[Congressional Record Volume 142, Number 143 (Monday, October 21, 1996)]
[Senate]
[Pages S12443-S12445]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  THE CONTINUED IMPORTANCE OF HEALTH CARE REFORM AND MEDICAL RESEARCH

 Mr. HEFLIN. Mr. President, over the years, we have 
participated in many efforts to assist the people of Alabama and the 
Nation in the area of health care, particularly in insuring adequate 
funding for biomedical research programs. The various budget battles to 
ensure that cancer research is maintained at the highest effective 
level became an annual effort during my tenure as a U.S. Senator.
  During the mid-1980's, it became necessary for me to author several 
amendments to various spending bills in order for important cancer 
research to be adequately conducted.
  Cancer is a disease that knows no class, income levels, lifestyle, 
race, or sex. It can strike anyone at any time, as evidenced by studies 
estimating that almost 1 million Americans develop this deadly disease 
annually.
  In Alabama, important research through grants from the National 
Institutes of Health [NIH] is being carried on at 13 universities, 
hospitals, and research institutes. Research particularly crucial to 
our efforts to conquer cancer is being done at the University of South 
Alabama in Mobile, the Southern Research Institute in Birmingham, and 
the University of Alabama at Birmingham. These institutions are well 
known for their important contributions to cancer research.
  The cancer research community throughout America, and the world, 
knows that one of the true flagships of cancer research is the Cancer 
Core Center at UAB, which has been listed among the three top U.S. 
centers for cancer research. It is one of the first centers recognized 
by the National Cancer Institute, and has experienced remarkable 
growth. In addition, it has developed some of the most sophisticated 
resources for basic science and clinical care in the southeast, and it 
is now a regional, national, and international resource for patient 
care and research.
  Through the National Institutes of Health, we have been successful in 
getting funds to establish grants for sickle cell centers at UAB, and 
the University of South Alabama. Sickle cells, or sickle cell anemia, 
is predominately an inherited, chronic blood disease where the red 
blood cells become crescent shaped and function abnormally. This is how 
it got its name. The pains from this disease are due to aggregations of 
sickle cells causing a temporary blockage of the small blood vessels. 
These cells are subject to early destruction in the circulation, 
causing a chronic anemia. Although it occurs primarily in people of 
African heritage, with one out of 400 African Americans affected, it 
also occurs in persons from Mediterranean and other countries. A 
clinical alert issued by health care professionals in January 1995 by 
the National Heart, Lung and Blood Institutes announced an effective 
treatment of an anticancer drug which showed a remarkable reduction 
with regard to the complications of this disease.
  In addition, other biomedical research is being conducted at Alabama 
A&M University, and Tuskegee University Veterinary Medicine program. 
Both these historical black universities have received funds for 
