to demonstrate how they are collectively working to improve the health and well-being of the American people. Whether through promoting preventive care and community health initiatives, conducting surveillance to prevent and respond to disease, or collaborating with researchers to determine how to make health care safer and more effective for all, each of these groups has a role to play in our nation’s health.

This year, AADR and the Friends of National Institute of Dental and Craniofacial

The finished product of the 3-D printing technology displayed at the Public Health Fair.

Research (FNIDCR) were joined at our booth by Mr. Walter Zimbeck and Mr. Mark Kauf, two researchers from Technology Assessment & Transfer, Inc., a Maryland-based research and development company, who received an NIDCR grant to develop 3-D printing technology for the production of high performance ceramic dental crowns, which has the potential to lower material and processing costs as well as improve restoration aesthetics and performance.

In addition to a display of some ceramic dental crowns they had produced, Mr. Zimbeck and Kauf set up a 3-D printer at the AADR booth so attendees could see the printing technology in action. To learn how the technology works, check out CHF’s Facebook live video.

AADR was proud to be a part of this event and enjoyed learning about other organizations’ public health initiatives. For more insight into the Public Health Fair, view the Facebook live recaps here, and scroll through the day’s Twitter stream by searching the hashtag #PublicHealthFair.

To learn more about the Coalition for Health Funding, visit the CHF website. For more information about AADR’s advocacy and government affairs work, visit our website or contact Lindsey Horan at lhoran@aadr.org.

 

 

 

 

Prevention Fund Remains a Target in Revised CHAMPION Act

Earlier this month, Rep. Walden introduced H.R. 3922, the “Community Health and Medical Professionals Improve Our Nation Act of 2017,” or the “CHAMPION Act,” to extend funding for community health centers, the National Health Service Corps, teaching health centers and other primary care programs. While federal funding extensions for these programs are critical, the CHAMPION Act proposed to fund them at the expense of the Prevention and Public Health Fund, the nation’s only dedicated investment in prevention and public health programs. In response, AADR sent a letter to House Energy and Commerce Committee leadership opposing the use of the Prevention Fund as an offset.

The House has now released a revised version of the CHAMPION Act, which folds in reauthorization for the Children’s Health Insurance Program (CHIP). Unfortunately, the Prevention Fund fares worse in the revised legislation, the CHAMPIONING HEALTHY KIDS Act, than in the original version passed by the Energy and Commerce Committee: a proposed $10.5 billion (or 75 percent) cut over the next eight years as opposed to the initial $6.35 billion proposed cut. Importantly, the revised bill would phase the Fund out after two years.

As a reminder, the Prevention Fund accounts for roughly 12 percent of the Centers for Disease Control and Prevention’s (CDC) budget, which includes funding for the Preventive Health and Health Services Block Grant. Among the grant dollars, nearly $4 million is provided for state oral health programs. The Fund also supports community prevention programs, such as tobacco cessation programs.

UPDATE: On Friday, November 3, the House of Representatives passed H.R. 3922 by a vote of 242 to 174. The bill included cutting the Prevention Fund by $6.35 billion, back to the Committee-approved level.

A number of organizations in the health funding community are speaking to members of Congress about the importance of the Prevention Fund, but ultimately, members of Congress want to hear from their constituents — you! We encourage those who support the Prevention Fund to reach out to their elected officials to educate them about the Prevention Fund and the harmful effect these cuts could have on public health, including public health research.

AADR has created an action alert to make contacting your elected officials easy.

Trust for America’s Health has also compiled a number of resources that may be helpful for your outreach:

If you have any questions about the Prevention Fund or about additional ways you can take action, please contact AADR Assistant Director of Government Affairs Lindsey Horan.

AADR Comments on Draft HHS Strategic Plan Call Attention to Oral Research

This week, the American Association for Dental Research (AADR) submitted feedback to the U.S. Department of Health and Human Services (HHS) on its draft strategic plan for fiscal years (FY) 2018-2022.

The newest version of the strategic plan takes important steps to achieve its aim to “address complex, multifaceted, and evolving health and human services issues.” Importantly, this included an emphasis on the promotion of evidence-based prevention and practices to achieve better health outcomes – a core component to achieving safer and more efficient, effective and equitable care.

AADR was also pleased, in particular, to see HHS reference oral health throughout its framework. As we think about how best to treat patients and improve health care outcomes, we must ensure that oral health is considered as an integral part of medical and other types of care.

