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APS Bulletin • Volume 19, Number 1, 2009
Pain and the Law
Ben A. Rich, PhD JD, Department Editor
Key Legislative Influencers: What They Mean for Health Reform and Pain Care
Jane Martinsons, Staff Writer
Change has come to Washington, but what exactly does that mean for pain care? In late January, as Reps. Lois Capps (D-CA) and Mike Rogers (D-MI) introduced the National Pain Care Policy Act (H.R. 756) in the House of Representatives, Bob Saner, legislative counsel for the Pain Care Coalition (PCC), spoke with APS Bulletin to give his take on key Washington influencers, including who’s new, who’s returned, and what the changes mean for health reform and pain care. The PCC comprises APS, the American Academy of Pain Medicine, the American Headache Society, and the American Society of Anesthesiology.
Even with the current economic crisis, it’s clear that healthcare reform is an important priority for this new administration. President Obama already has committed to two efforts: The permanent reauthorization and expansion of the State Children’s Health Insurance Program (SCHIP) and the American Recovery and Reinvestment Act of 2009, which is chocked full of new money for various health programs. States will receive that new slug of money to ensure that the economic downturn doesn’t cripple Medicaid. Both of these efforts are on the fast track at the beginning of the 111th Congress.
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“Keep in mind that in the overall scheme of things, particularly with the economic
crisis, the Pain Care Policy Act is a relatively small bill... Do you get it moving
at the beginning or the end of the session? Last year it was handled at the end, which is typical of small bills.” —Bob Saner, Legislative Counsel for the Pain Care Coalition |
Although it’s not clear how other healthcare reform measures will play out later in the year, key influencers on Capitol Hill are staking out their turf, Saner says. Despite his failing health, Senator Ted Kennedy (D-MA) has orchestrated a plan that presumably would originate in the Senate Committee on Health, Education, Labor and Pensions (HELP). Senator Max Baucus (D-MT), chair of the Senate Finance Committee, has a separate effort. “All of these efforts generally trend in the same direction—Maintain employer-based coverage where possible while expanding government backstops for those without it—but differ in many details,” Saner says. “At this point, there is no ‘front-runner’ plan on the Hill, and the President has not weighed in with his own plan.”
Still, health reform may be overshadowed by the economic crisis. Further, President Obama’s mandate for “big picture” health reform will have little effect on modest public health measures like those championed by the PCC last Congress, Saner says. Many of the President’s cabinet and staff choices come from his inner circle in Chicago or are previous members of the Clinton Administration. Saner emphasizes that the PCC will be scouting for people in President Obama’s inner circle who know and care about pain.
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A NEW CONGRESS—AND NEW PLANS FOR THE PAIN CARE COALITION The Pain Care Coalition (PCC) met in mid-January to assess its accomplishments over the last couple of years and to discuss plans for the next 2 years with a new Congress. Among its accomplishments, the PCC played a key role in drafting both the Veterans Pain Care Policy Act and the Military Pain Care Policy Act of 2008. The former was enacted into law last October, and the latter produced a directive from the House Armed Services Committee to the Defense Department to develop a pain care initiative in military health facilities. Now, the PCC’s top priority is to “push forward the remaining part of the initial agenda, the Pain Care Policy Act, to see if we can’t get that to the finish line in this Congress,” says Bob Saner, legislative counsel for the PCC. Last session, the House of Representatives passed the bill (H.R. 2994), but the Senate fell short on doing so. “The Coalition is pleased that this bill has already been reintroduced in the House as H.R. 756, and hopeful that it will be dropped in the Senate ‘hopper’ soon. We think this will be the Congress when we finally get that done,” Saner says. Much of the discussion centered on the National Institutes of Health (NIH). With national pain care policy acts advanced in Congress, the Pain Care Coalition plans to turn more of its attention to NIH funding for pain research. Saner says that the group aims to deliver “a broad congressional declaration” to the NIH and other government health agencies that makes clear that pain is a public health priority and calls for