biomedical, as well as agriculture research. This includes my 
sponsorship of the amendment to the farm bill, providing $50 million to 
legislation involving the 1890 land grant colleges, where Alabama A&M 
University and Tuskegee University were the top beneficiaries.
  In the mid-1980's, the Marshall Space Flight Center and the 
University of Alabama at Birmingham [UAB] made a major contribution to 
our Nation's cancer research efforts by managing a program for protein 
crystal growth experiments on the space shuttle. For years, UAB has 
been a world leader in this type of research, with their knowledge 
having been crucial in the development of new drugs to treat critical 
illnesses. I feel considerable pride that I changed a working 
relationship between UAB and Marshall Space Flight Center. The 
restrictions on gravity, however, created difficulties in growing 
protein crystals large enough for detailed study. In space, where there 
is no gravity, it was discovered that these crystals can be grown many 
times larger than on Earth, thus giving researchers samples large 
enough for accurate atomic characterization.
  During my years in the Senate, I have been an ardent believer of our 
space program. I feel this contribution by Marshall Space Flight 
Center, and UAB is indicative of the benefits society can reap from a 
successful space program. Likewise, I have helped in restoring funds 
for the National Heart, Lung and Blood Institute [NHLBI] of the 
National Institutes of Health. Discussions have been held with Dr. 
Claude Lenfant, Director of NHLBI, on many occasions regarding the 
research at UAB in the area of cardiology, led by Dr. Gerald Pohost. 
Both Dr. Lenfant and I have had the distinction of testifying before 
this Subcommittee on Appropriations for the Department of Labor, Health 
and Human Services and Education and Related Agencies of the Senate 
Appropriations Committee, regarding this research.
  At UAB, the cardiology division is one of the leaders in the Nation 
in research and teaching in clinical diagnosis and treatment. With 
areas of special expertise in the treatment of sudden death, 
interventional cardiology, cardiac transplants, and magnetic resonance 
imaging, the division continues to set the course for the future in 
basic and clinical research, and for the treatment of all forms of 
cardiovascular disease.
  Over the years, I have strongly supported appropriations for the 
National Institutes of Health. My testimony before the subcommittee 
focused primarily on the critical importance of funding for the 
National Cancer Institute, the Centers for Research Resources [NCRR], 
and the National Heart, Lung and Blood Institute. In my opinion, NCRR 
never received the attention it deserved.
  I was convinced that the biomedical research technology program at 
the University of Alabama's center was outstanding. It involves a 
unique, high-field magnetic resource image. This device has the 
potential to study the biomedical basis of human diseases without 
biopsy. These magnetic resonance mehtods have the capacity to determine 
tissue viability, as well as to examine biochemical and metabolic 
processes underlying heart disease, transplantation, rejection, and 
other common cardiac maladies.

