March 1999 Newsletter
OPTN Report on Waiting Times
Released
On January 22, 1999,
the Department of Health and Human Services (HHS) released
a report showing wide disparities in the length of time patients
wait for organ transplants in different geographic areas of
the United States. The study, produced by the United Network
for Organ Sharing under contract with HHS, includes data on
local waiting times across the country for patients placed
on a transplant waiting list during two periods of time: 1993
to 1995 for kidneys, and 1994 to 1996 for pancreas, kidney-pancreas,
hearts, livers, and lungs. The report also documents the number
of registered patients transplanted, organ recovery rates from
1994 to 1996 for each OPO, and waiting list activity (additions
and removals) for each transplant program nationwide. The Executive
Summary of “The 1997 Report of the OPTN: Waiting List Activity
and Donor Procurement” can be accessed from UNOS’ World Wide
Web site at www.unos.org. Organ-specific volumes may be ordered
by calling UNOS at 804-330-8541. For specific volumes of the
report, purchasers will be required to pay shipping and handling
charges.
“State of the
Union” Outlines Bold Health Initiatives
In the “State of the Union” Address,
President Clinton devoted attention to the “aging of America” through
proposals on Medicare and long-term care. Clinton proposed
using one-sixth of the budget surplus for the next 15 years
to keep Medicare solvent until 2020 and called on Congress
to reform Medicare to include prescription drug coverage. Other
key health care measures in the speech proposed:
• Investing $320 million in NIH
to further biomedical research in the areas of Parkinson’s,
Alzheimer’s, diabetes, and developing vaccines for tuberculosis,
malaria, and AIDS.
• Calling for the passage of the
Patients’ Bill of Rights, including provisions ensuring continuity
of care, the right to see a specialist, and the right to emergency
care.
• Expressing concern
over the threats to the privacy of electronic medical records.
• Rehashing plan
to allow those aged 55 and older to buy into Medicare.
• Calling for coverage
options for uninsured workers.
Legislative Priorities
for 106th Congress: Managed Care Debate
Congressional leaders
agreed that saving Social Security and Medicare are the government’s top
priorities in the 106th Congress. However, in the Senate, the “Patients’ Bill
of Rights” (S. 6) emerged as the Democrats top agenda item.
Sen. Tom Daschle (D-SD) and Rep. John Dingell (D-MI) re-introduced
last year’s bill in the Senate and House respectively. The “Patients’ Bill
of Rights” aims to allow patients to sue managed care plans
for damages over delayed or denied care, gives physicians the
authority to decide whether a service or treatment is “medically
necessary,” and affords patients greater access to specialty
care.
The Republicans
responded with their revival of last year’s legislation, “Patients’ Bill of Rights
Plus” (S. 300). Some of the core protections seek to provide
direct access to obstetrician-gynecologists and pediatricians,
continuity-of-care provisions, and guarantee coverage of emergency
services. The bill also contains a measure which would allow
patients and providers the right to an external appeal of health
plans’ decisions for rejecting thought to be medically unnecessary
or experimental. Senate staff informed us that the Republicans
made several changes to last year’s reform attempt in order
to clarify language and to further define loopholes of Democratic
critics.
AST Public Policy
staff have learned from senior leadership aides that House
Speaker Dennis Hastert
(R-IL) is promising a vote on patient protection legislation
this year and is calling for a bipartisan effort to produce
a reform package that ensures that health care is “affordable
and available” and will “empower” patients who feel they do
not have enough power over health decisions.
Medicare Commission
Debates Premium Support Model
The AST Public Policy
staff attended the meeting of the “National Bipartisan Commission on the Future
of Medicare,” the 17-member panel looking into the revamping
of the federal health program, in which Sen. John Breaux (D-LA)
introduced a draft proposal that would model Medicare as a
premium support system, similar to the Federal Employees Health
Benefits Program (FEHBP), where the government would make a
fixed contribution that each beneficiary would use to pay the
premium of the private health insurance plan of his or her
choice. This proposal was met with skepticism by commission
members, who requested more details on the core benefit package,
short- and long-term costs of the proposed system, how prescription
drug coverage could be added, and how graduate medical education
would be financed. Members also voiced concerns over the role
of the Health Care Financing Administration.
