WASHINGTON _ A bipartisan team of senators that calls itself the"mainstream coalition" was close to producing a bare bones health carereform plan on Friday. Focusing on cost containment rather thanuniversal coverage, the group has reportedly axed costly benefitprograms contained in the Democratic bill introduced by SenateMajority Leader George Mitchell (Maine).Although no specific language is yet available, the mainstreamapproach apparently relies upon insurance market reforms, deficitreduction and subsidies to aid the poorest Americans in obtaininghealth care coverage.Meanwhile, the House Democratic leadership bill drafted by Rep.Richard Gephardt (D-Ill.) is in limbo while the Congressional BudgetOffice (CBO) completes an analysis. And the Mitchell bill has beenmoving through the debate and amendment process in the Senate at aglacial pace for the last 10 days.Amgen Inc.'s vice president of government and public relations, PeterTeeley, told BioWorld that until the mainstream proposal is fleshedout, it's "a thumb-sucking exercise" to guess what it might contain.Although some pundits and senators have said health care reform isdoomed this year, Teeley maintains "it ain't over 'til it's over." (Incontrast, Sen. Phil Gramm (R-Texas) said on Thursday that Mitchell'sbill was "deader than Elvis.")Reports suggest that the mainstream plan may not contain elements thatthe biotechnology industry criticized in Mitchell's bill. For example,the mainstream group's Medicare outpatient prescription drug benefitwill reportedly provide coverage only for those who join managed careplans, such as health maintenance organizations (HMO). This featurecould remove the rebate requirements imposed by a government-delivered drug benefit option outlined in the Mitchell bill.Teeley agreed that early reports about the mainstream plan suggest itmay be less onerous than Mitchell's. "It's clearly a much more targetedapproach than any of the other bills with a much smaller drug benefitprovision," he said. "But if that's accepted by the leadership, you'regoing to have an amendment from [Sen. David] Pryor [D-Ark.] to geteverything back in."Pryor, a critic of high-priced drugs and a staunch supporter of seniorcitizens, is an advocate of a Medicare prescription drug benefitaccompanied by a full array of cost containment provisions, includingrequired rebates. Opposition to the mainstream plan is also bound tocome from the American Association of Retired Persons (AARP) andother seniors' groups that will balk at the skimpy drug benefits and thereported lack of coverage for long-term care. AARP recently endorsedboth the Mitchell and the Gephardt bills.AARP's chief lobbyist John Rother told BioWorld that the mainstreamproposal to extend prescription drug coverage only to those Medicarerecipients who are enrolled in HMOs, "essentially does nothing." Onlyabout 2.9 million of Medicare's 32 million beneficiaries receive carevia HMOs and they already have drug coverage. He said that althoughthe Mitchell drug benefit was costly (the CBO said it would cost $95billion between 1997 and 2002), it would save the system money in thelong run.As far as Teeley is concerned, both the House and Senate still havehealth care reform bills pending that contain provisions, such asrequired rebates, that are potentially damaging to competition andresearch and development in the drug industry. "Until these provisionsare removed, we are in jeopardy. It's too early to say what will happenhere," Teeley said. "George Mitchell is a determined and intelligentlegislator. He has a hard-core group of 40 senators, maybe as many as46, who support him."Republicans Likely To Vote NayOn the other side of the aisle however, are 40 Republicans who willmost likely vote against any comprehensive reform bill and against allprovisions that expand government involvement in the health caresystem, including those that the biotechnology industry has complainedabout.Those Republicans may be joined on certain narrow issues by a fewDemocrats in the Senate, namely senators from states with highconcentrations of pharmaceutical and biotechnology companies. Forexample, insiders believe that New Jersey Senators Bill Bradley andFrank Lautenberg, both Democrats, may make removal of rebaterequirements a condition of their support for Mitchell's bill. DemocratsDianne Feinstein and Barbara Boxer from California and EdwardKennedy and John Kerry from Massachusetts are expected to step up tothe plate for the biotechnology industry, as well.Biotechnology companies are largely concentrated in states withDemocratic senators _ such as New Jersey, Massachusetts, Californiaand Maryland _ and holding Democrats together will be Mitchell'smain objective in the tough fight ahead. Mainstream Plan May Contain Cost CommissionAlthough the mainstream plan is not finalized, it may also establish acommission to make recommendations on how to control costs and tobroaden access to the health care system. The Mitchell bill contained asimilar provision, dubbed the National Health Care Cost and CoverageCommission, that could make recommendations to Congress on a "fast-track" basis.Mitchell's commission was criticized by biotechnology industryadvocates and others as a stealth expansion of governmental controlover health care. The fast-track mechanism means that thecommission's legislative recommendations could be placed on theSenate floor for debate without amendments."This commission could set up an advisory council on breakthroughdrugs or any other type of price control mechanism for biotech drugs,"a Biotechnology Industry Organization background paper claimed."Investors in the biotechnology industry will fear the powers of thecost containment commission. They will take their investment dollarsto other industries."Gail Wilensky, former director of Medicare and Medicaid at theDepartment of Health and Human Services (HHS) Health CareFinancing Administration, criticized the fast-track powers enjoyed byMitchell's commission. "That is essentially a fast-track process forprice controls. It's an up-down vote in a confined time frame,"Wilensky told BioWorld. "It means that policies can get through thatare consistent with the Majority's views but that wouldn't necessarilypass as separate legislation."Not everyone in the industry was alarmed by Mitchell's cost andcoverage commission. As Genzyme Corp.'s Washington lobbyist LisaRaines reasoned, "There's nothing to stop HHS from establishing aprice review commission today if it wants to. (HHS Secretary) Shalaladoesn't need an act of Congress to do it."The mainstream coalition's proposed commission may or may notinclude the fast-track recommendation mechanism as in Mitchell's bill.Nonetheless, commissions of any kind in health care reform plans seemto make the pharmaceutical and biotechnology industries queasy. n

-- Lisa Piercey Washington Editor

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