stepping up pain care research, training, and professional and consumer education. PCC members agreed that the group needs to get “more traction inside the NIH and more leverage from Capitol Hill on NIH funding for pain research,” Saner says. Although APS meets annually with leaders of the Pain Consortium at the NIH, “in the long run, we need to get the House and Senate Appropriations Committees to simply tell the NIH that they have to put a higher priority on pain research, and that means spending more money on it.” Saner adds that an appropriations effort is underway and poised to accelerate in coming years. Already the Coalition is working with Senator Tom Harkin (D-IA), member of the Senate Appropriations Committee and chairman of the Appropriations subcommittee that funds NIH. “On the House side, some pain physicians in Pennsylvania have started an effort there [forming a coalition of research institutions to advocate for increased appropriations for pain] that has gained some modest traction,” Saner says. As for the VA, Rollin (Mac) Gallagher, MD, a longtime pain care advocate and deputy director of the VA’s national pain care strategy, told the PCC that the VA is taking serious note of last year’s legislation and is working hard internally to develop a new and even more ambitious pain care strategy. The PCC plans to stay focused on Congress rather than on regulatory agencies such as the Drug Enforcement Administration and the U.S. Food and Drug Administration (FDA), and on Medicare payment coverage. PCC members agree that individual pain care societies and their members are already effectively tackling these issues. Edward Michna, MD JD, was elected chairman of the PCC and will serve a 2-year term. Dr. Michna is one of two APS appointees to the PCC’s Steering Committee. Ronald Dubner, PhD DDS, professor and chair of the Department of Biomedical Sciences at the University of Maryland Dental School, continues to serve as an APS representative to PCC. He provides a unique perspective on pain research funding given his previous experience within the NIH. Meanwhile, PCC members expressed interest in broadening the group’s membership, enhancing the PCC’s visibility among members of participant societies, and creating a Web site. |
Last session, the PCC was successful advancing military and veteran pain care bills with two freshmen—Reps. Dave Loebsack (D-IA) and Tim Walz (D-MN)—in the lead, mainly because their senior committee leaderships helped them champion these bills as accomplishments in their first session. The PCC also will look for those opportunities among freshmen this year, even though the lead sponsors for the Pain Care Policy Act—Reps. Lois Capps (D-CA) and Mike Rogers (R-MI)—are firmly in place.
Freshmen are less likely to be key players on another PCC priority— National Institutes of Health (NIH) appropriations for pain research. That, according to Saner, is an inside game dominated by senior members on the relevant subcommittees.
So who are the key influencers?
HHS and NIH
Key Players
At press time, nominations for the NIH, the Centers for Medicare & Medicaid Services, the Food and Drug Administration, and the Centers for Disease Control had not been sent to Capitol Hill yet, although several names are active in the rumor mill. Meanwhile, Harold Varmus, MD, former director of the NIH, has been named a cochair of the President’s Council of Advisors on Science and Technology. Dr. Varmus has some knowledge and exposure to pain care issues through his former role at the NIH.
What It Means for Pain Care
Without new subcabinet appointees at the U.S. Department of Health and Human Services (HHS), it’s too early to speculate how this will affect pain care. It’s safe to predict, however, that the appointees will be more interested in new public health initiatives than their predecessors in the Bush Administration, and therefore less resistant to increases in NIH funding. Research science in general and NIH in particular, also may benefit from increased short-term funding through the American Recovery and Reinvestment Act, which was the first order of business for the new administration.
New House of Representatives
Key Players in the House Energy and Commerce Committee
This committee’s priorities could change in the wake of Henry Waxman’s (D-CA) successful challenge to John Dingell (D-MI) for chair of that panel. With Rep. Waxman at the helm, there could be significant changes to subcommittee assignments, including the health subcommittee. Rep. Waxman recently announced plans for Rep. Dingell to serve as his point person on health reform—that, at least, is the unofficial word. Reps. Capps and Rogers remain on the full committee, which has jurisdiction over the Pain Care Policy Act.
