Will cancer research atrophy under Trump administration?

Chatter at an early morning session on the third day of the  43rd annual meeting in Washington, D.C., was largely focused on the state of healthcare — and the survival, or repeal, of the Affordable Care Act — under the new President Trump administration.

A conversation about the state of healthcare at the Association of Community Cancer Centers’ annual meeting mostly focused on speculation over the Affordable Care Act’s future under the Trump administration. But the discussion shifted to the standing of the Cancer Moonshot Task Force, put in place during the final year of President Obama’s tenure.

Dr. Kavita Patel of the D.C.-based think tank The Brookings Institution and Dan Todd of Todd Strategy, both former Capitol Hill staffers, said any push for increasing the funding for cancer research will most likely come from agency heads, at the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health.

“There’s a commitment on Capitol Hill,” Todd said. “But the moonshot folks all went to work with former Vice President Biden. If there’s nobody [in the White House], it’s going to atrophy.”

The task force, helmed by former Vice President Joe Biden whose son, Beau, died of brain cancer in 2015, left D.C. the same day as the rest of the White House staff when President Obama left on Jan. 20. Today, it lives on as the nonprofit Biden Cancer Initiative, and the former vice president said the nonprofit’s work will focus on bringing down the cost of cancer treatments, enabling wider access to clinical trials, and supporting community oncology efforts.

Even before Obama and Biden left the White House, national cancer research received a boost. In December, the 21st Century Cures bill was passed into law. Through the law — the Capitol Hill commitment to which Todd referred — Congress appropriated $1.8 billion in new funding for cancer research.

Whether President Trump’s White House will take up the mantle of moonshot cancer research is an uncertainty. Although former members of the Cancer Moonshot Task Force had spoken with the incoming administration about the research — which includes a conversation between Biden and his successor, Vice President Mike Pence, about continuing the work — the new White House’s proposed budget removes $6 billion in funding from the National Institutes of Health.

“Trump’s [administration] agreed to help continue some of those efforts,” Patel said. “Doing that but releasing a budget where you’re cutting the NIH by billions of dollars does not make sense to me.”

Photo: azerberber, Getty Images

The rise of oncology nurse navigators in the shift to value-based cancer care

A cancer diagnosis can be frightening and confusing for a patient. There’s where the nurse navigator comes in.

Navigators are often oncology nurses who offer individualized assistance to patients, their families, and their caregivers to overcome barriers in the healthcare system through the duration of the patient’s treatment. That might mean providing educational materials to a patient or working with a patient’s oncologists to help gain access to clinical trials. Sometimes a navigator’s tasks have nothing to do with a patient’s cancer diagnosis — like finding a babysitter. Helping patients manage their cancer care and plan for the future is quickly becoming as important as administering chemotherapy treatment for the roughly 1.68 million Americans diagnosed with cancer last year.

As of last summer, the job of a navigator became even more crucial, as Tricia Strusowski, a registered nurse and consultant with Georgia-based Oncology Solutions, explained during a talk at the Association of Community Cancer Center’s 43rd annual meeting in Washington, D.C., last week.

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Many of the current cancer patients in the U.S. are 65 years or older and paying for treatment using Medicare benefits. In search of a new way to provide better quality and more coordinated oncology care, the Centers for Medicare and Medicaid Services (CMS) rolled out a new model for delivering care to cancer patients over the summer last year. The Oncology Care Model (OCM) is a five-year model being tested through June 2021 with nearly 200 physician groups and 17 payers. The goal: Better care, smarter spending, and, ultimately, healthier patients.

One of OCM’s hallmarks is that all the participating practices, as well as the CMS, have committed to providing enhanced services, like navigation, to cancer patients on Medicare. Already some early results from several participating practices are showing the difference. At one oncology practice in Pennsylvania, enhanced services including navigation have resulted in a 51 percent drop in emergency room visits among cancer patients.

But as the role of the navigator becomes more important, so too does the means by which navigators can measure job performance. As of this year, a new set of 35 navigation metrics is available to oncology practices participating in the OCM. The metrics are a baseline, which can be used by any medical institution, and were developed in part by Strusowski, — she was one of the team leaders of the Standardized Metrics Task Force of the Academy of Oncology Nurse and Patient Navigators.

