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POLICY COUNCIL LEGISLATIVE REPORT OVERVIEW On August 6, Congress returned to their home districts for a month long recess. This is an excellent time to contact your members of Congress and their staff about key pediatric issues. Issues that necessitate specific action are indicated below. Information on how to contact members of Congress and the White House is provided at the end of this legislative report. Members of the American Pediatric Society, Society for Pediatric Research and the Association of Medical School Pediatric Department Chairs are urged to continue to make your voices heard during this session of Congress. This report includes the following legislative updates:
Two years ago Congress passed and the President signed the Balanced Budget Act of 1997 (BBA), which included strict discretionary spending limits (so-called spending caps) on domestic programs. Both the fiscal restraints imposed by Congress and the White House in 1997 and the growing economy have resulted in an increasing federal budget surplus today – estimated at $14 billion in FY 2000. However, if the spending caps remain in place many of the discretionary child and adolescent health programs and services in the FY 2000 Labor, Health and Human Services Appropriations bill, in particular, will be significantly below the current – FY 1999 - funding levels. The Public Policy Council (PPC) is working together with a number of coalitions to increase funding for biomedical and health services research (including pediatric research), MCH Block Grant, health professions training, immunizations to name just a few important programs for children and adolescents. The House and Senate Appropriations Subcommittee on Labor/Health and Human Services and Education are scheduled to mark up their respective versions of the FY 2000 bill on September 9. Full Committee and House/Senate floor action could occur shortly thereafter. However, it is anticipated that Congress may fail to meet the September 30, 1999, deadline to pass the FY 2000 Labor/HHS/Education appropriations bill [the new fiscal year begins October 1, 1999] and a short-term continuing resolution will need to be passed to avoid a possible government shutdown.
National Institutes of Health [Funding]: The PPC continues to work with the medical research community, including the Ad Hoc Group for Medical Research Funding and Research!America, to advocate for an National Institutes of Health [NIH] appropriations of $18 billion in FY 2000. This 15% increase is the second step toward doubling the NIH by FY 2003. However, it is important that this increase does not come at the expense of other vital public health services and programs. In late July, House Labor/HHS/Education Appropriations Subcommittee Chairman John Porter (R-IL) indicated his intention to recommend an increase for the NIH of 8.6% - $1.3 billion. At this time, Senate Labor/HHS/Education Appropriations Subcommittee Chairman Arlen Specter (R-PA) remains committed to a $2 billion increase. Pediatric Research Initiative: Now in its fourth year, the Pediatric Research Initiative (PRI) provides money to fund new NIH extramural research devoted to the illnesses and conditions of children. Currently, the money is located in the Office of the NIH Director. In FY 1999, report language instructed NIH to fund the PRI at a level greater than FY 1998 ($38.5 million). Staff is currently working with the National Association of Children’s Hospitals and with congressional staff to seek authorizing language for the PRI. In addition, the PPC continues to advocate for adequate appropriations for the PRI in FY 2000, including $50 million for the Initiative, $20 million for pediatric research loan repayments, and $10 million in additional funds for pediatric research training grants. The later two programs, both new in FY 2000 and to be housed in the National Institute for Child Health and Human Development (NICHD), are valuable to train the future pediatric researchers needed to realize the investment in pediatric research. On July 27, Representative Jim Greenwood (R-PA) joined Senators Kit Bond (R-MO) and Mike DeWine (R-OH) by introducing the House companion bill to S.592/S.1091. Mr. Greenwood introduced, the Pediatric Research Act of 1999, H.R. 2621. It provides similar authorizing legislative language to S. 1091 for the PRI and the NICHD pediatric research training grants. This bill currently has four cosponsors and is awaiting action in the House Commerce Committee. It is unclear at this time how these legislative proposals will proceed during this Congress.
