by Clay Bennett

Tell me me what you think. Was the previous administration antagonistic towards the science, research and development sectors of the American economy? I’ve already voiced my opinion of the matter in a previous post. Please leave me a comment (or send me an email, if you prefer) to tell me why you agree or disagree with me.

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by Bruce Beattie

By executive order, the ban against federal funding for stem cell research has been removed. What are the implications for biomedical research in America? How much ground have we lost in our progress towards treatments and cures in traumatic brain injury and Parkinson’s disease, for example. Are our systems of bioethical oversight robust and competent enough to handle the responsible application of this powerful technology? I’m curious to know just what you think, so leave a comment.

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ARRA and You (Part II). Statistics serve only to confirm what we instinctively already knew, the Executive Order of 2001 which banned funding for embryonic stem cell research did not reflect the will of the people. (see fig. 7-18) Though we live in a representative democracy, the ignorance and fears of the minority should not overrule the cautious optimism of the majority. My biology background taught me that correlation does not suggest causation, but during 2002 when about 35% favored this research and nearly 50% opposed it, I’m nevertheless, tempted to surmise that the American people second guessed themselves, “perhaps the President knows something I don’t,” they mused. By 2004 however, public opinion had decisively migrated back in favor of supporting this kind of medical research. So the scientific community and the majority of the broader public alike, breathed a collective sigh of relief with the signing of an Executive Order that reverses the ban of federal funding for embryonic stem cell research. The President stated,

“…the potential [embryonic stem cell] research offers is great, and with proper guidelines and strict oversight, the perils can be avoided. That is a conclusion with which I agree. That is why I am signing this Executive Order, and why I hope Congress will act on a bi-partisan basis to provide further support for this research.”

It is the hope of future legislation combined with the Executive Memorandum directing the head of the White House Office of Science and Technology Policy to develop a strategy for restoring scientific integrity to government decision making that go further to prevent future challenges of this kind.

In conjunction with initiatives of the stimulus package (ARRA 2009), the new research agenda should indeed go a long way towards the recovery of the economy.

The changes that the Obama administration is bringing to biomedical research don’t end with this critical executive order. For the first time in the history of the National Science Foundation’s Survey of Research and Development Expenditures at Colleges and Universities (initiated in 1972), in a two year period (2005-7) federal funding decreased when adjusted for inflation. Combine this with a decreasing trend in federal share of overall research and development dollars spent. In light of these statistics, the $8.2 billion allocated to the National Institutes of Health for extramural research via the ARRA is a logical decision, to say the least. While $800 million will be targeted to priority research areas through Challenge Grants (more on this later), another $1.1 billion is allocated for Comparative Effectiveness Research (more on this later). Anyone who wants to deny that science research and biomedical research, in particular are not significant sectors of our economy is simply fooling themselves (further explanation to come). In short, the President has opened a new frontier (by expanding embryonic stem cell research) and provided the funding with which to explore it, responsibly and ethically. All in less than 40 days in office.

I have laid the foundations in this post to for the impact of the ARRA on the health and research sectors and on you. In the following weeks look for posts expanding on:

• Employment, Economic Recovery and the Research Sector
• Challenge Grant Research Priorities
• Comparative Effectiveness Research
• Preventive Health Interventions
• HITECH Act

Sources:

“A debt of gratitude to so many tireless advocates” at The White House Blog on March 9, 2009. http://www.whitehouse.gov/ blog/09/03/09 /A-debt-of-gratitude-to-so-many-tireless-advocates/

American Recovery and Reinvestment Act: Comparative Effectiveness Funding. March 2009. http://www.ahrq.gov/fund/cefarra.htm

Federal Policy. In Stem Cell Information. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2009 [cited March 16, 2009] Available at <http://stemcells.nih.gov/policy/ defaultpage>

NIH’s Role in the American Recovery and Reinvestment Act (ARRA). In From the Director. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services, 2009 [cited Saturday, March 16, 2009] Available at <http://www.nih.gov/about/director/ 02252009statement_arra.htm>

National Science Board. 2006. Science and Engineering Indicators 2006. Two volumes [Electronic Version]. Arlington, VA: National Science Foundation (volume 1, NSB 06-01; volume 2, NSB 06-01A). Available at<http://www.nsf.gov/statistics/seind06/>

National Science Foundation, Division of Science Resources Statistics
Universities Report Continued Decline in Real Federal S&E R&D Funding in FY 2007. Arlington, VA (NSF 08-320) [August 2008]. Available at <http://www.nsf.gov/statistics/infbrief/nsf08320/>

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by M. Wuerker (in Politico March 5, 2009)

Many stakeholders and special interest groups may become uneasy as the Administration makes progress towards reforming health care. Considering the current state of the system, can we really make things worse or is there nowhere to go but up? Leave me a comment and tell me what you think about this week’s satire feature.