As the Journal of Oncology Navigation & Survivorship noted in January, the metrics set guidelines on how navigators should communicate with patients and healthcare providers to help coordinate cancer care, “evaluate professional practice and care delivery and measure the impact of navigation.”

During her talk, Strusowski mentioned that the metrics will not only help demonstrate the value of navigation, but will also help meet the OCM program’s overall goal.

“The navigator needs to stay one step ahead of the patient,” she said. “And how can you enhance the patient experience when we don’t know what to measure on our navigation programs?”

Photo: PeopleImages.com, Getty Images

Why is clinical research so messed up and how can it be fixed?

From left: Dr. Michael Kolodziej of Flatiron Health, Dr. Gregg Shepard of Tennessee Oncology, Dr. James Hamrick of Flatiron Health, Dr. Cary Presant of City of Hope Medical Center, Melissa Pool of the Center for Cancer and Blood Disorders

Dr. Michael Kolodziej was set to moderate a talk on developing a new infrastructure for conducting clinical trials with cancer patients. Instead, the former lead of Aetna’s oncology program and currently national medical director for New York-based health IT company Flatiron Health took his seat, looked at the panel, and then announced to the crowd he was renaming the talk.

“Why is clinical research so messed up?” he asked. “And how can we fix it?”

Kolodziej’s made his presentation, which included four other oncology experts, during the Association of Community Cancer Center’s 43rd annual meeting in Washington D.C. this week. But the reason for changing the name of this talk to the two questions Kolodziej asked quickly became apparent to the audience. After all, there’s no point in talking about a new infrastructure for clinical trials without first tackling their current troubles.

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Narrow eligibility criteria, financial feasibility, and the impediment of sheer geography are three problems that repeatedly reared their heads during the 45-minute discussion.

For Melissa Pool, a registered nurse and clinical research director at the Center for Cancer and Blood Disorders near Dallas, the geography angle was an early sticking point, especially in a state that’s as large as Texas.

“The difficulties we have are getting clinical trials out to rural communities,” she said.

Dr. Cary Presant of the City of Hope Medical Center near Los Angeles, Calif., added that part of the current challenge of conducting clinical trials is just finding appropriate trials workable at particular community sites. Presant’s group currently has about four sites with two staff at each prepared to do clinical trials. But financial feasibility remains a question in a way it isn’t for a hospital or large medical center that has the full-time staff and the resources to conduct trials.

“We find that the amount of discretionary funds to be able to do clinical trials is rapidly diminishing,” Presant said. “Unless you have a large practice, clinical trials might be a loss leader.”

There’s also something to be said about finding the perceived “perfect patient” to participate oncological trials.

“At the point of care of enrolling patients, the number one barrier is the availability of a trial to fit that patient and narrow eligibility criteria,” said Dr. Gregg Shepard of Tennessee Oncology, a large oncology group with about 100 physicians.

Of course, the whole point of conducting clinical trials is to test the efficacy of new drugs or treatments, which might be a boon to cancer patients willing to take risks in the course of their treatment programs.

But it’s often more difficult to enroll most cancer patients in clinical trials. Present said many drug companies want patients without comorbidities or without prior cancer. Most cancer patients do have comorbidities that they are treating in tandem with their cancer.

The overarching problem, it seems, is that clinical trials in their current state aren’t exactly representative of the population of people in the U.S. who have cancer.

Where there does appear to be some hope for the future of clinical trials is in the continuing digitization of health, something that Dr. James Hamrick, a practicing physician with Kaiser Permanente Georgia and senior medical director for Flatiron Health touched on. The data that doctors enter at the point of care, the routine that goes into all cancer patient encounters, can be harnessed to guide clinical trials. This can be done in a retrospective way — by gathering patient data in the aggregate, and then analyzing it to get a real-time, big-picture sense of cancer care in the U.S. It can also be done in a prospective way, by using the data to inform whether eligibility criteria of future trials should be loosened.

“It’s one of the promises of the digitization of healthcare,” Hamrick said. “It’s also part of the implicit bargain we make with patients when we click away on computers in the exam room with patients. There’s an assumption that the data we’re putting into the computer is going somewhere and being used to help other cancer patients.”