Research data availability under the Freedom of Information Act – OMB Circular A-110: Included in Public Law 105-227, the Omnibus Appropriations bill from the 105th Congress, was a provision written by Senator Richard Shelby (R-AL) to instruct the Office of Management and Budget [OMB] to amend Circular A-110 (Uniform Administrative Requirements for Grants and Other Agreements with Institutions of Higher Education, Hospitals and other Non-Profit Organizations) "to ensure that all data produced under a [research] award will be made available to the public through the Freedom of Information Act" [FOIA]. Several legislative initiatives have been proposed to postpone or repeal the Shelby provision. In January, the late Representative George Brown (D-CA) introduced H.R. 88, a bill to repeal the legislative provision. This legislation currently has 43 cosponsors. On July 13, the House Appropriations Committee, by a vote of 25 – 33, rejected an amendment to the House Treasury-Postal Appropriations bill offered by Representatives James Walsh (R-NY) and David Price (D-NC) to delay by one year the OMB provision. On July 26, Senator Patrick Moynihan (D-NY) introduced S. 1437, the Thomas Jefferson Researcher’s Privilege Act of 1999, that also contains language that would repeal the Shelby provision. It is unclear at this time if the Brown or Moynihan bills will move independently or as part of another legislative proposal. On August 11, 1999, OMB issued a "request for comments on clarifying changes to the proposed revision on public access to research data." A copy of the notice can be found at: http://www.access.gpo.gov/su_docs/aces/aces140.html. Comments are due on September 10, 1999.
Stem cell research: The National Bioethics Advisory Commission (NBAC) finalized its report on human embryonic stem cells and research during their July 1999 meeting. The complete report remains unavailable at the time of this writing, but the draft report recommends that, with adequate consent procedures and federal oversight, stem cells for use in research may be taken from discarded embryos from IVF clinics or from elective abortions. The Commission advises that embryos not be created solely for research purposes, thereby discouraging the use of somatic cell nuclear transfer to create stem cell lines at this time. Finally, the report advocates that the federal fetal tissue ban be partially rescinded so that research with embryonic stem cells may be conducted and supported. The draft report, and shortly the final report, can be found on the Commission’s web site at www.bioethics.gov/nbac.html Several patient-groups, such as the Juvenile Diabetes Foundation, the Aging Alliance and others are actively encouraging the pursuit of this promising research. However, this remains an up-hill battle. An amendment to prohibit stem cell research with federal funds is expected to be offered on the Labor/HHS/Education FY 2000 appropriations bill. Staff will continue to closely monitor this issue. [Note: Background information is available on the NIH web-site at www.nih.gov.]
Medical Records Privacy: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was signed into law three years ago. This legislation required the Department of Health and Human Services to issue numerous regulations on administrative simplification of health care transactions. Additionally, the law mandated that the Congress enact legislation dealing with the privacy of the medical record within three years, otherwise the Secretary of HHS would have the authority to issue regulations addressing that issue. As of August 21, 1999, Congress will have missed their medical records privacy legislation deadline. As both House and Senate try to craft passable privacy legislation, two controversial issues remain at the heart of the debate, along with law enforcement access, private right of action, notice and security:
Senate Action: In the Senate, there are three prominent bills, all of which address research and medical records privacy. On March 10, 1999, Senators Jim Jeffords (R-VT) and Chris Dodd (D-CT) introduced S. 578, the Health Care Personal Information Nondisclosure Act of 1999 or the Health Care PIN Act. This legislation upholds the Common Rule and FDA confidentiality procedures and instructs the Secretary and Congress to make recommendations and review the privacy of individually identifiable health information under the Common Rule information [the "Common Rule" or the Federal Policy for the Protection of Human Subjects was adapted in 1991 and subjects federally funded or regulated research to federal oversight requirements including local institutional review boards or IRBs]. Senators Patrick Leahy (D-VT) and Edward Kennedy (D-MA) introduced S. 573, the Medical Information Privacy and Security Act, also on March 10, 1999. Leahy’s bill focuses more on the interaction between the Secretary of Health and Human Services and the IRBs under the Common Rule, requiring submission of the names of IRB members to the Secretary and requiring the Secretary’s periodic monitoring of and technical assistance to these boards. Assurance of confidentiality protection is on the researcher in Leahy’s legislation, which requires the researcher to remove identifiers at the earliest possible time consistent with the purpose of the research unless an IRB determines that there is reason