While the President proposed using
15 percent of the budget surpluses over the next 15 years to
shore up Medicare as it stands today, Medicare Commission members
argue that this prolongs the problems and prevents any significant
reform to the program. AST Public Policy staff have learned
from Commission staff that, while some members are calling
for the extension of the March 1st deadline to report to Congress
on their recommendations to overhaul Medicare, several Commission
leaders are still stressing the need to finish their work on
time. In order to make a formal recommendation, the 17-member
panel must reach a consensus of 11 votes favoring any plan.
Congress Facing
August Deadline on Medical Privacy
AST Public Policy
staff have learned that Senate Health, Education, Labor and
Pensions Chairman
James Jeffords (R-VT) and House Republicans are expected to
introduce legislation attempting to tackle the privacy issue
rather than allowing the administration to act in default.
In the 1996 insurance portability law, Congress assigned itself
an August, 1999, deadline for enacting legislation to ensure
confidentiality of patient records. If this deadline is not
met, privacy regulations proposed by Health and Human Services
(HHS) to go into effect. HHS proposed regulations would permit
patients to obtain a copy of their records and propose corrections.
They would require organizations that provide and pay for health
care to give patients a clear, written explanation of how they
will use, store and disclose information. The regulations would
apply to doctors’ offices, hospitals, insurance companies,
employers, claims administrators and pharmacies.
Senator Specter
and Senator Harkin Call for More Research Funding
Senator Arlen Specter
(R-PA) and Senator Tom Harkin (D-IA) introduced Senate Resolution
19 calling
on Congress to increase funding for biomedical research by
$2 billion for the FY 2000 budget. The measure, introduced
last week, specifically cites the challenges associated with
hepatitis C virus, an insidious liver condition leading to
an increase in liver transplants, and the comprehensive threat
posed by cancer to any tissue or organ of the body, and the
subsequent need to address these problems by providing the
National Institutes of Health (NIH) with the resources it deserves.
Although the resolution is “non-binding” and would not automatically
mandate an increase in funds for NIH if passed, it is, nonetheless,
a significant step in providing support for biomedical research.
Both Senators are key members of the Appropriations Subcommittee
that has jurisdiction over NIH funding.
NIH Announces
New Grant Application Procedures
On January 21st, AST Public Policy
staff received an announcement from Dr. Harold Varmus, Director
of the National Institutes of Health (NIH), regarding new grant
application, review, and award procedures that will apply with
the June 1, 1999, grant application receipt date. The new streamlined
format, known as the Modular Research Grant Application and
Award Initiative, will apply to many major research grant applications,
including the most popular research grant mechanisms.
NIH announced its goal of reducing
an applications receipt to award cycle from ten months to six
months by the year 2000. Under the new grant application and
award procedure, applicants will request total direct costs
in $25,000 increments, up to $250,000, in any year of a project.
Applicants requesting more than $250,000 in direct costs in
any given year will continue to follow existing application
and award procedures. For more information on the new grant
process, please access the following Web Page sponsored by
NIH: http://www.nih.gov/grants/funding/modular/modular.htm.
Surgeon General Honored; Cites
Research as Top Priority
AST Public Policy
Staff attended the Genome Action Coalition’s 4th Annual James
D. Watson Lecture and Award Ceremony where Dr. David Satcher,
Surgeon General
and Assistant Secretary, Office of Public Health and Science,
was presented with the James D. Watson Award for outstanding
service in the field of genome research by the Genome Action
Coalition. In accepting the award, Dr. Satcher spoke on the
need for sound, cutting-edge research in attaining public health
care goals. He emphasized the need to apply the most recent
technology to the current health care system. Dr. Satcher outlined
the following evolving health care priorities he will pursue
as Surgeon General in the next few years.
