This was a vote on an amendment by Rep. Paul Tonko (D-NY) that would have required the Government Accountability Office (GAO—which conducts investigations, audits, and studies on behalf of Congress) to determine the impact of limiting federal funding for graduate medical education to $46 million per year on the number of primary care physicians that could be trained. This amendment was offered to legislation limiting federal funding for graduate medical education to $46 million per year.

Specifically, the underlying graduate medical education bill repealed a provision of a major health care reform law (that established near-universal health care coverage in the U.S., and was signed into law by President Obama in 2010) that provided “mandatory” federal funding for programs that provide training to medical residents. Mandatory funding is not subject to any limitations set by Congress. (Social Security and Medicare are prime examples of programs that operate on mandatory funding.) This bill would have converted the medical education initiative to a “discretionary,” program—meaning it would be subject to limits imposed by annual spending bills. The underlying bill also limited federal funding for graduate medical education to $46 million per year.

Tonko urged support for his amendment: “…My amendment is very simple. It requires that we find out exactly how many primary care physicians we will lose if Republicans succeed in cutting teaching health centers across the country. My amendment commissions the Government Accountability Office to report on these findings so that the American people can see how drastically these cuts will eliminate jobs and will hurt the quality, access and affordability of primary care health options. I am interested to know… if some of my Republican colleagues are aware that, if H.R. 1216 is adopted, there will be fewer primary care doctors working in their communities. For example, this bill cuts funding for 23 physicians at the teaching health center in the heart of Scranton, Pennsylvania. These 23 individuals are being trained to provide basic health care for constituents in the greater Scranton area.”

Rep. Guthrie (R-KY) opposed the amendment: “I oppose the general premise that a program must have mandatory funding in order to be effective. This type of thinking has led us to massive budget deficits as far as the eye can see….It seems to me that some people's solutions to reining in the discretionary ledger of our Federal budget is to simply shift programs from discretionary to mandatory and let the spending cruise on auto pilot. That is not responsible governing. In a time of $1.5 trillion annual deficits, we must make spending priorities. However, setting priorities involves tough choices. The people that oppose this bill do so because they are unwilling to make the tough choices on what programs the federal government should fund and what they should not.”

The House rejected this amendment by a vote of 186-231. Voting “yea” were 181 Democrats and 5 Republicans. 229 Republicans and 2 Democrats voted “nay.” As a result, the House rejected an amendment that would have required the Government Accountability Office to determine the impact of limiting federal funding for graduate medical education to $46 million per year on the number of primary care physicians that could be trained.