Roll Call: Latest News on Capitol Hill, Congress, Politics and Elections
December 19, 2014

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December 15, 2014

Economist Critiques the Daft World Health Organization

Congress this weekend passed an omnibus spending bill, which includes $5.4 billion in added funds to respond to the Ebola crisis in West Africa.  The funding flows to federal agencies managing the Ebola response effort. However, leadership on the global response to combat Ebola rests on the World Health Organization (WHO). The UN agency has faced criticism for allowing the outbreak to grow out of control. In a lead commentary this week, the Economist newspaper urges a reorganization of the WHO’s broad mission to fit limited and largely dismal resources. The magazine also comments on the WHO’s “daft organizational structure,” which mirrors other United Nations organizations.  The Economist notes:

 The WHO’s failure to lead the response to the Ebola crisis should be used as a spur to rethink what the WHO is for, and how it is financed and run. Instead of doing the job of governments, it should focus on the things they cannot manage alone, such as helping poor countries set up health systems, disseminating the best medical research and policies, and combating global epidemics. Politicians must be stopped from using regional offices as a parking-place for friends and relations of their allies. Dr Chan should be able to direct her own organisation: that means being able to hire and fire. And if the world wants an outfit capable of dealing with emergencies such as Ebola, it needs to pay for it. That means increasing dues—and not leaving it to scrabble for handouts.






Congress Quietly Clears Steroid and Doping Agency Bills

Two measures addressing the control of the use of anabolic steroids used by athletes quietly cleared Congress late last week. Senators Orrin Hatch, R-Utah, and Sheldon Whitehouse, D-R.I., gained Senate action on a bill (HR 4771) that seeks to add 25 known designer steroids to the Drug Enforcement Administration’s list of controlled substances and allows the DEA to list any new steroids in the future.

Separately, the House on Friday — in a pro-forma session — completed action on a separate bill (S 2338) renewing funding authorization for the U.S. Anti-Doping Agency (USADA). The independent agency was established by the U.S. Olympic Committee to monitor doping in U.S. Olympic sports. The renewal bill broadens the definition of performance-enhancing drugs monitored by agency. The Olympics provides large portion of funding for the USADA and the measure allows for $91 million in possible federal appropriations over the next 5 years.

By Paul Jenks Posted at 11:06 a.m.

Senate Prepares to Approve Surgeon General Nomination; Groups Offer Medicare Suggestions

Week Ahead

The Senate, after passing the fiscal 2015 omnibus funding bill on Saturday, does not want to leave too quickly. A few items remain on the agenda over the next two days. Today, senators will vote to confirm the nomination of Vivek Murthy as Surgeon General. The position advises the Department of Health and Human Services on public health matters and manages the Commissioned Corps of the Public Health Service. Early procedural maneuvering towards a vote on the nomination, which is contested by many Republicans, was enabled by weekend deliberations on the omnibus spending bill.

Separately, this week the Medicare Payment Advisory Commission, which is charged with advising Congress on payments to Medicare providers, holds a two-day public meeting on Thursday and Friday. Also, on Tuesday the bipartisan duo of former senators Bob Kerrey and Jack Danforth will release an update to a hallmark 1994 effort to devise a overhaul of federal entitlement spending. The two senators led one of several efforts to overhaul funding for Social Security and Medicare but – like other efforts – failed to garner a consensus agreement. Next year, with Republicans in control of both congressional budget panels, suggestions on changing Medicare funding will lurk on the agenda for possible addition to annual congressional budget proposals.




December 12, 2014

Congress Keeps Tabs on “Three-person Embryos”

A fertility technique that can produce “three-person embryos” to prevent women from passing on rare genetic diseases has drawn the attention of  lawmakers who set the budgets for federal agencies including the Food and Drug Administration.

At issue is mitochondrial manipulation, in which genetic material from one woman can be moved into the egg of another. This technique has been developed to help women who otherwise would risk passing on rare mitochondrial diseases to their children, but there’s some thought that it also may aid older women seeking to become mothers.

Full story

Is the Veterans’ Health Care System Cheaper than Private Care?

A Congressional Budget Office report released this week looks at the Veterans Health Administration (VHA) and examines the difficulties in comparing the cost effectiveness of federal and private health care. At first, the CBO assumed – based upon earlier studies – that VHA care costs less than equivalent care provided in the private sector. Now, the budget agency is no longer so sure.

Changes at the VHA, the complexities of cost comparisons and the paucity of new studies make a current comparison difficult. Meanwhile, the VHA is expanding the use of private health care services to compensate for highly publicized and very long treatment waiting times.