Using medical data will never replace the randomized clinical trial, Hamrick said. But with data, doctors in the future can stay one step ahead of trials by understanding who among their patients would be eligible for them. In a talk filled with important examinations of problems, the angle on healthcare data provided a spot of hope for reforming how clinical trials are done in the future.

Photo: From left: Dr. Michael Kolodziej of Flatiron Health, Dr. Gregg Shepard of Tennessee Oncology, Dr. James Hamrick of Kaiser Permanente, Dr. Cary Presant of City of Hope Medical Center, Melissa Pool of the Center for Cancer and Blood Disorders

Photo: Andrew Zaleski

5 healthcare trends impacting cancer care

Lindsay Conway, a managing director of The Advisory Board Company. Photo: Andrew Zaleski

Five big trends will shape the business of cancer care in 2017, according to Lindsay Conway, a managing director of The Advisory Board Company in Washington, D.C. As part of the company’s Research and Insights division, she conducts research for The Advisory Board Company’s Oncology Roundtable on topics such as the effects of healthcare reform on cancer patients and cancer-care providers.

At the annual meeting of the Association of Community Cancer Centers this week, Conway talked about trends impacting cancer care, some of which I’ve highlighted.

Reimbursement and reform are at a turning point.

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The healthcare industry is “continuing to grapple with how to deal with cost,” Conway said, something that will “remain true regardless of what happens in Congress.” As healthcare repeal, reform, and replace continues to be debated by D.C.’s lawmakers, the question then becomes: What happens in the interim that will drive high-quality cancer care at a lower cost? Conway said private payers can do their own reform. She added that private payers are increasingly aggressive about pushing cancer patients to lower-priced care. Instead of paying for infusion therapy at the hospital, for instance, private insurera may suggest having it done at an outpatient facility. Still, Conway’s message was cautionary. “Private payers have been on the forefront of designing value-driven ways to pay for cancer care, but we’re not going to arrive at a satisfying payment solution any time soon.”

Enhanced care navigation will be necessary as cancer patient comorbidities increase.

Cancer care programs need to worry about the services cancer patients are using across the healthcare system as they’re going through cancer treatment. As Conway said, roughly 22 percent of Medicaid patients are also dealing with ailments like diabetes, COPD, and heart disease. Citing an example from the University of Alabama at Birmingham (UAB) Health System, Conway said that enhanced navigation services are the answer to an increasingly comorbid population of cancer patients. Over the last decade at UAB, a new approach has taken shape, where care navigators work exclusively with high-risk patients and focus time on activities that might generate cost-savings. (Checking to make sure a patient is taking their medication, for instance.) The results Conway shared were huge. Of the patients in the UAB Health System who received navigation, there was a 58 percent decrease in hospitalizations. That equates to $4,000 in savings per patient to Medicare, or a total of $54 million in savings to Medicare across all patients over a two-year period.

The rise of telehealth in cancer care 

Virtual care, through smartphone app or over the Internet, can reduce costs and increase access. Virtual consultations, Conway said, will increase 60 percent by 2020. They’re gaining traction now for two main reasons: value-based payment, and the ability to quickly and easily do things like monitor patients at home remotely. Conway cited the University of Michigan’s Breast Cancer Ally app as one of the revolutionary models of virtual care currently in use today. Oncologists introduce the app to patients once they receive their diagnosis, and then the patient and oncologist collaborate to enter pertinent information into the app. From there, the app takes over, providing information, for example, about treatment options or instructions on recommended exercises to perform after surgery. As Conway said, the app serves the dual purposes of virtual care: improving patient education and a patient’s ability to make complex decisions about their breast cancer treatment in consultation with their oncology team.

Patients are acting more and more like consumers.

Patients have increasing expectations for service, convenience, and coordination of their care,” Conway said. Learning about providers and treatment options is getting easier thanks to the wealth of information available online. Even for patients who don’t have Internet access, a friend or family member usually steps in to direct and help out with online research. Perhaps most surprising: Online reviews cancer patients read on websites like Zocdoc and Angie’s List are more persuasive than experiences shared by friends or family members. Conway said 69 percent of cancer patients in a recent survey said they’d be inclined to switch care providers if they read a negative review online.