to keep identifiers and the information is protected. Senator Bob Bennett (R-UT) introduced S. 881, the Medical Information Protection Act of 1999, on April 27. The health research provision of S. 881 continues to employ the Common Rule for protected health information. Under Bennett’s bill, researchers examining health care records or medical archives may use protected health information if such procedures are consistent with the existing contracts or safeguards of the institution. Information may also be disclosed to a manufacturer of a drug, biologic or medical device for safety or efficacy studies. Senator Jeffords, as Chair of the Senate Health, Education, Labor and Pensions Committee, has worked to craft a substitute amendment to his S. 578 and reach a compromise among the many interests. The measure, minus certain exceptions, would preempt state laws that are "less restrictive" than the federal bill. In addition, the substitute bill would codify the Common Rule for publicly funded research. However, all efforts to take up this compromise legislation in the Senate HELP Committee have been postponed until issues such as private right of action and the right of minors to confidential care can be resolved. House of Representatives Action: There have been a similar series of privacy bills introduced in the House. Of greatest concern was the inclusion of limited health records privacy protection language as part of H.R. 10, the Financial Services Modernization Act, introduced by Representative Jim Leach (R-IA), Chair of the House Banking and Financial Services Committee. Despite the efforts of many groups, including the AMA and American Lung Association, to remove the language, it remained in the bill passed by the House 346-86. However, on July 30, the House voted 241-132 in support of a motion by Representative John LaFalce (D-NY) to instruct conferees to remove the medical records privacy from the conferenced bill. At the time of this writing, it is anticipated that this language will be struck from the final bill. In March, Representative Edward Markey (D-MA) introduced H.R. 1057, the Medical Information Privacy and Security Act, which currently has 41 cosponsors. Under this bill, the Common Rule is upheld and extended to all health research. In addition, the Secretary is instructed to prepare and submit recommendations on whether written informed consent is required before protected health information can be used in health research. Representatives Gary Condit (D-CA), Henry Waxman (D-CA), John Dingell (D-MI) and Markey also introduced H.R. 1941, the Health Information Privacy Act, which legislates that a health information custodian could disclose health information for research purposes without prior patient consent, but only for uses that have been approved by an entity certified by the Secretary. Finally Representative Jim Greenwood (R-PA) introduced H.R. 2470, the Medical Information Protection and Research Enhancement Act of 1999, on July 12. This bill is similar to Senator Bennett’s proposal and currently has 8 cosponsors. The legislation would permit researchers to access protected health information with the consent of an IRB or another formal review committee. The bill also prohibits any unauthorized attempts to gain access to individually identifiable research databases for non-research purposes. Agency for Health Care Policy and Research – Reauthorization: On August 5, the House Commerce Committee approved, by unanimous voice vote, a bill to reauthorize and to rename the Agency for Health Care Policy and Research. The bill, H.R. 2506, was introduced by Subcommittee Chair Michael Bilirakis (R-FL). H.R. 2506 would change the Agency’s name to the "Agency for Health Research and Quality" and authorize $250 million for the agency in FY 2000 and "such sums as necessary" in fiscal years 2001 to 2004. The legislation would redefine the Agency’s mission to "emphasize its role as a partner to the private sector with responsibility for promoting health care quality through research, analyzing and disseminating scientific evidence, and advancing private and public efforts to improve health care quality." The Senate legislation, S. 580, introduced by Senator Bill Frist (R-TN), is similar to the House bill. S. 580 renames the agency the "Agency for Healthcare Research and Quality" and authorizes the agency through 2006. This legislative language was included as part of the Senate Patients’ Bill of Rights, S. 1344, passed by the Senate on July 15.
Clinical Research: On May 13, Representative Jim Greenwood (R-PA) reintroduced the Clinical Research Enhancement Act of 1999, H.R. 1798. The bill now has 29 cosponsors. During Representative Greenwood’s remarks on the floor of the House, he identified the members of the Public Policy Council and the American Academy of Pediatrics as supporters of his legislation. This bill is designed to help reverse the pattern of "the clinical investigator as an endangered species" by authorizing funds to improve the peer review process for clinical research grants, to establish general clinical research centers, to make new training awards focused on clinical investigators, and to expand the existing intramural loan repayment program. Staff will continue to work to correct the disincentives that guide physicians away from much-needed clinical research careers.