Key Players in the Health Subcommittee
Frank Pallone, Jr. (D-NJ) will return as chair of this subcommittee, and former Chairman Dingell may play a more important role here than before. Rep. Capps will continue to play a key role on the subcommittee and presumably Rep. Rogers will as well, although formal subcommittee assignments have not been made yet on the Republican side. In terms of health reform, other key players on this committee will be Reps. Waxman, Dingell, Ed Markey (D-MA), Pallone, and, on the Republican side, Joe Barton (R-TX) and Nathan Deal (R-GA).
What It Means for Pain Care
Reps. Capps and Rogers remain in positions to move the Pain Care Policy Act again as they did last year. They will need help from Reps. Waxman and Barton with respect to the right legislative timing and the vehicle. Because the bill went through the House Committee and the full House successfully last year, Saner believes individual committee members will not need convincing. At this point, the focus is more on tactics and strategy with an eye toward the Senate.
“Keep in mind that in the overall scheme of things, particularly with the economic crisis, the Pain Care Policy Act is a relatively small bill,” Saner says. “Do you get it moving at the beginning or the end of the session? Last year it was handled at the end, which is typical of small bills. However, [Reps.] Capps and Rogers want this passed, so we follow their lead and work with them to help them do that.”
Key Players in the House Ways and Means Committee
There is not a lot of change in key players, particularly on the Democratic side. Charlie Rangel (D-NY), who chairs the full committee, has been under scrutiny for some of his financial dealings. Although unlikely, if he were asked to step aside either temporarily or permanently, Pete Stark (D-CA) would be chairman. Even if Rep. Rangel doesn’t step aside, Rep. Stark, as chair of the Subcommittee on Health, should be considered a very key player on health reform. Other important figures on this committee are Sander Levin (D-MI) and Jim McDermott (D-WA).
On the Republican side, there is an interesting development with Dave Camp from Michigan moving up to become the ranking Republican on the House Ways and Means Committee. “This means that, to have any hope of having a bipartisan healthcare reform bill (versus one that Democrats push on Republicans on the House side), [Rep.] Rangel has to have [Rep.] Camp’s support,” Saner says. “He also needs [Rep.] Barton from the Commerce Committee and the Republican leader in the House, John Boehner [OH], on board. Otherwise it’s just a Democratic bill, and all of the real action is in the Senate.”
What It Means to Health Reform
Although irrelevant for purposes of the Pain Care Policy Act, the Ways and Means Committee is vital to health reform because of its jurisdiction over much of the existing Medicare program, and on tax policy. If, as many assume, there is a tax-policy component to any healthcare reform bill, this committee will have considerable influence.
Key Players on House Appropriations
Dave Obey (D-WI) continues as chair of the full committee and Jerry Lewis (R-CA) as ranking minority member. Rep. Obey also maintains his role as chair of the Labor HHS Subcommittee, which writes the NIH funding bill each year. Todd Tiahrt of Kansas is ranking Republican on the subcommittee. Other important players for NIH funding will be Nita Lowey (D-NY) and Rosa De Lauro (D-CT).
New Senate
Key Players
There are eight new Democrats representing Colorado, New Hampshire, New Mexico, North Carolina, Oregon, Virginia, Alaska, and Minnesota, and two new Republicans in Idaho and Nebraska. Pain care allies Christopher Dodd (D-CT) and Orrin Hatch (R-UT) likely will be back in senior posts on HELP. Small public health bills generally move through HELP in a bipartisan way. Senator Michael Enzi (R-WY), ranking minority member of the HELP Committee, and Senator Tom Coburn (R-OK), who was a last-minute obstacle to the pain bill in the Senate last fall, will remain on the committee.
Assuming the PCC will have continuing involvement with the Senate Armed Services and VA Committees next Congress, two or three spots could be filled on the Republican side of Armed Services and only one Democratic slot (Obama’s vacancy) on the VA Committee. Two key PCC allies on the VA Pain Bill, Senators Daniel Akaka (D-HI) and Richard Burr (R-NC), were not up for reelection this year and both will be back on the committee in key roles.
