WASHINGTONRep. Rick Lazio (R-NY) is a vocal advocate within
Congress for cancer research and cancer patients. The fourth-term
representative from Long Island is founder of the House Cancer
Awareness Working Group. He has been a leader in efforts to increase
the National Cancer Institute (NCI) budget and has sponsored or
co-sponsored major pieces of cancer legislation.
Rep. Lazio serves in two key House leadership roles. He is Assistant
Majority Leader, a post in which he helps set the House legislative
agenda, and Deputy Majority Whip, where he helps track the policy
views and voting intentions of Republican members.
In this interview with Patrick Young, ONIs Washington Bureau
Chief, Rep. Lazio looks ahead at the major cancer issues that
Congress will confront in the months before the 2000 elections.
ONI: What do you see as the most important cancer-related issues
facing the Congress in the coming year?
REP. LAZIO: Obviously, we need to press forward with significant
increases in the budgets of the National Institutes of Health and the
National Cancer Institute. We need to continue to press forward on
access to clinical trials. Victims of childhood cancer who are
treated in clinical trials at NIH protocol hospitals have made
significant progress in terms of survivability. We need to do the
same for adults.
Medicare reimbursement for clinical trials is an important issue, and
we need to complete our work on managed care so that ordinary care in
clinical trials is covered as a reimbursable expense. [See the IOM
recommendations to the Health Care Financing Administration .]
Three of the four managed care bills considered by the House last
year had my language, which included paying for patient care in
FDA-sponsored clinical trials. Unfortunately, the bill that passed
the House, the Norwood-Dingell bill, did not. I hope we will be able
to correct that oversight this year, either at the House-Senate
conference on the bill or in legislation.
There are other problems. We need to do a better job of getting
minorities into clinical trials, especially cancer trials. We need to
do better at getting more adults as a percentage into clinical
trials. We need to continue to be vigilant about ensuring that the
people who are considering participating in clinical trials dont
have to fear employment or insurance discrimination.
And we need to make sure that people have access to the information
they need to find out how they can volunteer to participate in
clinical trials. That is one broad area that deserves strong support,
and we have the opportunity to do that with Medicare and managed care
initiatives that would extend reimbursement to people in clinical trials.
ONI: Do you expect passage of the Breast and Cervical Cancer
Treatment Act, which you introduced in 1999?
REP. LAZIO: That would be another high priority for the Congress and
for the President, I would hope. This bill would also help to close a
gap in coverage. Right now, we have a successful screening program
run by the Centers for Disease Control and Prevention for women above
the Medicaid line, often classified as the working poor.
The perversity of the current system is that there is no public
program to treat these women. If they do not have insurance, they
have to rely on a patchwork of charity care with poor follow-up and
certainly without any sense of comprehensive care.
The Breast and Cervical Cancer Treatment Act would give states the
option to provide Medicaid coverage to women who are diagnosed
through CDC-supported screenings. That will be among the highest
cancer priorities on the federal level this year.
ONI: Are there other major issues that Congress should deal with
REP. LAZIO: There are many administrative issues, some of which we
have dealt with on a short-term basis, others that we have not yet confronted.
For example, there is the AWP 17 proposal by the Administration,
which would reduce the Medicare reimbursement of cancer drugs. This
would save the federal government some money in the short run, but
the probable outcome of this program is that we will have more
patients who dont get appropriate anticancer medication at
As a result, their health problems will become more acute and more
expensive for the federal government. So, what seems like a
short-term, up-front fix will likely cost the federal government a
lot more money. We need, at the very least, to authorize a study of
Another issue is a Health Care Financing Administration rule, likely
to be offered, that would deny Medicare reimbursement for any
self-injected cancer drug or any that is theoretically
That would also have the net effect of potentially denying patients
who could mitigate their illness the ability to do so and, therefore,
put them in the position where they will need more intensive, more
invasive, more acute, and more expensive treatment. That would be a mistake.
We have included some language in the Omnibus Appropriations Bill
that prevents HCFA from moving forward with these regulations right
now, but it is a temporary fix, and we need to stay very vigilant on that.
ONI: That raises the question of oral cancer medications, for
which Medicare re-fuses to pay. Will Congress change that?
REP. LAZIO: This issue is categorically very similar. By using either
a self-injected or an oral therapy, patients are empowered to care
for themselves. Denial of these benefits has the net effect of
exacerbating adverse health effects and, therefore, exacerbating
So these restrictions do not make sense, except from some
green-eyeshade point of view, and they show no real appreciation of
the long-term consequences, both for the health of the individual and
for the budget.
ONI: Is it reasonable for cancer advocates to expect the
continuation of the 10%-plus increases in the NCI budget that we have
seen in the last few years?
REP. LAZIO: Yes. One commitment of the majority in Congress is to try
to double the NIH budget and, through it, that of NCI. We had nearly
a 15% increase for this fiscal year. I think that commitment will be
sustained. As long as the number of research proposals far outstrip
our resources to fund them, and as long as we are witnessing this
explosive era of discovery, this is the time to leverage federal
resources in basic research to expedite the breakthroughs that are
already on the horizon.
We have enormous potential over the next 5 years to open new vistas
of knowledge on cancer. This is a blessing, in the sense that the
dollars that have been invested by the federal government and by
private foundations are really yielding results, and they are
It is frustrating in that you know that the discoveries will not be
in time for some cancer patients. It is a time of great promise and
of great potential for unparalleled discovery. It is also a time to
redouble our efforts, to leverage our dollars, and to make sure no
stone goes unturned.
ONI: How effective are groups such as the American Society of
Clinical Oncology and the National Coalition for Cancer Research in
influencing the passage of legislation?
REP. LAZIO: They are very helpful. They help provide forums that
build the knowledge base of congressional staff and the members
themselves. They help provide a filtering process between the
researchers and the policy makers.
ONI: The relationship in Congress between the two parties can get
a bit fractious. Does partisanship influence efforts to pass cancer legislation?
REP. LAZIO: Generally, efforts in the war against cancer are
bipartisan, but like any other issue, partisanship rears its ugly
head. It is incumbent on the members to remind themselves that we are
talking about a disease that knows neither Republican nor Democrat.
It doesnt care who is affected by it. Cancer has got to be
fought with that understanding. It is a disease that knows no
boundaries, and it deserves and requires a bipartisan commitment. ONI