2011-09-01

Debt Deal Sets Up New Spending Challenges for NIH and Medicare Physician Payment

President Obama and Congress reached agreement on legislation to raise the nation’s debt limit and reduce the national deficit just prior to the August 2 deadline. While the passage of the “Budget Control Act of 2011” ends one of the most litigious legislative periods in contemporary congressional history, new difficulties lie ahead. Another deadline looms September 30 for passage of the fiscal year (FY) 2012 spending bill or a funding extension resolution that will impact funding for the National Institutes of Health. Beyond FY 2012 funding comes action by the Budget Control Act’s new special congressional panel, assigned to find $1.5 trillion in additional reductions and possible Medicare cuts on top of the scheduled 29.5 percent physician payment reduction beginning in January. The panel is required to report its recommendations to the Congress by a majority vote no later than November 23, 2011. Congress is required to vote on the recommendations by December 23, 2011. If the panel finds at least $1.5 trillion in savings and its recommendations are enacted by Congress, the debt ceiling will be raised by $1.5 trillion. If the panel fails to produce a bill, its bill is not enacted, or it produces less than $1.2 trillion in savings, the debt limit will increase by $1.2 trillion and across-the-board cuts known as “sequestration” will be triggered to achieve $1.2 trillion in savings. For the latest information about the Budget Control Act and how it will impact hematologists, please visit the ASH website.

Meanwhile, progress on most fiscal year (FY) 2012 spending bills was slowed significantly due to the deficit negotiations. With both the Senate and House adjourned until early September, it remains unlikely that the appropriations process will be completed by the start of the new fiscal year on October 1. As a result, Congress would have to implement what is known as a continuing resolution that would simply fund the government at current levels to avoid a government shutdown.

In lieu of the finalization of the FY 2012 budget, the Society encourages all members to visit the ASH Advocacy Center (www.hematology.org/takeaction) to take action to urge support for NIH funding. To obtain the latest information about the FY 2012 budget and its impact on NIH, please visit the ASH website.

Update on Hematologic Drug Shortages: ASH Advocacy and Resources for Physicians 

The United States continues to experience severe shortages of drugs used to treat patients with hematologic malignancies, including leukemia and lymphoma. An increasing number of physicians have been forced to take their patients off therapies midtreatment, delay treatment, choose alternative therapies that are less effective, and ration their remaining supplies of these therapies. ASH members have reported severe shortages of carmustine (BiCNU), bleomycin injection, cytarabine (Ara-C), daunorubicin, leucovorin, and thiotepa.

The Society has taken a number of steps to provide its membership and the patients they serve with the most up-to-date information to assist them during this critical time while working with policymakers on possible solutions. Information about specific drug shortages (including what is causing the delays and when the drugs will become available) is posted on the ASH website as it becomes available. ASH has also alerted the Food and Drug Administration (FDA) to the hematology/oncology drug shortages and requested an official response to the matter.

ASH also continues to work with policymakers on legislation to address this problem. Members of the ASH Committees on Government Affairs and Practice, along with ASH Vice President Dr. Armand Keating and Dr. Samuel Silver, chair of the ASH Reimbursement Subcommittee, met with congressional offices to garner support for legislation (S. 296 and H.R. 2245, the Preserving Access to Life-Saving Medications Act) that seeks to take the first steps toward addressing the critical shortages of certain hematology-related chemotherapy and other lifesaving drugs. The Society requested that a congressional hearing on the problem of drug shortages take place, where the FDA’s ability to address this problem, as well as how future shortages may be prevented, will be discussed.

Update on Health Reform Implementation: Opportunities for Patients with Pre-Existing Conditions 

The Patient Protection and Affordable Care Act enacted last year created a new program that provides a health coverage option for individuals who have been uninsured for at least six months, have a pre-existing condition, and have been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private insurance company. This program will provide coverage until 2014 when such individuals will have access to affordable health insurance choices through an exchange and can no longer be discriminated against based on a preexisting condition.

The U.S. Department of Health and Human Services (HHS) is trying to increase enrollment in this program for people with pre-existing medical conditions by reducing premiums and easing application requirements. HHS announced on May 31 that an applicant for the Pre-existing Condition Insurance Plan (PCIP) will be able to qualify in part by submitting a letter from a physician, physician assistant, or nurse practitioner stating that the patient has or has had a pre-existing medical condition, disability, or illness. The department previously had required PCIP applicants to submit a letter of denial from a health plan before qualifying.

HHS also is lowering plan premiums by up to 40 percent in 18 states and notifying other states that they can enact similar premium reductions. The application and premium changes became effective July 1. The federal government is running the program in the following states: AL, AZ, DC, DE, FL, GA, HI, ID, IN, KY, LA, MA, MN, MS, ND, NE, NV, SC, TN, TX, VA, VT, WV, and WY. The remaining states are running their own programs.

HHS has posted information about the program and brochures or to share with patients at www.healthcare.gov/center/brochures/pcip_toolkit_news.html. 

Take Action Today 

Help effect change! Go to http://grassroots.hematology.org to read about ASH’s latest advocacy efforts on issues that impact hematology, find resources to help you get in contact with your legislators, and sign up for the ASH Advocacy Update, a monthly electronic newsletter concerning ASH advocacy news and information.

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