Navigating precision medicine

A variety of key innovations are revolutionizing how oncologists are treating cancer. How much of a dent those innovations, like hormone therapy and next-generation sequencing, are making all depends on how widespread they are. (The former is almost standard practice, whereas next-gen sequencing — capturing genomic information about a cancer — is still being perfected.) But as precision medicine becomes more prevalent, cancer care organizations will need to navigate three challenges, Conway said: how to make sense of new developments in precision medicine; how to prioritize investments in new medical equipment and facilities; and how to operationalize their approaches by making sure key care providers receive ongoing and up-to-date education. “We are all betting big on the promise of precision medicine,” she said.

How did it come to this? Ryan and Trump pull healthcare bill after coming up short on votes.

U.S. Speaker of the House Paul Ryan answers questions at a press conference at the U.S. Capitol after President Trump’s healthcare bill was pulled from the floor of the House of Representatives. (Photo by Win McNamee/Getty Images)

Despite days of intense negotiations and last-minute concessions to win over wavering GOP conservatives and moderates, House Republican leaders Friday failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act.

House Speaker Paul Ryan pulled the bill from consideration after he rushed to the White House to tell President Donald Trump that there weren’t the 216 votes necessary for passage.

“We came really close today, but we came up short,” he told reporters at a hastily called news conference.

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When pressed about what happens to the federal health law, he added, “We’re going to be living with Obamacare for the foreseeable future.”

Ryan originally had hoped to hold a floor vote on the measure Thursday — timed to coincide with the seventh anniversary of the ACA — but decided to delay that effort because GOP leaders didn’t have enough “yes” votes. The House had been in session Friday while members debated parts of the bill.

The legislation was damaged by a variety of issues raised by competing factions of the party. Many members were spooked by reports by the Congressional Budget Office showing that the bill would lead eventually to 24 million people losing insurance, while some moderate Republicans worried that ending the ACA’s Medicaid expansion would hurt low-income Americans.

At the same time, conservatives, especially the hard-right House Freedom Caucus that often has needled party leaders, complained that the bill kept too much of the ACA structure in place. They wanted a straight repeal of Obamacare, but party leaders said that couldn’t pass the Senate, where Republicans don’t have enough votes to stop a filibuster. So they chose to use a complicated legislative strategy called budget reconciliation that would allow them to repeal only parts of the ACA that affect federal spending.

The decision came after a chaotic week of negotiations, as party leaders sought to woo more conservatives. Trump personally lobbied 120 members through personal meetings or phone calls, according to a count provided Friday by his spokesman, Sean Spicer. “The president and the team here have left everything on the field,” Spicer said.

On Thursday evening, Trump dispatched Office of Management and Development Director Mick Mulvaney to tell his former House GOP colleagues that the president wanted a vote on Friday. It was time to move on to other priorities, including tax reform, he told House Republicans.

“He said the president needs this, the president has said he wants a vote tomorrow, up or down. If for any reason it goes down, we’re just going to move forward with additional parts of his agenda. This is our moment in time,” Rep. Chris Collins (R-New York), a loyal Trump ally, told reporters late Thursday. “If it doesn’t pass, we’re moving beyond health care. … We are done negotiating.”

Trump’s edict clearly irked some lawmakers, including the Freedom Caucus chairman, Rep. Mark Meadows (R-North Carolina), whose group of more than two dozen members represented the strongest bloc against the measure.

“Anytime you don’t have 216 votes, negotiations are not totally over,” he told reporters who had surrounded him in a Capitol basement hallway as he headed into the party’s caucus meeting.

Shortly before Ryan’s press conference, Trump called Washington Post reporter Robert Costa to say they were pulling the bill back from consideration. Costa said the president seemed at ease with the decision and did not blame Ryan for the defeat.

Trump, Ryan and other GOP lawmakers tweaked their initial package in a variety of ways to win over both conservatives and moderates. But every time one change was made to win votes in one camp, it repelled support in another.

The White House on Thursday accepted conservatives’ demands that the legislation strip federal guarantees of essential health benefits in insurance policies. But that was another problem for moderates, and Democrats suggested the provision would not survive in the Senate.

Republican moderates in the House — as well as the Senate — objected to the bill’s provisions that would shift Medicaid from an open-ended entitlement to a set amount of funding for states that would also give governors and state lawmakers more flexibility over the program. Moderates also were concerned that the package’s tax credits would not be generous enough to help older Americans — who could be charged five times more for coverage than their younger counterparts — afford coverage.

