Actions by the Senate and House Appropriations Committees over the past two weeks signal disturbing and confusing trends for medical and cancer research funding. However, the Senate Appropriations Committee provided funds for a newly created Geraldine Ferraro Cancer Education Program in the Centers for Disease Control and Prevention (CDC) for hematological cancers.
NIH and NCI Funding
The House Appropriations Committee followed President Bush's fiscal year 2004 $27,663,991,000 recommendation for the National Institutes of Health (NIH), representing an annual increase of $681 billion. The Senate Appropriations Committee recommended $28.9 billion, a $1 billion increase over last year.
Within those amounts, both committees equaled the president's recommendation of $4.77 billion for the National Cancer Institute. This represents an increase of $170 million over last year, or slightly more than two percent.
Unless any amendments to increase funding for NCI are introduced and approved during the full House or Senate deliberations on the appropriations bill, it seems likely that the NCI funding for next year has been set.
The numbers for NIH will fall some between the House and Senate numbers, but it is generally acknowledged that the Senate numbers will be the optimistic outcome. After completing a five-year process to double the NIH funding, the new figures provide a sobering view of the future of federally supported medical and cancer research.
The newly approved funding levels seemingly ensure that NCI will not be able to improve on its current performance of funding just 28% of its approved grants. In fact, that number is likely to go down.
CDC Numbers Deliver Mixed Messages
While the Senate provided $5 million for the Ferraro Program, it's overall recommendation of $801.8 million for the CDC Chronic Disease and Prevention Program, which houses the cancer programs, was substantially lessby $61 millionthan the amount recommended by the House and the president.
To compare, the House provided $862 million for the CDC Chronic Disease and Prevention Programalmost $28 million more than the president requested in his budget. The House included no funds for the Ferraro program. The House has not yet made public how this funding will be broken down for its cancer programs.
The Senate did release its breakdown, providing $316.625 million for the CDC cancer programs, of which $5 million was designated for the newly created Ferraro program. It is unclear if the House and Senate conference to reconcile the bills will include the Ferraro program in the final bill, especially since the Housewhich did not include funds for the Ferraro programprovided substantially more funds for the CDC than the Senate.
Advocates Action Needed
Since both the House and Senate intend to move toward final passage of each of their versions of the bill prior to the scheduled August congressional recess, it is imperative that advocates contact their representatives and senators to support.
- The Senate recommendation of $28.9 billion for NIH;
- The House recommendation of funding for the CDC cancer programs; and
- The Senate recommendation of $5 million for the CDC Geraldine Ferraro Cancer Education Program.
Medicare Reform Endanger Quality of Cancer Care
The IMF believes that it is essential that any Medicare reform bill preserves access for all patients and maintains the quality of currently available cancer care. We support the goals of the National Patient Advocate Foundation to "...not lose the patient in the process of reducing physician pay."
The IMF is absolutely committed to expanding access to coverage for drug therapy through Medicare for all seniors, but is equally opposed to any action that might reduce access to current levels of cancer care during this process.
It is important to understand that there are two different issues at stake:
- Medicare currently overpays for chemotherapy drugs, which results in higher co-payments. We believe that this flawed system should be reformed in order to reduce the co-payments of Medicare patients.
- However, Medicare underpays medical oncologists and hematological oncologists for the expenses their practices incur when treating cancer patients, specifically including the services of oncology nurses, pharmacists, social workers and others involved in delivering quality cancer care.
If Congress fixes the flawed payment system for chemotherapy drugs, it must also ensure that adequate reimbursement exists for the other patient services. Otherwise, access to care of beneficiaries of Medicare will be in serious jeopardy.
Do not roll back 20 years' of progress in cancer care in the process of reducing cancer physicians' income!
Contact your members of Congress to advocate the following points:
- It is important that America's seniors, many of whom live on fixed incomes, no longer be required to pay for all of their prescription drugs.
- Commend Congress for its effort to add a prescription drug benefit to the Medicare program.
- We are very concerned that the proposals currently being considered by Congress will devastate the quality cancer care that seniors now receive.
- Medicare beneficiaries deserve prescription drug coverage, but hundreds of millions of dollars should not be removed from cancer care to pay for it.
- We believe Medicare drug payments need to be reformed to reduce co-payments.
- However, this reform must be balanced with an appropriate reform of the practice expenses paid to oncologists. The current proposals under consideration by Congress will cut hundreds of millions of dollars from cancer care.
- If these cuts take place, some Medicare beneficiaries will find that have to travel great distances to receive the care they need. Other beneficiaries will find that their oncology practices have scaled back staff and they are unable to receive the administrative services of nurses and pharmacists to support their therapies.
- Please make sure that changes in Medicare policy do not undermine the quality of cancer care available to America's cancer patients by failing to reimburse physician practices for the time and cost of the vital services they provide.