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Melody Barnes, Director of Domestic Policy during the White House Forum on Health Reform (photo by Pete Souza)

ARRA and You (Part I).  The “fierce urgency of now” is the concept that President Barack Obama used to explain why he would run for president. Yet it can also be used to characterize his motivation and subsequent actions in the push to reform health care.

With the new legislation, American Recovery and Reinvestment Act of 2009 coverage for millions was protected or extended.

1. Health insurance coverage for 7 million Americans was extended via insurance premium assistance for COBRA benefits.
2. Families are no longer in jeopardy of loosing current benefits from Medicaid and CHIP due to $15 billion in Federal Medical Assistance Percentage funding allocated to states.

Without pause, the President continues to move forward his agenda for reform. The release of a budget blueprint, proposes a $634 billion reserve fund to extend coverage to some of the 47 million Americans who are currently uninsured. “This is the first step towards getting health care reform done this year,” White House domestic policy adviser Melody C. Barnes told allies on one conference call. “We can’t underestimate the importance of rallying around this budget. It serves as a footprint for something bigger.” In contrast, others express doubts about the prospects for overhauling health care. For example, Sen. Mike Enzi, the senior Republican on the Senate Health, Education, Labor and Pensions Committee stated, “It needs to be done up front and quickly. I’m not so sure that we haven’t already lost that, with so many other things coming in and weighing us down.” As was the case in bringing a stimulus package into law, it appears the President will remain undaunted and continue to seize the opportunities created by environment, his political capitol, his strategic leadership and timing to accomplish the essential goals of his health agenda:

1. providing affordable, comprehensive and portable health coverage for every American;
2. modernizing the U.S. health care system to contain spiraling health care costs and improve the quality of patient care; and
3. promoting prevention and strengthening public health, to prevent disease and protect against natural and man-made disasters.

As he so aptly noted in his address to a joint session of the Congress,

“[Health-care costs are] one of the major reasons why small businesses close their doors and corporations ship jobs overseas…This is a cost that now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. ….Given these facts, we can no longer afford to put health-care reform on hold.”

So it is no surprise that on the following Thursday, March 5 the administration convened the White House Health Reform Summit. The event sought to convene the varied stakeholders in the health care reform debate and ultimately, get buy-in. The President stated, “I want to be very clear, at the outset, that while everybody has a right to take part in this discussion, nobody has the right to take it over and dominate.” Participants included leaders from the (American Medical Association) AMA and other medical specialty societies; trade groups for drug makers, insurance companies and hospitals; CEOs of companies including Pfizer and General Mills; advocacy groups such as the American Heart Association and American Diabetes Association; and unions such as SEIU and the Teamsters.

Lawmakers also met on Thursday as they have been given the task of working out the details and writing the actual legislation around several key principles set forth by the President:

• maintaining choice of insurance and doctors,
• ensuring affordable coverage,
• protecting Americans’ financial health,
• investing in prevention and wellness,
• improving patient safety and quality of care.

If you missed the live coverage on CSPAN, you can find a summary and important document links at the White House blog and continue to follow the entire process of health care reform at the newly launched HealthReform.gov. Opponents to the progress of health care reform will have take notice of “the fierce urgency of now” momentum and perhaps much more are already on the President’s side. Regional White House Forums on Health Reform are currently under way to expand upon what was gained at the White House forum.

Sources:

Obama Has Big Challenges In Overhauling Health Care {Obama Has Big Challenges In Overhauling Health Care (2009, February 21) [Electronic Version]. The Washington Post} and Obama Proposes $634 Billion Fund For Health Care {Connolly, C. (2009, February 26) Obama Proposes $634 Billion Fund for Health Care [Electronic Version]. The Washington Post, A01} and Brown, CB. Obama wants Congress to Weigh In (2009, March 6) Politico, p. 3 (Volume 3: Number 24)

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Health and the 44th Presidential Administration (Part III). In three nearly back-to-back announcements, President Obama is working prodigiously to fill his leadership roster for health care. Of course, the most newsworthy was his selection of Kansas Governor Kathleen Sebelius as Secretary-designate of the Department of Health and Human Services (HHS). The White House Office of Health Reform, however will be lead by Nancy Ann DeParle who headed up the Center for Medicare & Medicaid Services during the Clinton administration. The administration may deem DeParle, a Beltway-insider, as having a greater amount of political clout to handle what is sure to be high-stakes negotiation within the White House Office of Health Reform. Both women have a depth of experience in health care financing and health insurance, a stakeholder group incidentally with a powerful voice in previous rounds of the health reform debate.