The House package also lost the support of key GOP allies, including the Club for Growth and Heritage Action. Physician, patient and hospital groups also opposed it.

It’s not clear what will happen next to the Republican effort to overturn or modify Obamacare. But White House officials told members Thursday that if they couldn’t pass the legislation, the president wanted to turn to other priorities, including tax reform. “The president understands this is it,” Spicer said. “We had this opportunity to — to change the trajectory of health care, to help improve — put a health care system in place and to end the nightmare that Republicans have campaigned on called Obamacare.”

As House health bill vote nears, what would be consequences of dumping essential benefits?

A last-minute attempt by conservative Republicans to dump standards for health benefits in plans sold to individuals would probably lower the average consumer’s upfront insurance costs, such as premiums and deductibles, said experts on both sides of the debate to repeal and replace the Affordable Care Act.

But, they add, it will likely also induce insurers to offer much skimpier plans, potentially excluding the gravely ill, and putting consumers at greater financial risk if they need care.

For example, a woman who had elected not to have maternity coverage could face financial ruin from an unintended pregnancy. A healthy young man who didn’t buy drug coverage could be bankrupted if diagnosed with cancer requiring expensive prescription medicine. Someone needing emergency treatment at a non-network hospital might not be covered.

What might be desirable for business would leave patients vulnerable.

“What you don’t want if you’re an insurer is only sick people buying whatever product you have,” said Christopher Koller, president of the Milbank Memorial Fund and a former Rhode Island insurance commissioner. “So the way to get healthy people is to offer cheaper products designed for the healthy people.”

The proposed change could give carriers wide room to do that by eliminating or shrinking “essential health benefits” including hospitalization, prescription drugs, mental health treatment and lab services from plan requirements — especially if state regulators don’t step in to fill the void, analysts said.

The Affordable Care Act requires companies selling coverage to individuals and families through online marketplaces to offer 10 essential benefits, which also include maternity, wellness and preventive services — plus emergency room treatment at all hospitals. Small-group plans offered by many small employers also must carry such benefits.

Conservative House Republicans want to exclude the rule from any replacement, arguing it drives up cost and stifles consumer choice.

On Thursday, President Donald Trump agreed after meeting with members of the conservative Freedom Caucus to leave it out of the measure under consideration, said White House Press Secretary Sean Spicer. “Part of the reason that premiums have spiked out of control is because under Obamacare, there were these mandated services that had to be included,” Spicer told reporters.

Pushed by Trump, House Republican leaders agreed late Thursday to a Friday vote on the bill but were still trying to line up support. “Tomorrow we will show the American people that we will repeal and replace this broken law because it’s collapsing and it’s failing families,” said House Speaker Paul Ryan (R-Wisconsin). “And tomorrow we’re proceeding.” When asked if he had the votes, Ryan didn’t answer and walked briskly away from the press corps.

But axing essential benefits could bring back the pre-ACA days when insurers avoided expensive patients by excluding services they needed, said Gary Claxton, a vice president and insurance expert at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

“They’re not going to offer benefits that attract people with chronic illness if they can help it,” said Claxton, whose collection of old insurance policies shows what the market looked like before.

One Aetna plan didn’t cover most mental health or addiction services — important to moderate Republicans as well as Democrats concerned about fighting the opioid crisis. Another Aetna plan didn’t cover any mental health treatment. A HealthNet plan didn’t cover outpatient rehabilitative services.

Before the ACA most individual plans didn’t include maternity coverage, either.

The House replacement bill could make individual coverage for the chronically ill even more scarce than a few years ago because it retains an ACA rule that forces plans to accept members with preexisting illness, analysts said.

Before President Barack Obama’s health overhaul, insurers could reject sick applicants or charge them higher premiums.

Lacking that ability under a Republican law but newly able to shrink benefits, insurers might be more tempted than ever to avoid covering expensive conditions. That way the sickest consumers wouldn’t even bother to apply.

“You could see even worse holes in the insurance package” than before the ACA, said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University. “If we’re going into a world where a carrier is going to have to accept all comers and they can’t charge them based on their health status, the benefit design becomes a much bigger deal” in how insurers keep the sick out of their plans, she said.