Factors favoring lower costs for veterans care include lower prices for pharmaceutical products and likely lower pay rates for doctors. Also, the private sector’s favoring of fee-for-service payments probably hikes the cost of private care. However, the report notes in conclusion: “even if VHA currently provided care at a lower cost than the private sector, expanding the VHA system might not be cheaper in the longer term than increasing the use of private-sector providers.”

And as my colleague Connor O’Brien wrote recently in CQ Weekly (subscription), some health care experts say it might be better to subsidize private heath care for veterans than to keep up the current government-run system.


December 9, 2014

Senate Advances Newborn Screening Bill

The Senate on Monday evening quietly amended and passed a bill renewing grants and research programs on inheritable disorders in newborns and children (HR 1281). The measure reauthorizes newborn screening programs through fiscal year 2019. The bill would extend the term of a committee that sets screening recommendations, and it would renew a grant program for screening and education and an information clearinghouse on newborn screening issues for parents and health professionals.

The Senate passed a similar measure earlier this year (S 1417) but this time passed the House bill along with an amendment offered by Kentucky Republican Sen. Rand Paul, which clarifies conditions for research on blood samples from newborns. The amended bill returns to the House, which might consider it by the end of the week.

December 8, 2014

Week Ahead: Breast Health Bill and Gruber

The House is scheduled to open debate Tuesday on a bill renewing breast health education programs for five years.

The legislation (HR 5185) would reauthorize until 2019 language in the Affordable Care Act known as the Young Women’s Breast Health Education and Awareness Requires Learning Young (EARLY) Act program. The initiative stresses improvement in breast health education and awareness in young women. It includes a national education campaign by the Centers for Disease Control and Prevention (CDC) on breast health aimed at young women, physicians and other health care professionals, using the best available evidence. The program also supports breast cancer research   and grants for organizations that conduct outreach to young women diagnosed with breast cancer.

The House Oversight and Government Reform will review the bill in a Tuesday hearing featuring Centers for Medicare and Medicaid Services head Marilyn Tavenner and MIT economist and health law adviser Jonathan Gruber. Separately, a House panel will examine ways of stemming the growth in federal health care spending with an official from the Medicare Payment Advisory Commission and budget watchdogs. Also a Senate committee this week hosts the President of Liberia in a discussion on the international response to the Ebola crisis.

Today, the Board of Governors of the Patient-Centered Outcomes Research Institute will vote on whether to approve funding for comparative clinical effectiveness research on hepatitis C virus infections.

December 5, 2014

Scientists Seek to Guide Nanoparticles in the Human Body

Some holiday gift lists this year likely include flying drones offering aerial views and opportunities to spy on neighbors. This week’s Economist newspaper looks at efforts to develop drone-like devices that can navigate the human body and hunt down tumors and deliver drugs. While the devices are not electronic, they are just particles, scientists are hoping to give them some kind of collective intelligence, much like a flock of birds.


Indian Health Service Seeks to Trim Physician Payment Rates

The federal government directly provides health care services to veterans, members of the armed services and Native Americans. Most congressional attention focuses on the veterans’ and military health care systems managed by the Department of Veterans Affairs and the Pentagon. The Indian Health Service (IHS) — a branch of the Department of Health and Human Services — also delivers health care services through various health centers around the country.

However, there are not enough health centers and treatment often relies on outside health care providers. Also, provider payment for external health services for Native Americans is subject to available funds — which are often depleted before the end of the fiscal year. IHS estimates that 146,928 contract care service requests in 2013 were denied because funding for the year was exhausted.

Not all IHS contracted services are tied to existing payment rates used for the Medicare program. The agency, in a regulatory proposal published today, suggests that physician and other health provider payments should be linked to Medicare payment rates. The change would save money and free up funds for more services, since some current local contracts and payment rates are much higher than Medicare rates. A 2013 Government Accountability Office report noted that just linking physician payments to Medicare rates could save $32 million.



December 4, 2014

Infant Death Reporting and Ebola Drug Bills Sent to the White House

The House on Wednesday cleared its agenda of two pending health bills. Lawmakers approved added Senate changes and completed action on a bill seeking to enhance reporting — and hopefully improving research — on sudden infant deaths (HR 669). The House also approved a Senate bill allowing Ebola drug research into a FDA program expediting the development of tropical disease drugs (S 2917). Both measures now head to the White House for final presidential approval.

Also on Wednesday, the House overwhelmingly — and in an emotional debate — approved a bill that establishes tax-exempt savings accounts for individuals with disabilities. The bill, which now moves to the Senate, is not controversial but is largely funded by several adjustments to Medicare provider payments.