• Provide a healthy
start to our children including pre-natal care.
• Promote healthy
lifestyles by reducing toxins, working against substance abuse,
emphasizing
importance of nutrition and physical activity, and promoting
responsible sexual activity.
• Change mental
health environment to one of caring and support.
• Eliminate discrimination
and disparities toward ethnic minorities by our health care
system.
• Move towards a
balanced community health system.
Dr. Satcher used the problems of
diabetes and End Stage Renal Disease (ESRD) as examples of
health disparities among minorities. During a recent trip to
the West Coast, the Surgeon General was reminded first hand
how kidney-related diseases disproportionately affect members
of the Native American and African American communities. In
response to these problems, Dr. Satcher advocated continued
research and stepped up efforts in the field of prevention
and early detection as just a few steps in the right direction.
Medicare Health Plans Consumer
and Performance Assessments Now Available
This week, the Health Care Financing
Administration (HCFA) began posting the results of a survey
involving more than 100,000 Medicare beneficiaries enrolled
in managed care plans that participate in Medicare on their
website (http://www.medicare.gov). The public can now examine
information assessing the quality of care provided by Medicare-contracted
health plans, as rated by other beneficiaries.
Medicare on “High-Risk” List
as HCFA Fails to Combat Fraud
A General Accounting
Office (GAO) report released this week once again characterized
Medicare
as “High-Risk,” as it analyzed federal programs to determine
which ones are most at risk for waste, fraud, and abuse. According
to the report, HCFA has been slow to develop initiatives to
curb fraud, waste, abuse, and mismanagement despite Congress’ legislative
efforts.
Subcommittee Assignments and
Leaders Named
Rep. Jesse Jackson, Jr. (D-IL) and
Rep. Randy Cunningham (R-CA) are the newest members of the
House Appropriations Health and Human Services Subcommittee.
Rep. Jackson is supportive of increased spending for biomedical
research, especially in the areas of minorities and women.
Rep. Cunningham is a supporter of cancer research. On the Senate
Appropriations Health and Human Service Subcommittee, Sen.
Ted Stevens (R-AK) and Sen. Jon Kyl (R-AZ) fill slots opened
by departing members.
The Senate Finance Committee Chairman,
Sen. William Roth (R-DE), called on Sen. John Chafee (R-RI)
to head the Health Care Subcommittee which has jurisdiction
over health programs under the Social Security Act and health
programs financed by a specific tax or trust funds such as
Medicare.
Sen. Joseph Lieberman (D-CT) replaces
retiring Sen. John Glenn (D-OH) as ranking member on the Senate
Governmental Affairs Committee charged with oversight of government
operations and organization and intergovernmental regulations.
The Governmental Affairs Permanent Subcommittee on Investigations,
chaired by Sen. Susan Collins (R-ME) and Sen. Carl Levin (D-MI)
as ranking member, is currently examining Medicare fraud and
abuse legislation.
AST’s
Support of Organ Donation Commended on the Floor of the
Congress
On February 2, 1999,
Congressman Elijah Cummings (D-MD) introduced the Organ Donor
Leave Act,
H.R. 457. The legislation seeks to incentivize organ donation
by increasing the amount of leave time for federal employees
serving as organ donors. During the introduction of the bill,
Congressman Cummings stated, “This bill has the support of
the American Society of Transplantation, the largest professional
transplant organization in the United States. In a letter expressing
their support for the bill, the AST stated, and I quote, ‘A
lack of leave time has served as a significant impediment and
disincentive for individuals willing to share the gift-of-life.’” In
addition, Congressman Cummings read an entire letter of support
from AST President John Neylan, M.D., on the floor. Cummings
praised the AST for its strong commitment to increasing donation
and its leadership regarding transplantation issues on Capitol
Hill.
