WASHINGTONA 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City Policyestablished by President Reagan in 1984 and rescinded by
President Clinton in 1993which bars nongovernment organizations that receive
federal funds from performing or supporting abortion for family planning in
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
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
On Capitol Hill, Congressan evenly split Senate and a House
with a thin Republican majoritywill 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
"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.
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 107th 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.