Capitol Hill Prognosticator Contemplates Mid-Terms' Impact on Medical Physicists

Healthcare was the top issue in many House races, says Matt Reiter, AAPM's lobbyist consultant. Matt and I recently spoke about what the mid-terms might mean for medical physicists. Here are some of Matt's thoughts on what lies ahead in the new Congress.

Healthcare Prices

Many Democratic candidates found success by running on a platform of reducing healthcare costs and protecting the Affordable Care Act's (ACA) provisions for health insurance coverage of preexisting conditions. With the Democrats winning control of the House largely on this message, they will now be expected to deliver results to their constituents. Prescription drugs should be the main focus of efforts to reduce healthcare prices. President Trump has expressed a strong desire to address this issue meaning there is certainly plenty of opportunity for bipartisanship on prescription drug prices. It remains to be seen exactly what legislative solutions will be introduced.

High prices for prescription drugs administered by healthcare providers in an office setting (Part B Drugs) are also drawing scrutiny. Most of the efforts on this issue, however, are being driven by the Administration through rulemaking. Specifically, the Administration proposed to replace the current Part B drug reimbursement methodology with one that pegs the price Medicare pays to an international price index. It is important to note that oncology treatments and diagnostic imaging would be among the most impacted procedures affected by this policy according to a 2015 GAO Report analyzing Part B drug prices. It is not clear if Democrats will unite to support this policy. The Obama Administration proposed its own revision to the Part B drug policy but ultimately chose not to finalize its proposal due to industry opposition. However, Democrats often compare the prices we pay for drugs with the prices other countries pay which would make the Trump Administration's proposal appealing.

Funding for Low-Dose Radiation Research

Earlier this year, both Chambers of Congress passed H.R. 589, the Department of Energy Research and Innovation Act, and it was signed into law by President Trump. This bill included a provision that requires the Department of Energy (DOE) to restart its low-dose radiation research program. The bill, however, does not authorize a funding level for the program which means the House and Senate Appropriations Committees will decide how much funding to give the DOE for this program. AAPM was a strong supporter of this legislation and will continue to support efforts to fund the DOE's low-dose radiation research program for the next fiscal year.

Continued Bipartisan Support for Research Funding

Despite a highly partisan political environment, one issue that has consistently enjoyed bipartisan support is funding for medical research. Congress has consistently increased funding for the National Institutes of Health (NIH) including about $2 billion in extra funding for the 2019 fiscal year. The National Cancer Institute (NCI) within NIH received a $479.1 million increase for FY 2019, bringing its total budget to $6.14 billion for the fiscal year. This funding will help support the NCI's National Cancer Moonshot Initiative, which funds new research, studies new innovations and improves research data sharing. The new Congress is primed for many political fights but NIH funding should continue to receive bipartisan support.

Source Security

Recent federal source security efforts have focused on reducing the use of CS-137 where alternative technologies are equally efficacious and available. We expect to see a continuance of certain programs that incentivize a shift to alternative technologies that replace traditional sources. These efforts have mainly targeted applications that use CS-137— specifically blood irradiator devices. An amendment to the 2018 National Defense Authorization Act (NDAA) directed the National Nuclear Security Administration (NNSA) to set a voluntary goal for eliminating the use of cesium chloride in blood irradiators by 2025. This is in addition to an existing voluntary program sponsored by the NNSA that subsidizes some of the cost for replacing CS-137 blood irradiators with devices that do not use CS-137.

Absent a security incident that prompts Congressional action, it is less likely that we see a successful legislative initiative to limit the use of source materials in medical or industrial applications. There has not been much of an appetite for such a measure in Congress outside of three Democratic senators who have little ability to meaningfully advance legislation without the support of Republican colleagues. Despite the House of Representatives switching to Democratic control, there has historically been bipartisan opposition in the House to past legislative attempts to drastically limit or eliminate the use of source material.

AAPM Government Relations will keep you updated as the new Congress progresses through the year. Please contact Richard J. Martin, JD, AAPM Government Relations Program Manager, at richard@aapm.org if you have any questions.