Animal Research/Legislation: For the third time, Representative Charles Canady (R-FL) has re-introduced the Pet Safety and Protection Act of 1999, H.R. 453. The bill currently has 64 co-sponsors. This legislation is based on the erroneous notion that research institutions obtain stolen pets for use in research activities. The bill would have an adverse impact on the ability of medical schools to obtain random-source animals for research and teaching. Animal Research/Appropriations: On February 26, the PPC joined with the National Association for Biomedical Research [NABR], American Veterinary Medical Association, the AAMC and others to request a $3.825 million increase to $13 million for FY 2000 funding for the USDA’s Animal Care unit of the Animal and Plant Health Inspection Service (APHIS). This essential program is dedicated to requiring minimum standards of humane care and treatment for animals bred for commercial sale, used in research, transported commercially, or exhibited to the public. Funding for the Animal Care unit has fallen below the levels appropriated at the beginning of the decade. The Senate Appropriations Committee approved a $2 million increase in FY 2000 funding for Animal Welfare Act enforcement – one million more than is proposed in the House-passed agriculture funding measure and $1.5 million over the President’s budget. The Senate report accompanying the agriculture appropriations bill to the Senate floor calls for the additional funds to be used to increase the number of field inspectors and to conduct follow-up inspections for non-compliance. The House and Senate will begin to reconcile the differences in the two bills during a conference agreement and will decide the final amount to be provided for APHIS Animal Care (AC). Prospects are quite good that AC may receive its first significant increase in a decade. The Public Policy Council will continue to work with both NABR and the animal research community to ensure that this program receives adequate funding.
The Balanced Budget Act (BBA) of 1997 created the Medicare Payment Advisory Commission (MedPAC) and the National Bipartisan Commission on the Future of Medicare. Both were designed to closely examine Medicare and make recommendations to Congress to preserve and reform the program. Among the issues both Commissions were required to examine were payments to teaching hospitals including graduate medical education (GME). National Bipartisan Commission on the Future of Medicare: On March 16, the Bipartisan Commission concluded its work without making formal recommendations to Congress. However, Commission Chair John Breaux’s (D-LA) proposal may remain politically alive. The FY 2000 Congressional budget resolution directs Congress to consider the proposal, signaling the GOP’s interest in pursuing these policy alternatives. In addition, the Senate Finance Committee has been conducting a series of hearings to address various policy alternatives to improve Medicare, including Senator Breaux’s premium support model. The PPC will continue to work to maintain the safety of graduate medical education including freestanding children’s hospitals. For more information, please see the Commission’s web site at www.medicare.commission.gov/medicare MedPAC: The Medicare Payment Advisory Commission [MedPAC] produced its recommendations to Congress regarding graduate medical education payments to teaching hospitals in time for their August 5 report. Gail Wilensky, former Administrator of the Health Care Financing Administration [HCFA] serves as the chair of MedPAC. MedPAC replaces the Prospective Payment Assessment and the Physician Payment Review Commissions. The Commission’s August report recommends that Medicare payments to teaching hospitals only reflect the added patient care costs of those institutions. The cost of graduate medical education, the Commission concluded, should not be an independent Medicare payment. The Association of American Medical Colleges President Jordan Cohen responded, saying the "report sends a very troubling message to Congress and our nation’s teaching hospitals by concluding that Medicare should no longer explicitly support physician training." In anticipation of the August report, the Federation of Pediatric Organizations, including the Public Policy Council member organizations, sent a letter to Gail Wilensky encouraging "the Commission [to] consider the implications of its actions this summer on the future of medical education and, more broadly, on both the quality of and access to health care in the 21st century – not only for Medicare beneficiaries but also for the entire patient population including children and adolescents." The PPC will continue to work to protect the federal investment in graduate medical education. For more information, please see the Commission’s web site at www.pprc.gov Graduate Medical Education/Children’s Hospitals: Freestanding children’s hospitals, those that do not share a Medicare provider number with an adult health care institution, do not qualify for the substantial GME support afforded to teaching institutions through the Medicare program. The Clinton Administration has offered a proposal in its FY 2000 budget submission to Congress to address the problem of underfunded graduate medical education programs in freestanding children’s hospitals. The President’s FY 2000 budget proposal included a $40 million temporary fix to provide GME payments