August 1999 Newsletter
Appropriations
Update: House and Senate Postpone Markups
On Wednesday, July
21, 1999, the House Appropriations Subcommittee on Labor, Health
and Human
Services (HHS), Education and Related Agencies canceled its
scheduled meeting to consider or “mark-up” the bill that funds
health related programs for FY 2000. As previously reported,
Congress must now face difficult budget choices brought on
by the 1997 Balanced Budget Agreement (BBA). The BBA placed “caps” or
limits on overall government spending. In an effort to hold
spending under these caps, the pool of money available to the
Labor, HHS Subcommittee, along with many of the other appropriations
subcommittees, is small. Specifically, under the present “allocation,” health
programs would be funded at approximately $12 billion below
FY 1999 levels. Congressional leaders including House Appropriations
Full Committee Chairman C.W. Bill Young (R-FL), Speaker Dennis
Hastert (R-IL), and others are trying to negotiate ways to
provide more funding for the Labor, HHS appropriations bill.
Thus far, no concrete ideas have been offered. No firm date
has been set to reschedule the mark-up.
The Senate Appropriations Subcommittee
on Labor, HHS, tentatively scheduled to mark-up its version
on July 28, 1999 also postponed the markup of their appropriations
bill. Ted Stevens (R-AK), Chairman of the Full Senate Appropriations
Subcommittee, has indicated that he would like the Senate to
the break the budget caps in order to allow for more funding
to flow to health programs. However, this action would require
a 60-vote majority in the Senate. Negotiations continue in
the Senate as the scheduled mark-up remains unknown. Both Senate
and House are now expected to take up the Labor, HHS appropriations
following the Congressional Recess scheduled for August 7 -
September 7.
As a result, AST members are still
encouraged to communicate with their Members of Congress regarding
the need for increased funding. Please see the sample letter
provided at http://www.a-s-t.org/policy/nih0699.htm.
AST Public Policy Staff will continue to monitor the budget
and appropriations process and provide updates on key developments.
Managed Care Reform
Debate Still Alive in the House
On Thursday, July 29, 1999, House
Speaker , J. Dennis Hastert (R-IL), announced that it is doubtful
that a bill to increase patients' rights in dealing with their
managed health care plans will be ready for floor action before
the August recess. This announcement follows two days of discussions
by House Republican leaders in regard to bringing a managed
care reform plan directly to the House floor for a vote by
next week prior to the August recess.
An ad hoc working
group of members from the three committees of jurisdiction;
the House Commerce
Committee, the House Ways and Means Committee, and the House
Education and Workforce Committee, are attempting to draft
a composite piece of legislation. However, during a Republican
Conference Meeting on July 29, 1999, leaders remained divided
over how much power to give patients and their doctors in dealing
with insurers. Collaborative legislation is expected to contain
elements of last year’s House-passed managed care reform bill
and some provisions from the Senate version (S. 1344) that
was passed in the Senate two weeks ago.
AST Public Policy
Staff will be utilizing AST’s website to alert members of ongoing developments
and action taken to continue to make AST’s voice heard on Capitol
Hill.
IOM Releases Report
on Organ Procurement and Transplantation
On July 20, 1999, the Institute
of Medicine (IOM) released its much anticipated report on organ
procurement and transplantation policies. The report focuses
primarily on issues relating to the policies and data concerning
liver procurement and allocation, because those were at the
center of the debate leading up to the committee's study. The
IOM Report concluded that the current system is reasonably
effective and equitable; however ,the allocation of livers
to those with the greatest medical needs could be more efficient
with improved supervision and oversight. The IOM Committee
generally supported the concepts presented in the U.S. Department
of Health and Human Services (HHS) Final Rule including enhanced
oversight and broader sharing of organs. The IOM Report reiterated
that the federal government should provide effective oversight
and review of the organ procurement and transplantation system
and make the necessary improvements.
In 1998, HHS published a new regulation,
setting the ground rules for organ procurement and allocation
in the United States. Congress suspended implementation of
the regulation, asking the IOM to study its possible ramifications
on organ donation rates, equitable access to transplantation,
and costs. Congress is expected to address the issue of organ
allocation prior to the October 21, 1999 expiration of the
congressionally mandated one-year moratorium.
The IOM Report is available on the
Internet at http://books.nap.edu/catalog/9628.html.
AST members should stay tuned to the AST website at http://www.a-s-t.org/pubpolicy.htm for
AST’s statement regarding the IOM Report.
