Congress May Revisit Cancer Bills It Failed to Pass in 2002

WASHINGTON—The 107th Congress, by general agreement, will not enter the history books as a major contributor to medical and health policy. However, legislation it failed to pass serves as a prologue to some of the issues the new 108th Congress will consider during the next 2 years, said Susan Erickson, acting director of the National Cancer Institute’s (NCI) Office of Policy Analysis and Response. "We will probably continue to see these themes, no matter what specific pieces of legislation come back," she said at a meeting of the National Cancer Advisory Board.

When the last Congress adjourned in late November 2002, it had failed to pass 11 of the 13 Fiscal Year 2003 appropriation bills, including the one for the Department of Health and Human Ser-
vices (HHS). That meant that all HHS components, including the NCI, remained in operation under a continuing resolution that kept their budgets at the level of FY 2002, which ended last September 30 (see ONI January 2003, p. 4).

The new Congress immediately extended the continuing resolution, and the House and Senate resumed work to enact the remaining FY 2003 appropriations bills.

In the last Congress, the Senate reported an HHS budget bill that included $4.642 billion for the NCI, an increase of 12% over its FY 2002 appropriation. That sum is unlikely to change in this session. The House, however, failed to agree on a budget for the department. When it does, a House-Senate conference committee will have to work out differences between the two bills before either body votes on a final HHS budget.

The 2002 election increased the number of Republican members in both houses and returned control of the Senate to the GOP. The Republicans now control both the Congress and the White House. The change of power in the Senate resulted in new chairmen of the committees that handle NCI’s budget appropriations. Sen. Ted Stevens (R-Alaska) now leads the Appropriations Committee and Sen. Arlen Specter (R-Penn) chairs the appropriations subcommittee that develops the NCI budget.

When the 107th Congress ended, all unenacted bills introduced by members of the House and Senate died with it, and they must be reintroduced before they can be considered again. Major pieces of health legislation that failed to win passage included:

• Medicare coverage for chemotherapy drugs and their administration. Two committees, one in each house, held hearings last year on the issue of reforming the system by which Medicare pays for chemotherapy drugs through average wholesale price (AWP), a major priority for cancer organizations and advocacy groups. However, neither reported out a bill for a vote.

• Medicare coverage for oral cancer drugs. Although this legislation had support from a majority of members in both houses, neither one enacted legislation, primarily because of the increased cost to the Medicare program.

• A Medicare prescription drug benefit. The House passed a bill; the Senate did not. Both Republicans and Democrats have proclaimed this legislation a high priority for the current Congress.

Other health-related bills that did not receive congressional endorsement included 8 measures relating to clinical trials access, 10 in the area of patient privacy and discrimination, and 6 that would increase access to medical care. However, given the faltering economy, increasing budget deficit, demands for tax cuts, and the threat of war with Iraq and ensuing terrorist attacks on the United States, it remains uncertain how willing Congress will be to increase funds for health programs.

Nonetheless, Ms. Erickson expects that many of the issues that concerned members of Congress last year will again surface in legislation introduced in the new Congress. These issues fall under four themes.

Four Themes

The first is the quality of cancer care in general and the 1971 National Cancer Act, which some influential members of the cancer community argue needs revisions. Health disparity and disease prevention are two other themes she sees surfacing in this congressional session, with the national obesity problem as a particular concern. Ms. Erickson noted that obesity is a risk factor for several cancers.

Finally, members of Congress may again introduce measures relating to cancer survivorship. "Survivorship is a theme that is included in the quality of cancer care legislation," Ms. Erickson said. "Most of the past legislation calls on NCI to create an Office of Survivorship. That office exists here, but they would put that office into statute." ONI

Three Cancer Related Bills That Passed Last Year

Susan Erickson, acting director of NCI’s Office of Policy Analysis and Response, cited three pieces of legislation passed by Congress and signed into law by President Bush in 2002 that hold specific relevance for NCI.

• The Medical Device User Fee and Modernization Act of 2002 authorizes NIH to conduct or support studies of the long-term health implications of silicone breast implants and directs it to report the status of NIH’s breast implant research portfolio to Congress.

• The Benign Brain Tumor Cancer Registries Amendment Act requires statewide cancer registries to collect data not only on malignant brain tumors but also on benign ones.

• The Rare Diseases Act of 2002 authorizes an Office of Rare Diseases at NIH and regional centers of excellence for rare disease research and training. "Several forms of cancer are considered to be rare diseases," Ms. Erickson noted.