  On several occasions, I visited the National Institutes of Health to 
discuss their programs and goals. I was most impressed with the 
competency and quality of their operations. NIH is responsible for 
placing the United States in a position of preeminence in biomedical 
research and biotechnology. During my tenure in the Senate, it was 
determined that we could not let this prime example of excellence 
deteriorate, especially when so many advances are being realized. 
Supporting the National Heart, Lung and Blood Institute

[[Page S12444]]

has been one of my pet priorities. It provides leadership for our 
national programs dealing with diseases of the heart, blood vessels, 
blood and lungs, and the use and management of blood and blood 
resources.
  In 1989, Congress provided $640 million for heart disease research, 
and by 1994, these estimates had grown to $737 million. These figures 
are for heart disease research, and I am proud to have been a leader 
with regard to providing Federal support in this area.
  For the National Heart, Lung and Blood Institute, appropriations 
including grants and direct operations went from $10,725,000 in 1950, 
to an appropriation of $1.2 billion in 1994. Perhaps because of my own 
health, I have great faith in the work of the National Heart, Lung and 
Blood Institute. In fact, my own heart problems were solved with many 
techniques developed under advance research which took place at UAB in 
Birmingham, and elsewhere in the country. Drs. Pohost and Roubin--my 
physicians in Birmingham--took excellent care of me, and showed me how 
much our country can benefit from clinical research supported by the 
Heart, Lung and Blood Institute.
  In February 1993, when the administration forwarded its budget 
proposal for 1994, it was $16 million less than the previous year's 
budget. Immediately, I went to work with a group of my colleagues in 
the House and Senate to increase the budget of the NHLBI to a more 
reasonable level of $1.27 billion, which was $75 million more than the 
administration's request--an increase of $63 million over the 1993 
budget. This set the stage for an annual increase. Also, this year, I 
urged Congress to establish a cardiovascular care consortium center to 
be headed by Dr. Pohost at UAB. The Conference Report on Labor, Health 
and Human Services and Education Appropriations included a $2.5 million 
for a project which the University Cardiovascular Care Consortium 
[UCCC] had proposed. It is called a best practices demonstration 
project, and we were able to convince the Health Care Financing 
Administration to endorse brief supportive language in the conference 
agreement to help ensure that this project recevies high priority.
  Although we were not able to adopt the provisions of the consortium 
in the appropriations bill, I have joined several Senators in 
contacting officials of the Health Care Financing Administration, 
urging the officials to move forward with a best practices 
demonstration project on congestive heart failure that the Senate 
Committee on Appropriations referenced in its fiscal year 1997 report. 
Congestive heart failure is the leading cause of mortality among 
Medicare beneficiaries. It is also the most costly diagnosis for the 
Medicare Program. A successful effort to develop and implement 
improvements in the quality and cost effectiveness of heart failure 
diagnosis and treatment would improve patient outcomes, thus reducing 
Medicare expenditures.
  The most contentious battles in my fight for improving health care 
and disease prevention for all Americans involved the Medicaid Program. 
Shortly after I took office in the U.S. Senate, officials of the 
Alabama Medicaid Agency contacted my office complaining that the Health 
Care Financing Administration in Washington was requiring the State of 
Alabama to return $10 million to the Federal Government. Apparently, 
the State had authorized distribution of durable medical equipment, 
which at that time was not allowable under the Federal Medicaid 
regulations. The Medicaid Program is administered at the State level 
within certain general Federal guidelines. I was advised that the State 
of Alabama could ill-afford to lose $10 million from its Medicaid 
budget. Therefore, my office successfully negotiated a settlement in 
favor of the State of Alabama with HCFA officials involving this 
dispute of Medicaid funds.
  As with cancer research, funding for Medicaid was virtually an annual 
battle. When Congress considered the 1993 omnibus budget reconciliation 
bill, I urged an amendment which was adopted, thus giving relief to 
hospitals that treated a high disproportionate share of poor patients. 
This legislative action resulted in the State of Alabama receiving 
annually $93 million additional dollars in Medicaid funds. This was 
because of the transitional amendment to the Omnibus Budget 
Reconciliation Act.
  During the summer of 1996, after the transitional period had passed, 
a glitch again appeared in the flow of Federal funds to Alabama, 
causing Federal officials to withhold about $94 million. I stayed in 
Washington during a recess period, endeavoring to work out a settlement 
of the issues between HCFA and the Alabama Medicaid Agency. We were 
able to negotiate a temporary settlement in this regard. The Alabama 
Medicaid Agency and my office negotiated with HCFA officials relative 
to a commitment by Alabama to comply with Federal requirements 
regarding patient's hospital payments, and to attempt to address HCFA's 
concerns with its hospital payment system. HCFA released the funds 
based on the State's commitment.
  Problems occurred in the Medicaid Program because of the method by 
which Alabama finances its Medicaid Program through so-called 
intergovernmental transfers, a method of counting some funds from State 
and county hospitals as part of its Medicaid share. Alabama now 
receives about $2.089 billion annually in Medicaid funding. This means 
that Alabama's contribution should be over $800 million. However, the 
fact remains that Alabama's general fund has been appropriating only 
about $140 t0 $150 million each year for Medicaid.