Michael Cannon, an analyst at the libertarian Cato Institute and a longtime Obamacare opponent, also believes dumping essential benefits while forcing insurers to accept all applicants at one “community” price would weaken coverage for chronically ill people.

“Getting rid of the essential health benefits in a community-rated market would cause coverage for the sick to get even worse than it is under current law,” he said. Republicans “are shooting themselves in the foot if they offer this proposal.”

Cannon favors full repeal of the ACA, allowing insurers to charge higher premiums for more expensive patients and helping consumers pay for plans with tax-favored health savings accounts.

In an absence of federal requirements for benefits, existing state standards would become more important. Some states might move to upgrade required benefits in line with the ACA rules but others probably won’t, according to analysts.

“You’re going to have a lot of insurers in states trying to understand what existing laws they have in place,” Koller said. “It’s going to be really critical to see how quickly the states react. There are going to be some states that will not.”

Mary Agnes Carey and Phil Galewitz contributed to this story.

Photo: byakkaya, Getty Images

White House delivers ultimatum on healthcare bill, setting scene for dramatic House vote Friday

There’s so much drama on Capitol Hill today and this evening. After years of failed attempts, the Republicans are finally positioned to repeal and replace the Affordable Care Act. But the vote, which was expected to take place Thursday, was delayed as it became clear that there weren’t enough votes from the conservative members of the “Freedom Caucus” and moderate members of the House Republicans to push the bill through.

Who would have thought there was so much diversity in the Republican party?

Republican leadership met with White House officials and party members Thursday evening to sway undecided or no voters to a yes. The White House also delivered an ultimatum to Republicans considering a no vote: Negotiations are over. Vote yes or move on with Obamacare.

If the bill is defeated, what would that say about the Trump’s negotiating skills? After all, Press Secretary Sean Spicer quipped at a media briefing yesterday, “There is no Plan B”.

The turn of events provoked plenty of discussion about what this vote means for the Republican party’s identity, whether Trump is setting House Speaker Paul Ryan as a scapegoat and evaluating the job Trump has done selling the healthcare bill to the American voters.

Amidst the drama, there was some room for a little comedy

And some apologizing…

A Congressional Budget Office Report published Thursday afternoon contended that under the revised bill 24 million would still lose their health insurance by 2026, despite reducing savings in federal spending.

The Republicans occupy a position they have strived to be in for years and yet as the bill makes it final approach to the floor of the House, Congressmen are feeling the full weight of this vote and the growing realization that some of the constituents will like it but many of them won’t. Just as passing ACA led many Americans to lose insurance when their previous plans became voided by the Act’s requirements, there will be winners and losers with this bill as well.

At the very least, there will be a lot of questions to address in the next 24 hours, whatever the outcome.

Photo: Justin Sullivan, Getty Images

Trump budget proposes 19 percent cut in NIH funding, leaving life science institutions reeling

As part of Trump’s budget proposal, he wants to chop $5.8B from the National Institutes of Health, or 19 percent, as part of a spending overhaul the Department of Health and Human Services.  The budget calls for a major reorganization of NIH’s institutes and centers, describing the move as a way to “help focus resources on the highest priority research and training activities.”

The proposal would also consolidate the Agency for Healthcare Research and Quality within NIH, and it would also mean “other consolidations and structural changes across NIH organizations and activities”.

Life science institutions are horrified.

It seems like only yesterday that Congress was prepared to boost NIH spending by $2 billion  — the biggest increase in 12 years.

Here is a round-up of reactions from national and regional institutions.

The American Cancer Society Cancer Action Network released a statement estimating that the NIH budget cuts were likely to cut $1 billion from the National Cancer Institute, noting it would be the biggest budget cut to the institution in its history.

Chris Hansen, president of the network said the cuts would be a significant setback for millions of American cancer patients, survivors and their families and would “dramatically constrain the prospect for breakthrough American medical innovation”.

For the last 50 years every major medical breakthrough can be traced back to investments in the NIH. Because of these investments, there are more than 15.5 million American cancer survivors alive today and researchers stand on the cusp of numerous innovative new diagnostic tools and treatments. From new immunotherapies that harness the body’s own immune system to destroy cancer cells to less toxic and more precise chemotherapies and advanced diagnostic and preventive tools.

