A New Year Revives Some Old Issues for President Bush and the Congress

Patrick Young

WASHINGTON—A new President and a new Congress have taken office, but Washington is still locked in debates over some of the same old issues. The inauguration of George W. Bush brought a new administration with a considerably different outlook from that of the Clinton era and a political philosophy and ethical and moral beliefs that could significantly affect health care policy and medical research, including oncology practice and research.

The new Administration quickly emphasized its antiabortion beliefs. Two days after taking office, President Bush reinstated the Mexico City Policy—established by President Reagan in 1984 and rescinded by President Clinton in 1993—which bars nongovernment organizations that receive federal funds from performing or supporting abortion for family planning in other nations.

Even before assuming the post of Secretary of Health and Human Services (HHS), former Wisconsin Gov. Tommy G. Thompson indicated he would seek a review of the FDA approval of the abortifacient mifepristone (RU-486). "It is a new drug; it’s contentious and controversial; the safety of it, as I understand it, is in question," Secretary Thompson said at his confirmation hearing.

Many health advocates wonder how such views will affect health and research policies in the Bush Administration and, in particular, whether abortion will become a litmus test in such decisions as selecting a replacement for the long-departed Harold Varmus, MD, as director of the National Institutes of Health.

On Capitol Hill, Congress—an evenly split Senate and a House with a thin Republican majority—will again confront some familiar and controversial issues. These issues range from the 5-year effort to double the NIH budget, to coverage by all third-party payers for the normal care costs associated with clinical trials, to a "Patients’ Bill of Rights."

Another question is whether the Bush Administration will reverse current NIH guidelines on embryonic stem cell research and ban such work by all federally funded investigators.

An issue likely to be revisited by Secretary Thompson is that of reimporting American-made prescription medications. Congress passed and President Clinton signed legislation last year that allowed reimportation, which proponents claimed would save consumers money. The bill, however, contained a provision for further review by HHS, and then-Secretary Donna E. Shalala refused to implement the law.

Sen. James Jeffords (R-VT), the bill’s sponsor, has urged Secretary Thompson to reverse Secretary Shalala’s decision, citing a legal analysis by the Congressional Research Service that he has the authority to do so. "This analysis gives new life to my goal of bringing lower prescription drug prices to all Americans," said Sen. Jeffords, chairman of the Senate Health, Education, Labor, and Pensions Committee.

Secretary Thompson is best known for reducing Wisconsin’s welfare rolls and instituting innovative reforms that increased health coverage for the state’s residents. He signed a state patients’ bill of rights into law, and worked to protect patient privacy.

A major negative of Secretary Thompson’s record, according to antismoking groups, was his friendly relations with the tobacco industry.

As governor, he four times signed increases in the state’s tobacco tax and last year signed the first ban on smoking in the Wisconsin Capitol. However, he also signed a smokers’ rights bill, and vetoed legislation that would have banned smoking in the general seating section of the Milwaukee Brewers’ new baseball stadium and a bill permitting communities to enact stronger tobacco control rules than imposed by the state. Moreover, as governor, Secretary Thompson received nearly $100,000 in contributions from the tobacco industry. He also visited England, Africa, and Australia on trips arranged by the National Governors Association but paid for by Philip Morris Co.

"His record in Wisconsin raises concerns about his commitment to reducing the toll from tobacco," said Bill Corr, executive vice president of the Campaign for Tobacco-Free Kids.

Some health groups also wonder about the new Administration’s commitment to tobacco control, given the Republican party’s generally positive support for the industry. One key question, for example, is whether a Bush Justice Department will vigorously pursue the federal lawsuit against the tobacco companies to recover federal funds spent for treating tobacco-related disease, which the Clinton Administration began.

NIH Budget

Congress approved a 14.2% budget increase for NIH and a 13.5% increase for the National Cancer Institute for fiscal year 2001. Although not quite enough to ensure doubling the NIH budget by FY 2003, it keeps the effort basically on track.

Medicare began covering the costs of routine care associated with clinical trials, effective Sept. 29, 2000. Bills to extend such coverage to other third-party payers will likely be introduced in the House and Senate this session. Chances of ensuring health coverage for all or even some of the nation’s 43 million uninsured appears to be a long shot.

A patients’ bill of rights appears to have a stronger chance of passage in the 107^th Congress. Senators and Representatives support the concept on a bipartisan basis. But the last Congress was unable to reach an agreement to resolve differences between a Senate bill, which covered about one third of the 161 million Americans with health insurance, and the House bill, which covered all 161 million. The idea of such a bill of rights remains popular on Capitol Hill, and a compromise between the House and Senate could well be worked out.