to children’s hospitals as part of the Health Resources and Services Administration [HRSA], Department of Health and Human Services. This proposal requires authorizing legislation, which has been developed with consultation of the National Association of Children’s Hospitals as well as some in the pediatric community. The draft legislative proposal was delivered to Speaker of the House Dennis Hastert on May 12.However, to date no action has been taken on this specific proposal. However, HRSA has contracted with a consultant for a demonstration project of nine children’s hospitals throughout the nation in an effort, among other things, to gain better data on what hospitals qualify as independent children’s hospitals and how many total residents train in those sites. The pediatric community has provided HRSA invaluable assistance and guidance throughout this process. It is the staff’s understanding that the nine demonstrations site are: Texas Children’s Hospital - Houston, Children's National in Washington, DC, St. Louis Children's, Children's Hospital – Los Angeles, Children's Denver, Seattle Children's Hospital & Regional Medical Center, and Columbus Children’s. Under the President’s proposal, if approved by Congress, it would be funded with discretionary dollars [as opposed to the Medicare trust fund]. This would mean that every year in the annual appropriations process new funding would need to be pursued in contrast to the automatic GME funding through the Medicare trust fund for other teaching hospitals under the current system. Moreover, as currently drafted it appears that this proposal could come at the expense of other valuable HRSA health professions training programs, such as Title VII. However, it should be noted that this issue – pediatric GME – is finally gaining recognition and momentum by both Congress and the White House. The PPC will closely monitoring this issue. On February 8, 1999, Senators Bob Kerrey (D-NE) and Kit Bond (R-MO) introduced S. 391 the Children’s Hospitals Education and Research Act of 1999. This legislation currently has 30 cosponsors. The bill would provide general revenues for graduate medical education for time-limited support for independent children’s teaching hospitals. The bill establishes a four-year fund "which will provide children’s hospitals with Federal teaching payments that are based on their per resident costs and the complexity of their patient population." On April 27, Representative Nancy Johnson (R-CT) introduced H.R. 1579, a similar bill in the House, which currently has 161 cosponsors. Representative Johnson’s bill would authorize a two-year fund with $280 million in FY 2000 and $285 million in FY 2001. AMSPDC has sent a letter to all members of Congress urging its support of S.391/H.R.1579.
Other GME Legislation: In March 1999, Representative Ben Cardin (D-MD) introduced H.R. 1224, the "All Payer Graduate Medical Education (GME) Act," a bill to fund graduate medical education through an all-payer fund. The bill currently has 12 cosponsors. Similar to Representative Cardin’s bill from the 105th Congress, this legislation would fund GME through both the Medicare system and through a separate trust fund, with a 1% tax on all health care plans. This would produce approximately $3.2 billion in revenue for direct and indirect medical education. On January 19, Senator Patrick Moynihan (D-NY) introduced S. 210, the Medical Education Trust Fund Act of 1999, also in an effort to produce a viable education trust fund for GME. At this time, this legislation has two cosponsors and has been referred to the Senate Finance Committee. The bill proposes to establish a Medical Education Trust Fund. From this source, payments could be made to Medical Schools, Teaching Hospitals and non-Medicare Teaching Hospitals. A new 1.5% tax would be levied on health insurance policies to provide necessary funds. In addition, the legislation would mandate a transfer of funds from Medicare to the new Education Trust Fund. Finally, the bill would establish a Medical Education Advisory Commission to develop new and innovative ways to train medical school graduates. Senator Moynihan also introduced the Graduate Medical Education Payment Restoration Act of 1999, S. 1023, on May 12. This legislation currently has 23 cosponsors and will freeze the current schedule of BBA reductions to the indirect portion of GME funding. Under the BBA, the indirect payment adjustor is scheduled to be reduced from 7.7 percent to 5.5 percent by FY 2001. This bill will maintain the current payment adjustor at its current level of 6.5 percent. Title VII – Health Professions Training Grants – Appropriations: Working with the Health Professions and Nursing Education Coalition, the pediatric academic societies recommend $316 million in FY 2000, for Titles VII and VIII, a modest 4 percent increase above current level funding [$304 million]. Moreover, the pediatric community is urging Congress to appropriate at least $30 million for general internal medicine/general pediatrics. Unfortunately, in President Clinton’s FY 2000 budget proposal, Title VII received a substantial cut, including zero funding for the primary care medicine/dentistry and public health workforce development "clusters." The primary care cluster includes general pediatrics training dollars. Staff is currently exploring other options with members of Congress to protect Title VII from such a devastating cut.