  This year, two different supplemental appropriations in the amount of 
$10 million brought it up to a level of $169 million. The difference 
between this amount and the $800 million match has caused chronic 
disputes between HCFA and the Alabama Medicaid Agency. Being able to 
avoid putting up Alabama's Medicaid share in real dollars has been a 
mixed blessing. It has certainly saved Alabama's general fund from 
going into serious deficit, due to the rapid increase in overall 
Medicaid expenditures caused in part by additional services mandated by 
Congress. In turn, this has enabled the State to keep taxes low, and to 
avoid having to shift funds from other needed services, including 
education.
  In September 1996, I was delighted when HCFA agreed to a request by 
the State's congressional delegation to release $94 million in moneys 
that had been withheld from the Medicaid Program in Alabama. Sooner or 
later, Alabama is going to be required to find some additional money to 
put into Medicaid. Thus, finding a solution to our most recent Medicaid 
crisis will not be easy, and I do not believe the answer we found will 
last very long. Accordingly, we will need to start thinking about what 
we are going to do with this fix expires.
  Looking to the future, Alabama's Representatives and Senators in 
Washington must examine all Medicaid reform proposals with great care. 
Such proposals offer States much greater flexibility in designing their 
Medicaid programs. This is clearly positive. If we do a good job, we 
can offer more cost-effective services to Medicaid recipients. But we 
must remember that the price of this flexibility may be that the 
Federal Government may at some point stop paying 70 percent of these 
health care costs. Alabama taxpayers will then have to pick up 100 
percent of the additional cost, including, for example, the nursing 
home bills of our rapidly increasing number of elderly citizens. This 
is a big price to pay, and we had better be certain what we are doing.
  In essence, the Federal Government should supply about 70 percent of 
Alabama's Medicaid funds and the State should supply about $700 
million. However, in actuality, the Federal Government is supplying 
about 92 percent of the Medicaid fund, and the State is supplying about 
8 percent. The settlement we just reached would not only release $94 
million in 1996, but it would release about $94 million in each of the 
next 5 years.
  There is a movement in Congress to block grant Medicaid programs. 
However, it seems that the Federal Government would not block grant the 
almost $2.1 billion that it is giving our State. It is likely that the 
Federal Government would only block grant $1.4 billion, which would 
represent the 70 to 30 percent ratio. This means the State would have 
to appropriate $170 million.
  Therefore, if you add $1.4 billion in Federal shares, and $170 
million in State shares, you will reach a total of

[[Page S12445]]

$1.57 billion. This is $530 million short of what is currently being 
funded for Alabama's Medicaid. There are no easy answers. There is much 
work that remains to be done.
  Additionally, in the area of public health education, I sponsored 
legislation to establish two health facilities at the University of 
Alabama at Birmingham to honor two of Alabama's legendary Senators; 
namely, the John J. Sparkman Center for International Public Health 
Education, and the Lister Hill Center for Health Policy. With $5 
million in appropriations to the Lister Hill Center, and $4 million in 
funds appropriated to the John J. Sparkman Center, both centers have 
been instrumental in developing research programs that address the 
needs in public health in the United States, as well as other 
developing countries.
  Initiated in 1980, the John J. Sparkman Center for International 
Public Health Education [SCIPHE] was provided initial support when 
Congress authorized funding for the establishment of an endowment at 
UAB. The endowment assures long-term support SCIPHE programs and 
activities which should be conducted primarily onsite in developing 
countries rather than at UAB or other academic institutions. Thus, the 
primary mandate of SCIPHE is to promote and provide sustainable 
training strategies for public health professional in developing 
countries.
  The Lister Hill Center [LHC] for Health Policy is also a 
congressionally endowed center, with a university-wide mission to 
facilitate the conduct of health policy research, in addition to 
disseminating the findings of that research beyond the usual academic 
channels. It also fosters research primarily through the work of its 
scholars in the areas of health care markets and managed care, maternal 
and child health, management in public health organizations, and 
clinical health services research. Scholars with national reputations 
in an area pertinent to health policy are invited monthly to give 
seminars. These seminar series are free of charge and are open to the 
UAB community.
  I was asked by officials at UAB, Auburn Veterinary Medicine School, 
NIH and the National Association of Bio-Medical Research Association to 
pass legislation making it a Federal crime to damage or destroy medical 
research centers. One of the awards I am most proud of is the 
Outstanding Service to Science Award from the National Association of 
Bio-Medical Research for passing such legislation as well as other 
contributions I made to biomedical research.
  I am proud to have played a small role in the promotion of health 
care and medical research during my tenure in the Senate. No one can 
argue that this type of reform and research are crucial to the future 
of our Nation and the well-being of our citizens. I am also proud that 
my home State is playing such an important role in this area.
  While we cannot ignore the need for improving access to quality 
health care, we also cannot forget the importance of medical research, 
health education, and disease prevention.

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