Academic medical centers remain hopeful that Congress will preserve funding for research and teaching costs included in Senate Majority Leader George Mitchell's healthcare reform plan.
But like healthcare reform, funding for academic medical centers hangs in the balance. In the give-and-take to pass a bill, the $72 billion provided over five years in the Maine Democrat's bill could become history.
Representatives of academic medical centers argue that the funding is necessary to survive under managed care.
"This is the central issue for future generations in the U.S. in order to maintain pre-eminence (in medical care)," said Kenneth E. Raske, president of the Greater New York Hospital Association.
Sens. Daniel Patrick Moynihan (D-N.Y.) and Edward Kennedy (D-Mass.), whose states include many of the nation's top teaching hospitals and medical schools, remain strong allies in the uphill battle to convince lawmakers that such funding is critical. The two Democratic chairmen are key sponsors of the section in Mr. Mitchell's bill that provides research and teaching subsidies.
Over a five-year period beginning in 1997, the bill would provide $27 billion for graduate medical education, $42 billion for academic health centers, $2 billion for medical schools and $1 billion for graduate nursing training. Revenues would be raised through a 1.75% tax on insurance premiums.
The funding pools aren't meant to hike reimbursement to teaching hospitals and academic medical centers "but to replace revenues they lose by shedding costs to remain viable," Mr. Raske said. Because of teaching and research costs, academic medical centers are "inherently uncompetitive," he said.
Academic medical center executives hope Congress sticks with Mr. Mitchell's bill, even though it generates less funding than they think is needed.
The Association of Academic Medical Colleges, which represents many of the teaching hospitals and all the medical schools in the United States, fears its members will be in grave danger if no healthcare reform bill passes.
"Nothing happening in Congress with reform is worse than any worst-case scenario bill," said Richard Knapp, vice president of the Washington-based AAMC.
Under current funding mechanisms, academic medical centers receive $15 billion to $18 billion a year to support research and teaching activities, said William N. Kelley, M.D., chief executive officer at the University of Pennsylvania Health System and dean of the school of medicine. But Mr. Mitchell's bill would generate less than $15 million a year, "so that's not even replacing our current funding," he said.
The bill introduced by House Majority Leader Richard Gephardt (D-Mo.) includes funding for academic medical centers, but the amount of subsidies to be provided remains a mystery.
And the plan introduced by a Senate bipartisan group provides no extra subsidies for research and teaching costs.
Another senator, Jay Rockefeller (D-W.Va.), wants the subsidies tied to targets that require academic centers to train more primary-care physicians and fewer specialists. But chances appeared slim that lawmakers would support an amendment to withdraw funding if such targets aren't included.
If teaching hospitals don't get some sort of subsidy, their missions to care for indigent patients and educate residents are in jeopardy, Mr. Knapp said.