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Clinton still trying for health care legacy

The administration has some unfinished health care matters to take care of as the president sprints to the finish line of his final term.

By Susan J. Landers, AMNews staff. May 22/29, 2000.

Washington -- Although President Clinton's efforts at comprehensive health reform failed dismally during his first term in office, he is still attempting to leave a health care legacy that includes a new patient protection law and a prescription drug benefit for all Medicare beneficiaries, said Donna Shalala, PhD, secretary of the Dept. of Health and Human Services.

The president's pace has not slowed as he nears the close of his final term, she said. On the contrary, "He is exhausting us," Dr. Shalala told members of the National Health Council on May 4. "The president doesn't know it's his last year," she joked.

Among the administration's high-priority issues identified by Dr. Shalala are the following.

Patients' rights legislation

The administration is frustrated with the slow pace of congressional negotiations in crafting a Patients' Bill of Rights, said Dr. Shalala. In an attempt to speed things up, Clinton had invited some of the top House and Senate negotiators to meet at the White House May 8 for a status report. But the meeting was postponed to allow several of those invited to attend the funeral of Cardinal John O'Connor, archbishop of New York.

Although negotiators have been meeting since early March, they have missed several self-imposed deadlines for crafting compromise legislation from the very different patient protection bills passed by the House and Senate.

The Norwood-Dingell bill, passed by the House, "is more than fine with us," said Dr. Shalala. The bill is also highly favored by the AMA.

Negotiators are still far apart on issues concerning how many people the law should cover and whether patients should be able to file lawsuits against their health plans if they are injured because they were denied coverage for treatments.

Regardless, she said, "We need to get to it. We don't want to leave it for the next administration."

Medicare drug benefit

"Everywhere I go, I hear problems that could be solved by passage of a Patients' Bill of Rights or the addition of a Medicare prescription drug benefit," Dr. Shalala said.

Dr. Shalala described physicians who are concerned because patients cannot afford to fill prescriptions and Medicare beneficiaries who show her their checkbooks to demonstrate the large amounts they must pay for medication.

Although the United States is in a golden age of biomedical research, she said, high costs are denying individuals access to the results of that research.

The Clinton administration developed a prescription drug plan that, when fully phased in, would cover half of beneficiaries' drug costs up to $5,000. House Democrats are currently drafting prescription drug legislation that is said to closely resemble the administration's proposal.

The uninsured

The president is also pursuing various strategies to provide health insurance to some of the 44 million Americans who currently are without coverage, said Dr. Shalala. She noted that 10 million of that total number are children.

The president is continuing his efforts to enroll more children in the State Children's Health Insurance Program, or SCHIP, and to instruct states to search for families who were inadvertently dropped from the Medicaid rolls when welfare reform was instituted.

A sweeping plan introduced by Clinton would include low-income parents in the SCHIP program and extend a Medicare buy-in option to people ages 55 to 64.

Dr. Shalala also pointed to the administration's initiative to shore up the nation's health care safety net of free clinics and community health centers that are currently laboring to supply unreimbursed care to low-income people.

Grants totaling $25 million have already been awarded to inspire communities to explore different approaches to provide coverage to low-income residents.

Privacy rules

Final rules governing the privacy of patients' medical records should be ready by summer's end, Dr. Shalala said. The job of drafting proposed regulations fell to HHS when Congress failed to meet its own deadline for passing legislation to do the job.

The administration remains hopeful that Congress will still enact privacy legislation, she said. When it does, the HHS regulations "will be the core Congress will build on."

She noted that the medical records privacy regulations "may be one of the most important contributions made by the administration."

Medical research

Funding levels at the nation's academic medical centers and research universities must be maintained, Dr. Shalala said. Although funding levels have been increasing at the National Institutes of Health, the challenge is to "ramp up" funding steadily, she said. Research funding cannot arbitrarily rise and fall, she noted.

She also cautioned research institutions' review boards to take more care with their oversight duties. "Every institution must look at what it's doing," she said. Although academic leaders may say that the recently reported incidents of abuses in projects involving human subjects are rare events, "that's not good enough," she warned.

Dr. Shalala reiterated her intention of moving the Office for Protection from Research Risks to a position that would be more directly under the supervision of the secretary's office and noted that a new director would be selected shortly.

Dr. Shalala, who is believed to have served as HHS secretary longer than anyone else, said she leaves the department with a stronger decision-making system.

"We will leave systems in place that are clearer about what we are doing and why we are doing it," she said.

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