Health care issues high on Democratic agenda for 2007

From the Kaiser Report--Price negotiations under the Medicare prescription drug benefit, SCHIP reauthorization, embryonic stem cell research, health care information technology and a number of other health-related issues are expected to be major legislative priorities in 2007, the Washington Post reports.

According to the Post, "After years in which Iraq and national security dominated the debate, ... the return of Democratic control in the House and Senate and the ramping up of the presidential campaigns are expected to bring health policy back into the legislative mix." House Democratic leaders have said that within the first 100 hours of taking control of Congress, they will pass bills that would lift restrictions on federal funding for embryonic stem cell research and authorize HHS to negotiate prescription drug prices with pharmaceutical companies under the Medicare prescription drug benefit.

President Bush in July 2006 vetoed a bill that would have increased funding for embryonic stem cell research. According to the Post, "Advocates in both parties say [that] the bill will pass again" and that another veto is likely.

On the issue of the Medicare prescription drug benefit, Democrats in the past that they would use money saved through negotiations with drug companies to close the so-called "doughnut hole" coverage gap in the program. However, the Post reports that "Democrats no longer say the savings would be enough to fill" the doughnut hole (Lee, Washington Post, 12/25/06).

Savings from lower drug prices is among several funding sources that are considered "highly uncertain" and that could affect whether Democrats will be able to finance their health care proposals, the Post reports.

Incoming House Budget Committee Chair John Spratt (D-S.C.) and incoming Senate Budget Committee Chair Kent Conrad (D-N.D.) said there is "little room in their budget blueprints for significant new domestic spending," including closing the doughnut hole, according to the Post (Montgomery, Washington Post, 12/26/06).

Negotiations Opposition
Price negotiations with pharmaceutical companies face opposition from Bush and HHS Secretary Mike Leavitt, who, "[f]or the first time in his political career, ... will answer to a Democratic majority," the Salt Lake Tribune reports (Gehrke, Salt Lake Tribune, 12/28/06). Wendell Primus, an aide to incoming House Speaker Nancy Pelosi (D-Calif.), said the Democrats' proposal would require the HHS secretary to negotiate with pharmaceutical companies but would not specify how. "It will be very simple language," Primus said, adding, "We do not think that Congress needs to hammer out all the details." According to the New York Times, the debate over the Medicare prescription drug benefit "highlights the profound differences between Democrats and Republicans over the future of the nation's health care system, the proper role of government and the role of private markets in securing the best value for the huge sums spent on health care" (Pear, New York Times, 1/2).

SCHIP
Although there is bipartisan support for reauthorizing SCHIP, there likely will be debate in Congress over how much to increase funding for the program, according to the Post. Currently, the federal government spends $5 billion annually to cover more than four million children through SCHIP, and some experts say an increase of at least $12.7 billion over five years is necessary to maintain coverage for the same number of children (Washington Post, 12/25/06). CMS estimates that 1.5 million children would lose SCHIP coverage by 2012 unless funding increases. The current program will expire Sept. 30 unless Congress acts to renew it (Zhang, Wall Street Journal, 12/30/06). Some Democrats have proposed expanding SCHIP coverage to some uninsured adults, "a move that would add billions more in costs and bring stiff opposition from Republicans, who say the program should focus on attracting more eligible kids," the Post reports.

Other Issues
In addition, legislation that would encourage use of electronic health records and health care information technology likely will receive bipartisan support if lawmakers can resolve disputes regarding "privacy concerns and potential conflicts of interest if hospitals were to sell such technology to their doctors," according to the Post. Lawmakers of both parties also likely will seek to address FDA's oversight of drug safety, which could include a re-examination of fees paid by pharmaceutical companies to FDA as part of the drug-approval process (Washington Post, 12/25/06). In addition, Democrats have drafted legislation that would shorten the approval process for generic versions of biotechnology drugs (New York Times, 1/2). Pelosi also has plans to bring to a vote a bill that would require health insurers to offer the same coverage levels for mental illnesses as for physical conditions, according to Pelosi spokesperson Brendan Daly (Frommer, AP/San Jose Mercury News, 12/28/06).

Fraud Law
In related news, hospitals and nursing homes nationwide are training staff on how to report health care fraud as part of a new law that takes effect this month, the New York Times reports. The law, part of the Deficit Reduction Act signed by Bush in February 2006, requires any company that does at least $5 million in Medicaid business annually to educate all employees on how to detect fraud, waste and abuse. In addition, companies must inform employees that they will be protected from retaliation and could receive a share of money recovered by the government if they report fraud. The law also applies to many HMOs, home care agencies, medical equipment suppliers, physicians groups, pharmacies and pharmaceutical companies. The Bush administration issued a guidance on the law on Dec. 13, 2006. As of late last month, many affected hospitals said they were unaware of the requirements, according to the Times (Pear, New York Times, 12/24/06).

Broadcast Coverage
NPR's "All Things Considered" on Tuesday reported on Democrats' proposal to allow HHS to negotiate with pharmaceutical companies under the Medicare prescription drug benefit. The segment includes comments from Rep. Rahm Emmanuel (D-Ill.); Mollyann Brodie, a Kaiser Family Foundation vice president and director of its Public Opinion and Media Research Program; Joe Antos, a health economist at the American Enterprise Institute; and Leavitt (Rovner, "All Things Considered," NPR, 1/1).