AST Welcomes the
Passage of the Organ Donor Leave Act
The Organ Donor
Leave Act, H.R. 457, sponsored by Representative Elijah Cummings
(D-MD), passed
the House on July 26, 1999. This legislation seeks to incentivize
organ donation by increasing the amount of leave time for federal
employees serving as organ donors. It provides those individuals
giving the “gift-of-life” with reassurance that they will be
granted an adequate amount of time to recuperate from the life-saving
process they volunteer to undertake.
Currently, federal employees are
allowed to use up to seven days of paid leave in order to donate
bone marrow or organs. The Organ Donor Leave Act would extend
this time to 30 days for organ donors since organ donations
generally require a longer recovery period.
AST has been actively involved in
this legislation since its introduction and was on record during
Rep. Cummings introductory floor statement as supporting this
initiative. AST Public Policy Staff is actively pursuing co-sponsorship
and movement of the Senate companion legislation sponsored
by Senator Daniel Akaka (D-HI). The Akaka bill is expected
to be taken up in the Senate during the first week in August.
Following a vote on the Senate floor, this legislation would
proceed to President Clinton for signature.
AST Board Member
Meets with Representative Sherrod Brown
Dr. Donald Hricik, AST Councilor-At-Large,
met with Representative Sherrod Brown (D-OH) to educate him
on the needs of Ohio transplant recipients whose transplants
are at risk due to lack of coverage for immunosuppressive drugs.
Dr. Hricik encouraged Rep. Brown to co-sponsor Representative
Charles Canady (R-FL) legislation, H.R. 1115. The Immunosuppressive
Drug Coverage Act seeks to eliminate the time limitation on
benefits for immunosuppressive drugs under the Medicare program,
currently limited to only three years after transplantation.
Dr. Hricik was accompanied
by Bruce Weir, President of the Transplant Recipients International
Organization, Inc. (TRIO) and a patient from Cleveland, Ohio.
Representative Brown seemed knowledgeable about the legislation
as the Ranking Minority Member of the House Commerce Committee.
On August 2, 1999, Rep. Brown signed on as a co-sponsor to
this legislation following Dr. Hricik’s meeting. AST Public
Policy Staff will continue to pursue co-sponsorship for this
legislation in conjunction with TRIO and the National Kidney
Foundation.
Medicare Proposes
2000 Physician Fee Schedule
The Health Care Financing Administration
(HCFA) published the Notice of Proposed Rulemaking regarding
physician fee scheduled for calendar year 2000 that seeks a
transition to a fairer physician payment system. The 2000 Medicare
physician fee schedule continues the transition relating payments
for physician practice expenses to the actual resources used
to provide medical services rather than physicians' historical
charges.
The fee schedule specifies payments
to physicians for more than 7,000 services and procedures,
ranging from routine office visits to cardiac bypass surgery.
In 2000, Medicare will spend about $37 billion on physician
services. Under the proposed fee schedule for calendar year
2000, physicians who provide services primarily in office settings,
such as family practice and internal medicine specialists,
would receive slightly increased payments, while physicians
who provide services primarily in the hospital setting would
receive slightly decreased payments. However, because of the
malpractice insurance cost adjustments, emergency department
physicians would receive a 2.7 percent increase and nephrologists
a 1.3 percent increase. No specialties are expected to receive
payment decreases or increases greater than 1 percent.
The FY 2000 Medicare Fee Schedule
is available from the Federal Register Online at http://www.access.gpo.gov/su_docs/aces/aces140.html in
the July 22, 1999 issue. Please contact AST Public Policy Staff
at 202-857-5322 should you have problems accessing the Medicare
Fee Schedule.
Survey Shows Conflict
Between Doctors and Managed Care Plans
A survey conducted by researchers
at the Kaiser Family Foundation and Harvard School of Public
Health found a high level of conflict between the medical professionals
and health insurers. The random survey of 1,053 doctors and
768 nurses released on Wednesday, July 28, 1999, showed almost
nine out of 10 doctors reporting that health plans have denied
coverage of needed services over the past two years.
About three-quarters of the doctors
and nurses said managed care has decreased the quality of care.
Denials of coverage for prescription drugs led the list --
61 percent of doctors said it happens on a weekly or monthly
basis. Denials for diagnostic tests (42 percent), overnight
hospital stays (31 percent), referrals to specialists (29 percent),
and mental health services (18 percent) followed. Among nurses,
48 percent said a health plan decision had resulted in a decline
in health for their patients.
The positive aspect of the survey
was that 68 percent of the doctors surveyed cited that managed
care had increased their use of practice guidelines and disease
management protocols. Managed care also contributed to the
greater likelihood that patients would receive preventive services
as relayed by 45 percent of the surveyed doctors.
Congressional
Budget Process and Timeline
To see the flow chart the government
must go through to product a budget, click here.
