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 this year?
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 critical times.
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 this proposal.
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 self-injectable.
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 costs.
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 exponential.
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