Key Players on the Senate HELP Committee
Sen. Kennedy is chairman of the committee and a monumental figure in Congress on healthcare issues. The big question is whether his health is going to permit him to continue playing a key role. If it doesn’t, the chairmanship of the committee probably goes to Sen. Dodd. Other key players on the Democratic side on this committee are Tom Harkin (D-IA) and Barbara Mikulski (D-MD). On the Republican side, key players on healthcare reform will likely be Sens. Enzi, Hatch, and Burr.
“In the Senate, any senator can have a strong voice on any issue, and something as big as healthcare reform will attract many volunteers,” Saner says, adding that one likely candidate on the Republican side is Sen. Burr. “When [Sen.] Burr served on the Commerce Committee in the House, he was knowledgeable and active on health issues, and he is off to a good start on health issues in the Senate. He also works well on bipartisan issues, which health reform must be in the Senate. He’s the logical choice for Republicans on the HELP Committee to lead health reform efforts.”
Key Players on the Senate Finance Committee
Sen. Baucus, chairman of this committee, has been active on Medicare and Medicaid for many years, and he has his own working group on health reform. He’s trying to stake out his place in that debate. The ranking Republican is Chuck Grassley (R-IA), who will be important in health reform. But Sen. Hatch, while number two behind Sen. Grassley, probably is more important than Sens. Grassley and Enzi among Republicans. A longtime senator, Hatch has been active in Medicare and Medicaid issues, as well as public health and NIH issues. He’s worked well in a bipartisan basis on healthcare issues, and he’s worked well with Sen. Kennedy on health issues, in particular.
“I can’t imagine a healthcare reform bill getting through the Senate without both [Sens.] Kennedy and Hatch on board,” Saner says. “Other key players are John D. Rockefeller IV (D-WV) and Ron Wyden (D-OR), who is a big player on Medicare and Medicaid issues, particularly long-term care. Aggressive and smart, [Sen.] Wyden will want a sizable voice on the Finance Committee.”
What It Means for Pain Care
The HELP Committee, not the Finance Committee, handles the Pain Care Policy Act. Sen. Hatch introduced the PCC-supported bill in the Senate last year, and Sen. Dodd was the lead cosponsor. Saner hopes they will do so again this year, hopefully early in the session so that both the PCC and grass roots APS members will have ample time to build support for it in the HELP Committee and the full Senate.
“We know from last year’s experience that Senator Coburn and perhaps other Republicans on the Committee will have reservations about the bill,” Saner says. “But we think we have the momentum, and we know we have a strong base of support from professional and patient advocates throughout the country. With hard work and perhaps just a bit of luck, we can get this important piece of business done in the 111th Congress.”
Key Players on the Senate Appropriations Committee
This committee sees more change at the top this year than any other of importance to the PCC’s legislative efforts. Longtime Chairman Byrd (D-WV) has stepped aside for health reasons, and longtime Republican power on the committee, Ted Stevens (R-AK), was defeated after first being convicted on ethics charges. The new full committee chair is Daniel Inouye (D-HI), with Thad Cochran (R-MS) continuing as ranking Republican. Tom Harkin (D-IA) continues as Chair of the Labor HHS Subcommittee, with Arlen Specter (R-PA) as ranking subcommittee Republican.
“With NIH funding for pain research declining, the PCC intends to spend a lot more time with the appropriators in the future,” Saner says. “This will take a strong grassroots push from APS members, coupled with some inside-the-Beltway advocacy. It will also take time, but increasing pain funding at NIH is definitely doable, and this subcommittee, more than any other Congressional pressure point, can make it happen.”
Interested in Politics?
Are you interested in becoming more involved in politics, either at the
leadership or grassroots level? Do you know a key influencer in Washington?
APS could use your help! Contact APS Senior Manager Cynthia Porter,
cporter@connect2amc.com or 847/375-4876, to get involved.
