May
29, 1998 Washington Round-Up
Appropriations Season to Start
after Memorial Day Recess
When Congress returns from Memorial
Day Recess on Tuesday, June 2, 1998, Congress will focus its
attention on the 13 appropriation bills for Fiscal Year 1999.
Among the most contentious bills will be the Labor, Health
and Human Services, and Education bill. The tentative discretionary
spending allocations for the House and Senate subcommittees
that hold jurisdiction over these bills have been set and are
the following:
President's Request Senate
Allocation House Allocation
(Budget Authority, in millions of
dollars)
Labor, HHS, Education $84,146 $82,319
$82,052
The total amount of discretionary
spending for all 13 subcommittees in both the Senate and House
is $532,820 billion, which is approximately $6 billion less
than the White House requested for FY 1999.
At a luncheon on
May 18th, Senator Ted Steven (R-AK), Chairman of the Senate
Appropriations Committee,
explained to all 13 Senate Appropriation Subcommittee Chairmen
that they should only spend 95% of their allocation, and reserve
the remainder of the cost for the "year 2000 computer fix program" that
starts next year. This would make it more difficult for Senator
Arlen Specter (R-PA), Chairman of the Senate Appropriations
Subcommittee for Labor, Health and Human Services, and Education,
to provide a substantial increase to the National Institutes
of Health (NIH) for FY 1999.
The ASTP has initiated
and conducted a variety of targeted grassroots efforts to mobilize
Congress
in support of increased research funding at the NIH. In addition,
ASTP has testified before the House Appropriations Subcommittee
on Labor, Health and Human Services and the Appropriations
Subcommittee on Veterans Affairs. ASTP grassroots efforts have
included targeted letter-writing, telephone call, and e-mail
campaigns focused on the Members of Congress serving on the
Appropriations Committees. ASTP leadership has also been conducting
a series of "face-to-face" meetings on Capitol Hill to educate
key Congressional leaders on the importance of increased funding
for research.
Tobacco Legislation Continues
to Travel Rough Road in the Senate
In hopes of leaving
for the Memorial Day recess with one of the "most far-reaching consumer and
public health bills of the modern era," sponsors of tobacco
legislation in the U.S. Senate withdrew their measure late
on Thursday, May 21, 1998. S. 1415, the Universal Tobacco Settlement
Act, a bill to reform and restructure the processes by which
tobacco products are manufactured, marketed, and distributed,
to prevent the use of tobacco products by minors, and to redress
the adverse health effects of tobacco use, had been the Senate's
best hope for tobacco legislation this year. However, two factors
broke down any chances of the bill before Memorial Day adjournment:
1) The deletion of an $8 billion
annual civil liability cap on tobacco firms, which was one
of the more favorable parts of the legislation for big tobacco
companies.
2) An amendment that would strengthen
goals in the bill to reduce youth smoking by punishing companies
for not meeting a target of reducing teen smoking by 67 percent
over the next 10 years. Opponents called this measure unconstitutional
to punish companies for not meeting a goal that it cannot directly
control.
A large portion
of the funding within the President's FY 1999 budget request
is based upon a tobacco settlement bill being passed by Congress
this year. This directly
reflects upon funding for the NIH, as the increase proposed
by the President within the Labor, HHS, and Education section
of the budget, where the NIH is funded, is based upon monies
that currently do not exist.
Managed Care Following Suit in
the House
Trying to put together
a managed care proposal that would be agreeable by both parties
for passage
before the Memorial Day recess, the House Republican health
care task force has continued to run into roadblocks. On Wednesday,
May 20, 1998, Speaker Newt Gingrich (R-GA) urged the task force
to rework its draft proposal to make sure that it does not
place excessive Federal mandates and constraints on managed
care plans or employers. Gingrich stated that, "I believe in
empowering citizens, not bureaucrats," over his concerns that
the task force's proposal would be too regulatory and involve
the government too much in the health care process.