Our comments both commend HHS for its calls to support research, improve access for vulnerable and under-served populations and promote healthy behaviors that have a direct impact on oral health as well as offer suggestions to bring greater representation to oral health issues throughout the plan.

Read AADR’s full comments on the HHS Strategic Plan FY 2018-2022 here.

Status Update: Fiscal Year 2018 Appropriations

Under regular order in the annual budget and appropriations process, the president would release the president’s budget submission in February and Congress would complete its budget resolution, which sets the top-line budget totals and divides spending into categories, by mid-April. However, as we have seen over the past several years, ‘regular order’ has become more of the exception than the rule as continuing resolutions (CRs) are passed to keep the government afloat (until budget deals can be reached), and appropriations deadlines are continually pushed back.

In this year’s case, the public didn’t see movement with respect to fiscal year 2018 budget resolutions until the House Budget Committee unveiled its budget blueprint in July and the Senate Budget Committee unveiled its version late last month. Among the biggest takeaways in both the House and Senate versions are the cuts to non-defense spending, which covers everything outside of the defense portfolio, including scientific research, education, etc.:

“The Senate’s resolution keeps defense spending at the budget cap levels outlined by the Budget Control Act. It hacks away at non-defense spending starting in 2019, cutting it by as much as $106 billion by 2027. The House, on the other hand, cuts into non-defense spending right away, but includes a $70 billion increase in defense spending in 2018 alone” (The Hill).

The full House narrowly passed its $4.1 trillion budget resolution last Thursday, October 5, creating a pathway through which members could pass tax reform via the budget reconciliation process. The full Senate is expected to consider its budget resolution in mid-October.

Drilling down further into fiscal 2018 spending, the House and Senate are also working to finalize their respective spending bills, including appropriations for the Departments of Labor, Health and Human Services, Education and Related Agencies (Labor-HHS). The House, which in mid-September voted along party lines to approve a package of 12 spending bills, is farther ahead in the process than the Senate, whose Labor-HHS bill for fiscal 2018 was approved by the Senate Appropriations Committee just last month.

Relevant for AADR members, the House and Senate bills call for a $1.1 and $2 billion increase, respectively, for the National Institutes of Health (NIH). The two spending bills also call for increases to the budget of the National Institute of Dental and Craniofacial Research (NIDCR). The House bill provides roughly $432.36 million for NIDCR, and the Senate bill provides just under $439.74 million, compared with the fiscal 2017 level of $425.75 million.

The House and Senate bills will ultimately have to be reconciled, and in anticipation of the end of the fiscal year on September 30, lawmakers voted to extend 2017 spending levels until December 8, 2017 to give them more time to reach an agreement. However, it is not clear whether Congress and the White House will be able to make a deal by that time.

AADR will continue to keep its members apprised of the budget process and how developments unfold in the weeks to come.

Fiscal Year 2018 Resources:

AADR sends letter to House leadership opposing CHAMPION Act’s reliance on Prevention Fund dollars

The American Association for Dental Research (AADR) this week sent a letter to House Energy and Commerce Committee leadership expressing AADR’s opposition to using money from the Prevention and Public Health Fund (Prevention Fund) as an offset to pay for the Community Health and Medical Professionals Improve our Nation Act of 2017, or CHAMPION Act.

The CHAMPION Act, proposed by Representative Greg Walden (R-OR), calls for critical federal funding extensions for programs such as Community Health Centers and the National Health Service Corps. While it is critical that Congress fund these programs, the CHAMPION Act proposes to do so at the expense of the Prevention Fund (specifically by cutting $6.35 billion from the Fund over the next eight years) and the agencies and essential public health programs it supports. The Prevention Fund, as the nation’s only dedicated investment in prevention and public health programs, works in concert with the programs included in the CHAMPION Act to collectively improve the health of all Americans.

In addition to the Prevention Fund’s roles in supporting community prevention programs, such as tobacco cessation programs, and expanding public health research and tracking efforts, it also accounts for roughly 12 percent of the budget for the Centers for Disease Control and Prevention (CDC), including funding for the Preventive Health and Health Services Block Grant. This program provides nearly $4 million for state oral health programs and plays a key role in supporting preventive dental care.

Therefore, AADR asked that while policymakers work to extend funding for these primary care programs that they find solutions that do not cut or divert current or future funding allocations from the Prevention Fund. As AADR noted in its letter, “The Prevention Fund and its initiatives would benefit these programs, resulting in better care at the state level and healthier families across the nation.”

Read AADR’s letter here.