National Health Service Corps: Two years ago, the National Health Service Corps sent notification to health professions schools and students of its intention to begin withholding federal taxes on the entire amount of scholarships awards to NHSC scholarship recipients. The scholarship consists of funds for tuition, fees, and other reasonable educational expenses and a monthly stipend for living expenses. The President’s FY 2000 budget included a provision to "amend current law to provide that any amounts received by an individual under the National Health Service Corps (NHSC) … are ‘qualified scholarships’ excludable from income, without regard to the recipient’s future service obligation." Several legislative corrections have been introduced. Senator Jim Jeffords (R-VT) introduced S. 288, to amend the IRS code to exempt NHSC scholarship payments from income for tax purposes. This legislation currently has ten cosponsors. Representative Nancy Johnson (R-CT), who took the lead on this issue on the 105th Congress, introduced H.R. 1414, the Health Care Access Promotion Act of 1999, to exempt NHSC payments from taxes. H.R. 1414 currently has 31 cosponsors. The recently passed $792 billion tax bill, H.R. 2488, includes a provision that exempts payments for tuition and education-related expenses from gross income for tax purposes under the NHSC Scholarship Program. However, within hours of the bill’s approval by Congress, President Clinton announced he would veto the tax package. Staff will continue to work to eliminate this impediment to NHSC scholarship recipients.
Uniformed Services University of the Health Services [USUHS]: Once again Sen. Russ Feingold (D-WI) has introduced legislation, S. 126, the Uniformed Services University of the Health Sciences Termination and Deficit Reduction Act of 1999, to terminate the USUHS. This has been part of Sen. Feingold’s overall efforts to reduce the federal deficit. This bill at this time has no cosponsors and as in previous years it is not expected to pass. THE FUTURE OF PEDIATRIC EDUCATION II – A Project of the Pediatric Community: The final recommendations of the FOPE II Task Force have been released and are now available on the web site of the American Academy of Pediatrics at: http://www.aap.org/profed/fope1.htm The final report will be published in Pediatrics in late 1999 or early 2000. Health Professionals for Diversity Coalition: The Health Professionals for Diversity Coalition is continuing its efforts to maintain and promote affirmative action in health professional education. This coalition is coordinated by the AAMC and is comprised of 51 medical, health and education organizations including the AMA, ACP-ASIM, AAFP, NMA, the Academy. The coalition is continuing to monitor activities at the state level to dismantle affirmative action programs such as the state of Washington’s anti-affirmative initiative that was approved by the voters last year and the recent challenges to the University of Michigan’s undergraduate admissions policies. Additional information can be found on the coalition at: www.aamc.org/about/progemph/diverse Representative Jesse Jackson, Jr. (D-IL) introduced H.R. 2391, the National Center for Research on Domestic Health Disparities Act on June 30 with 70 cosponsors. The bill would establish a national center for research on domestic health disparities at the National Institutes of Health. The Center would also be crucial to promoting research endowment programs through the centers of excellence and the legislation will establish an Advisory Council to the Center Director. H.R. 2391 is currently awaiting action by the House Commerce Committee. MATERNAL AND CHILD HEALTH BLOCK GRANT On January 19, 1999, Sen. Patrick Moynihan introduced S. 207, Amendments to the Maternal and Child Health Services Block Grant. The legislation would increase the authorization of appropriations for Title V, the Maternal and Child Health Block Grant program to $840 million in FY 2000. Under current law, Title V is permanently authorized at $705 million. It was last extended in FY 1993. The PPC will closely monitor and participate in efforts to increase the authorization level. The PPC is joining with other Title V advocates in supporting a $100 million increase in funding (appropriations) for FY 2000. Current funding for the Maternal and Child Health Block Grant program is $700 million. [This includes $5 million for traumatic brain injury]. CLINICAL LABORATORY IMPROVEMENT ACT (CLIA) On February 3, 1998, Representative Bill Archer (R-TX) reintroduced the Clinical Laboratory Improvement Act Amendments of 1999, HR 528. Identical to earlier legislative attempts to eliminate the burden of CLIA, H.R. 528 seeks to exempt physicians’ office labs from the clinical lab requirements under CLIA but maintains oversight of pap smear testing (the initial impetus for CLIA’s enactment). H.R. 528 currently has 18 cosponsors and has been referred to the House Commerce Committee. Working with the American Academy of Pediatrics, the PPC will