Congressman Dennis Hastert (R-IL),
Chairman of the task force, explained that the group has been
meeting on a monthly basis to produce a comprehensive and bi-partisan
plan, and had hoped to have a proposal before leaving for the
Memorial Day recess, but did not.
The task force's bill may address
such issues as requiring insurers to pay for emergency medical
care, appealing a health plan's decision on coverage; purchasing
groups to allow small businesses to receive the same discounts
on health insurance as large companies receive; and changing
the current tax code to broaden the deductibility of tax benefits.
Congressional leaders stated that they now hope that the task
force's proposal will be completed by mid-June.
The ASTP has met with and educated
members of the House Republican health care task force on key
transplantation principles that should be included in any managed
care reform package. In addition to meetings on Capitol Hill,
ASTP conducted a Congressional grassroots letter-writing campaign
addressing the concerns of the Society with regard to managed
care.
Congressman Stark Introduces
GME Physician Workforce Shortage Legislation
On Thursday, May
21, 1998, Congressman Fortney "Pete" Stark, Ranking Minority Member of the House
Ways & Means Health Subcommittee, introduced the "Medicare
Critical Need GME Protection Act of 1998." This bill would
give the Secretary of the Department of Health and Human Services
the opportunity to fully fund direct graduate medical education
(GME) for specialties where a shortage of physicians exists.
Rep. Stark stated
that, "Congress
has already recognized two subspecialties for full funding
of GME - preventive medicine and geriatric medicine. My bill
simply provides the Secretary of Health and Human Services
with the ability to define other appropriate specialties and
subspecialties for similar treatment, and to provide full GME
funding for as long as the Secretary deems it is necessary." Stark
continued by stating that, "In general, the U.S. has an oversupply
of physicians. But there are exceptions. We should not hinder
training of specialists where there is evidence of a serious
shortage."
In his extension of remarks to introduce
the bill, Congressman Stark uses nephrology as one example
of a current subspecialty facing serious shortages of professionals.
Shalala Appoints Fox as HRSA
Administrator
On May 12, 1998, Health and Human
Services (HHS) Secretary Donna E. Shalala announced the appointment
of Claude Earl Fox, M.D., M.P.H., as administrator of the Health
Resources and Services Administration (HRSA). Dr. Fox has been
acting in the position since March 17, 1997.
HRSA, with a $3.67 billion budget,
expands access to care for poor, uninsured and isolated individuals
and families through an array of grants to state and local
governments, health care providers, and health professions
training programs.
The ASTP continues to work with
HRSA on the OPTN regulations. A meeting between the ASTP and
Dr. Fox has been scheduled on Wednesday, June 17, 1998, to
discuss the regulations.
The ASTP is also
working with the staff of the House Commerce Committee to assist
in the planning
of their upcoming hearings on the OPTN regulations. The Commerce
Committee is tentatively scheduled to hold hearings on June
18th to examine HHS Secretary Shalala's recently released OPTN
regulations.
Nethercutt to Introduce Legislation
on Pancreas Transplants
Representative George Nethercutt
(R-WA) is currently drafting legislation for Medicare benefits
for pancreas transplants, according to the Insulin Free-Times.
Nethercutt, whose daughter has Type 1 diabetes, is drafting
the legislation because of continuing lack of coverage of pancreas
transplants.
Teaching Hospitals Press HCFA
for Medical Education Payments
Teaching hospitals that provide
services to Medicare patients have not been receiving their
direct payments from HCFA as required under the Balanced Budget
Act (BBA) of 1997. The American Hospital Association (AHA)
and the Association of American Medical Colleges (AAMC) sent
a May 19th letter to HCFA requesting the money. The BBA required
the agency to begin to make indirect medical education and
direct graduate medical education payments on January 1, 1998.
However, in late February HCFA announced that no payments would
be made until final instructions were issued, which was projected
for July 1998. The AHA and AAMC wrote to the agency that they
have learned that the delay will be even longer and have requested
that Medicare pay interest on all payments owed. The two organizations
estimated that more than $100 million could be held up while
teaching hospitals continue to provide services to Medicare
patients.
