Look for Incremental Insurance Reform Steps With New Congress

WASHINGTON--Republican control of the US Congress means that thechance for comprehensive health-care reform, as envisioned bythe Clinton administration, is over. But incremental changes tothe health-care system, including insurance reforms that limitor exclude preexisting condition clauses, may gain significantsupport, says Stacey Beckhardt, of the American Society of ClinicalOncology (ASCO).

The midterm election victory gave the Republican party a 230 to204 seat advantage in the House and a 53 to 47 margin in the Senate.As a result, the Republican Congress is likely to adhere to its"Contract with America," which was signed by more than300 Republicans on the steps of the Capitol prior to the Novemberelections.

That agenda includes measures to cut taxes, increase defense spending,and reduce government waste, said Ms. Beckhardt, ASCO's directorof government relations. Oncology News International asked Ms.Beckhardt and other experts to predict what a Republican Congressmay mean for health-care reform and oncology-related issues incoming months.

It is possible that Senate Republicans will pursue smaller health-carereform initiatives, such as malpractice reform and insurance reform,including portability of insurance, small group reform, and limitson preexisting conditions, Ms. Beckhardt said.

Moreover, Sen. Robert Dole (R-Kan)--and a number of other Republicansenators--have presidential ambitions, so it is likely that theRepublicans will try to "do something" on health care,Ms. Beckhardt said.

Martha McNeil, of the American Cancer Society (ACS), agreed thatinsurance reform has a good chance of passage in Congress. Butit is not a priority with most Senate Republicans, so it willnot happen right away, said Ms. McNeil, legislative representativefor the ACS national public issues office. Eliminating preexistingcondition clauses from insurance benefits is an important issuefor many cancer patients, so it is "distressing" thatinsurance reform is not at the top of the congressional agenda,she said.

In the House, designated House Speaker, Rep. Newt Gingrich (R-Ga),has proposed significant changes to various committees that challengethe seniority system of that institution, Ms. Beckhardt said,and it is difficult to predict what these changes may mean forhealth-care reform.

Paying for Clinical Trials

Ensuring coverage of patient care costs associated with approvedclinical trials will be a top issue for most cancer organizations.There was bipartisan support for this issue in both the Houseand Senate prior to the elections, and there is hope in the cancercommunity that it can be bundled into a larger insurance reformpackage, Ms. Beckhardt said.

But some states are not waiting for federal legislation in thisarea and are tackling this issue on their own, according to Ms.McNeil. Rhode Island, for example, passed legislation in 1994requiring insurance coverage of patient care costs associatedwith phase III trials; this same law also provides coverage forcertain unapproved uses of approved drugs, she said.

It is likely that more states will take these same steps if theyfeel that the federal government cannot or will not address thisimportant issue, Ms. McNeil commented.

Last year's discussions in the House Energy and Commerce Committeeabout regulating nicotine levels in cigarettes and other tobaccoproducts are likely to come to a halt, Ms. Beckhardt said. Rep.ThomasBliley (R-Va) will chair the committee, and his state is heavilydependent on tobacco production.

A tobacco tax, on the other hand, could still gain support inCongress, Ms.McNeil said. The Clinton administration may try toframe the health-care debate in new terms by underscoring healthcosts associated with tobacco-related diseases, she said. Moreover,cancer prevention and control is a nonpartisan issue, so manyof the new members of Congress may be open to this issue, shesaid.

Impact on NIH Funding

It is unclear what will happen to funding for the National Institutesof Health (NIH) in the new Congress, said

Marguerite Donoghue, of the National Coalition for Cancer Research.Almost half of the members in the House have held their seatsfor 2 years or less, which means they may have little understandingof the NIH's research programs and the National Cancer Program."This presents a very interesting challenge to the researchcommunity with regards to public education," she said

In the House and Senate, however, the leadership tends to be verysupportive of the NIH and understands the importance of investingin medical research and education, Ms. Donoghue said.

She believes that the "real" issue in the next few yearsis what impact the "Contract with America" will haveon domestic spending. Republican members of the House tend tobe strong backers of this agenda, which would require significantreductions in either discretionary spending or entitlement programsto support tax cuts, military spending increases, and other programs.

The NIH is a federal domestic program, Ms. Donoghue pointed out,and sources in the Senate have told her that cuts in domesticspending could be in the range of 28% to 40% over the next 5 years.