The Office of National AIDS Policy is set to be led by Jeffrey S. Crowley. With a background in public health, Crowley will bring the appropriate knowledge for managing the health of populations and the dynamics of epidemics in leading the effort to set an appropriate national policy. He will also serve as a member of the Domestic Policy Council. The President stated the following:

“In [AIDS and disability policy], we continue to face serious challenges and we must take bold steps to meet them. I look forward to Jeffrey’s leadership on these critical issues.”

Mary Wakefield has been appointed Administrator of the Health Resources and Services Administration (HRSA). President Obama made the following comments regarding her appointment:

“As a nurse, a Ph.D., and a leading rural health care advocate, Mary Wakefield brings expertise that will be instrumental in expanding and improving services for those who are currently uninsured or underserved. Under her leadership we will be able to expand and improve the care provided at the Community Health Centers which serve millions of uninsured Americans and address severe provider shortages across the country.”

For even more insight into this health braintrust, check out what’s on the bookshelf (a widget to the right) featuring books and articles with references and contributions from these political appointees. Several leaders are now in place and not a moment too soon. With the American Recovery and Reinvestment Act of 2009 now signed into law and the more recent unveiling of the budget proposal for 2010, there is plenty of (health care) work to be done.

Sources:

Sebelius at HHS at the White House Blog and Administrator of HRSA Announced and Obama Names Head of AIDS Policy Office and Obama Picks Kansas Governor Sebelius as Health Secretary – washingtonpost.com.

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44 to increase portions of health insurance and cover more currently uninsured children

Last week, by a margin of 66 to 32 votes (including 9 Republicans), the Senate approved expansion and reauthorization of SCHIP and today, President Obama signed that bill into law. This legislation was resurrected and revised after two vetos by former President Bush and began making its way through the Congress once again scarcely a week before the Inauguration. The critical health insurance program administered by the states, expands medical coverage to some 4 million children nation-wide whose parents do not qualify for Medicaid. This is estimated to bring the total number of children enrolled in the program to 11 million. Many of these families are newly unemployed or part of the legions of working poor in this country. With the passage of this law, we can count this as the first victory in the Obama plan to reform health care in this country.

Watch: Video of the signing ceremony at the White House

Sources:

Obama Views Children’s Health Bill as Step One at washingtonpost.com

Senate Approves Children’s Health Bill at NYTimes.com

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by Vic Harville Little Rock, Arkansas

Today’s House vote to expand SCHIP brings Americans one step closer to universal access to health insurance. With a vote of 289 to 139, the House passed a bill to expand the capacity of State Children’s Health Insurance Plans (SCHIP) from 6 to nearly 11 million enrollees. Earlier versions of this legislation were vetoed twice by President Bush but President-Elect Obama stated, “In this moment of crisis, ensuring that every child in America has access to affordable health care is not just good economic policy, but a moral obligation we hold as parents and citizens.”

Specifically, the current crisis in unemployment has left an increasing number of families in the difficult position of making too much to qualify for Medicaid but too little to pay the extremely expensive premiums for health insurance offered through COBRA once an employee has lost his or her job. Combine this fact with the trend for health insurance policies toward providing less comprehensive coverage for greater and greater premiums. The result is millions of children who have fallen through the cracks in a fragmented system. This program, originally created with the Balanced Budget Act of 1997 has sought to remedy the problem of uninsured children since it’s inception. Passage of this new legislation will go further towards accomplishing that goal, as well as accomplishing one of the three key pillars of the proposed Obama-Biden administration’s health care plan—universal access to care.

Sources:

Long Stalled by GOP, Expansion of Children’s Health Insurance Program Is Approved In House

Department of Labor http://www.dol.gov/dol/topic/health-plans/cobra.htm

Kaiser Family Foundation http://www.kaiseredu.org/topics_im.asp?id=704&imID=1&parentID=65

A primer of the innovative ideas of David Cutler, health economist, author of “Your Money or Your Life,” and adviser to President-elect Obama.

The New York Times > Magazine > The Quality Cure?.

(Featured in the March 13, 2005 edition of the New York Times Magazine)

A primer of the health policy advice Dr. Jeanne Lambrew, the newly named Deputy Director of the White House Office of Health Reform has for the President-elect.

Dear 44: Take a pragmatic approach – Jeanne M. Lambrew – Politico.com.