continue its involvement with other medical societies to seek meaningful CLIA relief in 1999. CHILDREN’S HEALTH INSURANCE COVERAGE AND ACCESS TO CARE The pediatric community continues to play a major role in the implementation phase of the State Children’s Health Insurance Program (SCHIP). While SCHIP is an important first step in meeting the health care needs for all children and adolescents, even if it is implemented perfectly, at least 3.2 million children will remain uninsured. The pediatric community must remain committed to the goal of establishing a system where all children, regardless of their family income, employment status or state of residence, have quality health care coverage. STATE CHILDREN’S HEALTH INSURANCE PROGRAM (SCHIP) Potential SCHIP/Medicaid Funding Cuts: Due to the tight spending caps and limitations on discretionary spending, the House Appropriations Committee, in an effort to "find" more discretionary dollars, has expressed its interest in reducing the federal contribution to the Medicaid program from 50 percent to 45 percent. Another offset under consideration is a proposal to reduce funds available to SCHIP by $5.2 billion. In addition, despite the objections of the State Governors, the House Appropriations Subcommittee for Labor Health and Human Services may be considering changing the current method of Medicaid administrative match to either a block-grant or a cost allocation reduction. On August 5, 1999, the Senate Finance Committee released two letters: one urging House appropriators not to target SCHIP funds for budget offsets and another directing the Department of Health and Human Services to make sure states are collecting data needed to illustrate the effectiveness of the program. Senate Finance Committee Chair William Roth (R-DE) and Ranking Minority Member Senator Daniel Patrick Moynihan were joined on the SCHIP letter by House Commerce Committee Chairman Thomas Bliley (R-VA) and Ranking Minority Member John Dingell (D-MI). National SCHIP Outreach Campaign: On February 23, 1999, President Clinton, along with the National Governor’s Association, unveiled a national SCHIP outreach campaign that features a toll-free hotline. The nationwide, toll-free number is (877) KIDS NOW. Other outreach initiatives include public service announcements and corporate distribution of information on the insurance program to their customers. In a survey released on July 30, 1999, by the Kaiser Commission on Medicaid, currently the number of children participating in the State Child Health Insurance Program is 1.3 million. Though much of the activity surrounding Title XXI has moved to the states, there is still legislation pending at the federal level concerning Title XXI: H.R. 827, "Improved Maternal and Children’s Health Coverage Act of 1999:" Introduced by Rep. Diana DeGette (D-CO) with Rep. Connie Morella (R-MD), this legislation now has 104 cosponsors. It requires states to use a uniform application to determine eligibility for both Medicaid and their SCHIP program. It also requires states to participate in a toll-free number being established to improve coordinated outreach efforts. The bill assures coordination of pediatric providers within a family. It also provides expanded coverage options, such as giving states the option to provide coverage to pregnant women. S. 206, "CHIP Data and Evaluation Improvement Act of 1999" Introduced by Senator Patrick Moynihan (D-NY) and Senator John Chafee (R-RI), this legislation provides for improved data collection and evaluations of State Children’s Health Insurance Programs. "The Children’s Health Insurance Accountability Act of 1998," S.636 was introduced by Senator Jack Reed (D-RI) on March 16. It currently has seven cosponsors. This legislation establishes a set of managed care standards that are specific and unique to children, including:
This legislation is designed to serve as the children’s piece to any other larger managed care legislation moving through Congress. Senate Action on Managed Care: On July 15, 1999, the Senate approved, by a vote of 53-47, S. 1334, the Republican "Patients’ Bill of Rights Plus Act." President Clinton promised to veto the bill. The Republican bill rejected the Democrats effort to allow patients to sue health plans in state court if they are injured as a result of denied or delayed benefits. The Senate bill also does not let physicians decide what medical care in medically necessary. The bill limits most of its protections to the 48 million Americans who cannot be helped by state patient protection laws because they are self-insured health plans. President Clinton and the Democrats believe that any bill must cover all 161 million Americans with private health insurance. S. 1334 does not include a number of important pediatric provisions such as; the ability to choose a pediatrician as a primary care provider and access to pediatric specialists. House Action on Managed Care: There has been an important breakthrough in the managed care debate in the House of