WASHINGTON _ Strap on your seat belts. Health care reform isabout to take some sharp twists and turns as it passes through threeHouse committees and two Senate committees in the 21 congressionalworking weeks left in 1994. Lawmakers, back in town after a two-week Easter recess, have seven short weeks until the Memorial Dayrecess."We are entering a crazy and confusing period for health care reform,"Biotechnology Industry Organization (BIO) vice president ofgovernment relations Chuck Ludlam told an audience at a TuesdayBIO meeting.Congress' current working period, April 11 through May 27, is alreadybeing referred to as "the seven weeks from hell" by denizens of CapitolHill. It could produce three separate bills from the three Housecommittees with primary authority over health care: Ways and Means,Energy and Commerce and Education and Labor. At the end of atortuous process, which will involve the House Rules Committee, onebill will pass the full House unless all the bills are rejected.While the House process is expected to be highly partisan _ the finalbill may squeak past with the support of 218 Democrats and almost noRepublicans _ the Senate process will undoubtedly be bipartisan. TwoSenate committees, Finance and Labor, will produce bills for the fullSenate to consider. Again, one bill will emerge from the Senate.The House and Senate bills will then go into conference, an intensenegotiation between congressional leaders from both chambers. Thecompromise bill would then have to be confirmed by the House andSenate and signed into law by President Clinton."We (the biotechnology industry) will be in jeopardy until the last dayof the conference," said Ludlam, who predicted that a conference couldtake place as early as August.So far, only the health subcommittee of the House Ways and Meanscommittee has managed to produce a full-fledged bill. But the bill,sponsored by subcommittee chairman Rep. Fortney "Pete" Stark (D-Calif.), has been sharply criticized by the BIO. "This is a bill withevery conceivable kind of elaborate intervention you can imagine interms of price controls," charged Ludlam.Indeed, Stark's bill already has been targeted for major revision bypowerful Ways and Means committee chairman Rep. DanRostenkowski (D-Ill.). Rostenkowski and his colleagues may revise theStark bill or reject it entirely and craft a new bill. Either way, a finalbill will eventually leave Ways and Means and proceed to the fullHouse.Meanwhile, Energy and Commerce Committee chairman Rep. JohnDingell (D-Mich.) is working on lining up Democrats in his committeeto support a bill. Dingell may chair a mark-up session on hiscommittee's version of health care reform as early as next week.According to Ludlam, Dingell is a force to be reckoned with and he isdeeply committed to health care reform. But Ludlam said that BIO hasmade its case against drug price control measures to members of theEnergy and Commerce committee. "We have won the intellectualdebate with committee members but not the deletion of specific pricecontrol provisions from the bill," claimed Ludlam.The House Education and Labor committee, which is expected toproduce a liberal health care plan akin to President Clinton's HealthSecurity Act, is still crafting its bill.All three House bills may contain elements loathsome to thebiotechnology industry. According to Ludlam, these would include anyform of a committee to review the reasonableness of prices of newdrugs, a provision for the secretary of Health and Human Services(HHS) to negotiate special rebates for new drugs under Medicare andthe power for the HHS secretary to "blacklist" certain drugs fromMedicare coverage.Fighting these provisions will be an uphill battle for the industry. "Weare dealing with skepticism and hostility toward the biopharmaceuticalindustry," acknowledged Ludlam.In the coming weeks and months, legislators will make increasinglypainful political and financial choices on issues such as universalcoverage, employer mandates, prescription drug benefits and newtaxes. Paying for health care reform has become the central challengefacing this Congress.Recent news from the Congressional Budget Office (CBO) mayprovide one glimmer of hope for those who wish to abolish a drugprice review committee from any health care plan. CBO scores eachindividual element of legislation according to its impact: either it costsmoney, saves money, generates revenue or is neutral.CBO scores are critical because law requires that new legislation bedeficit-neutral. In the zero sum game of budgeting for health care,items which generate revenues or control costs are the most valuableplayers. Expenditures are losers. And deficit-neutral proposals may beable to fly under the radar.According to Ludlam, CBO has scored a breakthrough drug committeeas neutral, costwise. This may make it easier for legislators to bargainthat chip away in the final hours of negotiation. Early reports suggestthe blacklisting provision may be scored as a savings. Ludlam said thatscoring the HHS secretary's privilege to negotiate rebates on new drugswill be problematic.He said that the power of CBO scores cannot be overestimated."Stark's bill proved that if you put draconian price controls into thesystem for everybody, you can convince CBO that the bill will pay foritself," said Ludlam.
-- By Lisa Piercey Washington Editor
(c) 1997 American Health Consultants. All rights reserved.