“These developments save lives and spur economic progress. NIH-funded medical research is conducted in thousands of labs and universities across the country. These grants in turn spawn increased private investment and development. Drastically reducing NIH’s budget would jeopardize our nation’s potential to save more lives while simultaneously risking America’s position as the global leader in medical research.

The Science Coalition, a nonprofit, nonpartisan organization of public and private research universities offered a statement that put the proposed cuts in historical context and said they threatened the position of the U.S. as the world’s leader of research and development.

“Since World War II, America’s commitment to scientific breakthroughs has been a continual driver of U.S. economic growth. The personal computer, the Internet, smartphones are all based on research that had its beginnings in labs and centers funded in part by the federal government. The biomedical revolution with its advancement of disease-fighting vaccines and lifesaving drugs and the advance of diagnostic tools such as the MRI would not have occurred without federal support of collaborative research. And, most of the technologies that have made our men and women in uniform the world’s most effective fighting force, all had their start and ongoing improvements in federally funded scientific research.

“Other nations, particularly China, South Korea and India, are investing aggressively in discovery and innovation and are on the path to passing the United States as the world’s largest performer of R&D.”

Jon Retzlaff is the chief policy officer for American Association for Cancer Research, an organization whose 37,000 members include researchers and patient advocates who will feel the sting of Trump’s proposed cuts. He told The Philadelphia Inquirer:

” You have world-renowned institutions in Philadelphia that are reliant on federal funding and so this kind of proposal will set back the tremendous progress that those institutions are making,” he said. “I don’t think there’s ever been a more important time for us to be bringing together the entire medical research community.”

He added: “It’s unfortunate because now is the time to be pressing the accelerator, not utilizing the parking brake.”

University of Pennsylvania Health System is among the largest beneficiaries of NIH funding — amounting to $392 million for fiscal year 2016. Spokeswoman Susan Phillips told the Inquirer it planned to make a case for the NIH funding it receives and “highlight the value of the research we do for our country and in support of the nation’s position as a world leader in biomedical innovation.”

Photo: Bigstock 

What did the CBO’s estimate of the American Health Care Act reveal?

The Congressional Budget Office is out with its estimate of what effects the Republican health bill, “The American Health Care Act,” would have on the nation’s health care system and how much it would cost the federal government. The GOP plan is designed to partially repeal and replace the Affordable Care Act passed during the Obama administration.

Here are some of the CBO highlights:

  • $337 billion reduction in the deficit. That’s CBO’s estimate over the next decade, taking into account both decreased government spending in the form of less help to individuals to purchase insurance and lower payments to states for the Medicaid program. It also includes decreased revenue from the repeal of the taxes imposed by the ACA to pay for the new benefits.
  • 24 million more people without insurance in a decade. The federal budget experts estimate that people will lose insurance and that the drop will kick in quickly. In 2018, they say 14 million more people would join the ranks of the uninsured. It would reach the 24 million by 2026, when “an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”
  • $880 billion drop in federal Medicaid spending over the decade. That comes primarily by imposing, for the first time, a cap on federal contributions to the program for those with low incomes.
  • 15 to 20 percent increase in 2018 premiums, but relief would follow. Monthly costs for insurance would go up at first, due to the elimination of the requirement for most people to have insurance or else pay a tax penalty. After 2018, CBO estimates that average premiums would actually drop by 10 percent by 2026 compared to current law. That is because the lower prices for younger people would encourage more to sign up. By contrast, the law would “substantially [raise] premiums for older people.”
  • 14 million fewer Medicaid enrollees by 2026. That’s 17 percent fewer than projected under current law. The projection includes people who are currently eligible and would lose coverage, as well as people who might have become eligible if more states, as expected, expanded coverage under the ACA. CBO projects that is unlikely to happen now.
  • 95 percent of people who are getting Medicaid through the health law’s expansion would lose that enhanced federal funding. The CBO estimates that only 5 percent of enrollees in the expansion program would remain eligible for the higher federal payments by 2024, since the bill would phase out those payments to states as patients cycle in and out of eligibility.
  • 15 percent of Planned Parenthood clinic patients would “lose access to care.” These patients generally live in areas without other sources of medical care for low-income people. The Republican bill would cut out Medicaid funding for Planned Parenthood for a year.

Photo: YinYang, Getty Images