Representatives. Reps. Charlie Norwood (R-GA) and John Dingell (D-MI) have introduced H.R. 2723, "The Bipartisan Consensus Managed Care Improvement Act." This legislation contains several of the pediatric-specific provisions that the pediatric community supports. For example, the bill includes access to pediatric specialists, and provides for choice of a pediatrician as the primary care provider. Specifically, the bill states: "If a group health plan, or a health insurance issuer in connection with the provision of health insurance coverage, requires or provides for an enrollee to designate a participating primary care provider for a child of such enrollee, the plan or issuer shall permit the enrollee to designate a physician who specializes in pediatrics as the child’s primary care provider." The Norwood-Dingell bill (or the "Dingwood bill" as some call it!) would allow patients to sue health plans for damages over delayed or denied benefits but would exempt the health plans from punitive damages if they follow the recommendations of external reviewers. The bill emphasizes its external appeals process, which would allow patients to appeal benefit denials to independent medical reviewers. The bill does not include the legal definition of "medical necessity" that Democrats included in their bill, opting instead to leave the final decisions on medical necessity to the physicians who conduct the external reviews. President Clinton has endorsed the bill and Rep. Norwood believes he can get 300 cosponsors… he already has 235. House Minority Leader Richard Gephardt (D-MO) also supports the bill. The bill has more than enough Republicans to guarantee the bill’s passage in the House, where the Republicans hold only a five-seat majority, if all Democrats vote for it. For up-to-date advocacy and "take action" information on managed care, visit the American Academy of Pediatrics’ Member’s Only web site at www.aap.org click Members Only and then Federal Affairs. ****************** HOW TO CONTACT YOUR MEMBER OF CONGRESS The summer congressional recess of the first session of the 106th Congress provides an excellent opportunity to contact your members of Congress. The following provides you the necessary information to make these contacts. Also consider using the district work periods (Congressional recess) to invite your member of congress (and/or their staff) to your facility, office or community-based pediatric program. The congressional recess schedule for this session of Congress is listed below.
Be courteous, to the point, and include key information, using examples, if possible, to support your position. Address only one issue in each letter and, if possible, keep the length to one page. CALL YOUR MEMBER OF CONGRESS You can contact your Senators and Representative’s office by calling the Capitol Hill Switchboard at (202) 224-3121. If you do not know who your Representative is, the switch board operator will be able to direct you to the proper office. Ask to speak to the staff member who works on health care issues. Be prepared to leave a very short message as well as your name and address. Fax: Most offices have fax machines, so you can call and ask for the fax number if you would like to fax your letter. Some offices do not give out their fax numbers, however. E-mail: Most members of Congress have e-mail addresses, but there is no set format for them. We suggest calling the Member’s office to get an accurate e-mail address. This may not be the quickest or most effective mechanism to contact members offices because of the incredible volume of e-mails Congressional offices receive and each office’s response to e-mails varies greatly. HOW TO CONTACT THE PRESIDENT Phone: 202-456-1111 (You can enter by push-button your opinions on certain topics, or press ‘O’ to speak to an operator.) The Honorable William J. Clinton 1999 CONGRESSIONAL RECESS SCHEDULE
**************** Although it is vitally important that all of your representatives in Congress hear the Public Policy Council’s messages, several members will play particularly large roles in the up-coming debates about funding for the FY 2000 Labor, Health and Human Services, Education Appropriations bill. In particular, please take this opportunity to contact the members of the House and Senate Appropriations Committees and the House and Senate Leadership [members of the House or Senate L-HHS-Ed Subcommittees are preceded by an *]: HOUSE APPROPRIATIONS COMMITTEE
SENATE APPROPRIATIONS COMMITTEE
HOUSE AND SENATE LEADERSHIP Dennis Hastert (R-IL), Speaker of the House Trent Lott (R-MS), Senate Majority Leader **************** Additional information and resource materials on these or other issues related to child health are available from the Washington Coordinator for the Societies: Karen M. Hendricks, JD, (khendricks@aap.org) or Jennifer Stevens, Legislative Assistant (jstevens@aap.org) at 601 13th Street, NW, Suite 400 North, Washington, DC 20005; phone: 800/336-5475; fax: 202/393-6137. PUBLIC POLICY COUNCIL:
SUBMITTED BY: August 1999 |