December 3, 2014

Pentagon Bill Settles on $3 Drug Copayments

Congress usually honors one legislative measure with speedy passage before the end of the year – the annual Defense Department authorization bill. The measure renews Pentagon programs, including one of the largest elements of the defense budget — military health programs. The giant Operations and Maintenance portion of the Pentagon budget is pressed by the rapid growth of the Defense Health Program, which not only covers military health care but also some medical research programs.

Later this week, the House will likely vote on this year’s compromise Defense bill. Normally the measure is expedited for action prior to the Oct. 1 start of the new fiscal year but this year’s bill was stalled, in large part, over disagreement on increasing pharmacy co-pays for the Pentagon’s TRICARE program which covers 9.5 million military active-duty service members, families and retirees. This year’s compromise bill settled on a $3 co-payment for retail prescriptions and mail-order non-generic prescriptions.


FDA Panel Continues to Mull Blood Donor Policies

A FDA advisory panel on Tuesday struggled on a decision to lift a ban on gay men donating blood. The donation restriction is tied to concerns about the safety of the blood supply. The FDA group avoided a decision on changing the policy, while a separate panel last month voted allow blood donations from gay men who have not had sex in more than a year. However, a group of lawmakers are growing impatient on the FDA’s deliberations on the topic.

CQ HealthBeat’s (@CQHealthTweet) Kerry Young reported (subscription) on the Tuesday panel discussion, which focused on the balancing of risks and the politics of any changes to blood donation polices. Additional concerns were voiced about blood donations from people who travel to regions where malaria is present. The advisory panel discussions and decisions are not binding and the ultimate decision on changing blood donor policies rests with the FDA.


December 1, 2014

To Cut or Not to Cut: CDC Poised to Offer Circumcision Guidance (Updated)

The Centers for Disease Control and Prevention on Tuesday will unveil new guidance on health outcomes relating to elective male circumcision. The agency has been developing counseling guidance for health care providers based upon recent clinical trials and reports that have demonstrated some effectiveness of circumcision in reducing the risk of HIV and several sexually transmitted diseases. The report will also address social, ethical and religious factors relating to circumcision. A notice opening up a 45-day comment period on the looming guidance text will be published on Tuesday.

A recent federal survey indicated 88 percent of non-Hispanic white men and 79 percent of non-Hispanic black men are circumcised but the rates are lower for other ethnicities. However, the study also notes that many of those surveyed did not correctly identify whether they are circumcised.

Update:  The CDC on Tuesday released proposed guidance and background materials on circumcision counseling.




By Paul Jenks Posted at 2:43 p.m.

Week Ahead: Children’s Health Insurance Options and Veterans’ Care

The primary objective for Congress over the next two weeks is an agreement on a stopgap spending bill funding the federal government beyond Dec. 11. The current leading suggestion is a hybrid package offering possible full-year discretionary funding for most federal agencies, including health care programs, plus a temporary spending provisions for immigration programs.

However, congressional committees continue year-end hearings on several  health topics. On Wednesday, a House Energy and Commerce Committee panel offers a preview of upcoming options on the 2015 renewal of the Children’s Health Insurance Program. Also, congressional veterans’ panels examine VA health caregiver support and Hepatitis C treatment programs.

Meanwhile, on Wednesday afternoon the Bipartisan Policy Center sponsors a discussion on the use of technology to advance patient safety and the Cato Institute mulls the need for public funding to enhance scientific progress.

On Friday, two groups offer an analysis of what Congress will do next year on health care issues. The Alliance for Health Reform hosts a media-only briefing with congressional staffers and the Cato Institute examines available GOP options for repealing the health care overhaul law.

By Paul Jenks Posted at 8:55 a.m.

November 26, 2014

Smoking Rate Declines But Some Groups are Prone to Continue Puffing

The Centers for Disease Control and Prevention this week reports that the level of adults smoking cigarettes is at the lowest level since record keeping began in 1965. The CDC has been surveying regular declines in smoking rates and the agency’s current survey notes a decline in cigarette smoking from 20.0 percent of the population in 2005 to 17.8 percent in 2013. The CDC survey also highlights some population groups that are still particularly prone to smoking, including males, Southerners, American Indians/Alaska Natives, people with disabilities and those who are lesbian/gay/bisexual.

CQ HealthBeat’s (@CQHealthTweet) John Reichard reported (subscription) Tuesday on a various studies that indicate that one group, who reportedly smoke nearly 30 percent of all cigarettes, are people with mental illnesses. Federal officials from the Substance Abuse and Mental Health Services Administration this week noted that only one in four of the nation’s mental health treatment facilities have smoking cessation programs.



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