Tagged NIH

Trump’s Pediatric Cancer Crusade A Drop In Bucket Compared With Past Presidential Pitches

President Donald Trump announced Tuesday during his State of the Union address that he was asking Congress to allocate $500 million over the next 10 years for pediatric cancer research.

Organizations such as the American Cancer Society viewed the investment as a positive step.

“Any increase in current funding levels is a good thing,” said Keysha Brooks-Coley, the vice president of federal advocacy at the Cancer Action Network, the advocacy arm of the American Cancer Society. “We have to start someplace, and the president’s announcement puts us there.”

What’s unclear is how meaningful the increase is in relation to current federal spending on childhood cancer research.

The National Institutes of Health estimates its 2019 spending in this area to be $462 million, according to research portfolio data. So, $500 million over 10 years, or an average $50 million a year, amounts to a bit more than a 10 percent increase.

House Speaker Nancy Pelosi considered Trump’s proposed funding level insufficient, according to a congressional aide who was in a closed-door meeting Wednesday with her.

“Five hundred million dollars over 10 years — are you kidding me?” Pelosi reportedly said during the meeting. “Over 10 years, $500 million, $50 million a year. That’s like — what?! Who gave him that figure? It’s like the cost of his protection of his Mar-a-Lago or something.”

But a spokeswoman at the National Cancer Institute (NCI), which is a part of the NIH, told KHN it would “embrace the opportunity to lead a national initiative on childhood cancer.” However, she added, it was not clear whether the $500 million would come from completely new funding, or would include the already allotted funds — a point that she hopes would be clarified by the president’s soon-to-be released 2020 budget.

For now, a senior administration official told KHN “it is common practice that we don’t comment on deliberative or pre-decisional information prior to the release of the President’s FY2020 budget.”

To put it in perspective: The $500 million figure pales in comparison to other medical research initiatives that previous presidents have outlined amid the pomp and circumstance of this annual speech.

Barack Obama announced during his 2016 State of the Union that he wanted to “make America the country that cures cancer once and for all,” launching what came to be known as the “Cancer Moonshot” initiative. In his initial announcement, Obama proposed $1 billion to be parceled out over fiscal years 2016 and 2017.

That amounts to an average of $500 million over two years.

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But presidents don’t always get all they ask for. In December 2016, Congress passed the 21st Century Cures Act, which instead allotted $1.8 billion to the Moonshot effort over seven years. That averages to about $257 million for each of those years, though it’s up to Congress each year to decide on the Moonshot’s actual appropriation.

Obama also spearheaded the BRAIN initiative, which he announced in April 2013 and alluded to during the 2013 State of the Union. The BRAIN Initiative provides funding for brain-related research, including Alzheimer’s disease, traumatic brain injuries and epilepsy.

Obama wanted $100 million for fiscal year 2014, which he got. He also wanted funding to increase annually, which it did, until fiscal year 2017.

By far the largest health-related presidential pledge of the past 15 years was George W. Bush’s 2003 request for funding to end the global HIV/AIDS epidemic. During the 2003 State of the Union, Bush asked Congress “to commit $15 billion over the next five years, including nearly $10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.”

The public health program came to be known as the President’s Emergency Plan for AIDS Relief, or PEPFAR. Averaged out, Bush’s proposed spending was $3 billion a year. (In inflation-adjusted dollars, that would be $4.09 billion today.) Funding levels for PEPFAR surpassed $15 billion by 2008.

Last year, Trump signed the Childhood Cancer STAR Act, which appropriates $30 million a year for the NIH and the Centers for Disease Control and Prevention to spend on research for childhood cancer. Under Trump, the NIH’s budget has increased from $36 billion in 2017 to an estimated $39 billion in 2019.

According to the American Cancer Society, pediatric cancer makes up fewer than 1 percent of all cancers diagnosed each year. The NCI says that cancer is the leading cause of death by disease for children past infancy, and in 2018 it was estimated that 1,780 children would die from various forms of the disease.

Former Rep. John Dingell Dies; Longest-Serving Congressman Was A Force In Health Policy

Former Rep. John Dingell, the Michigan Democrat who holds the record as the longest-serving member of the U.S. House, died Thursday night in Michigan. He was 92.

And while his name was not familiar to many, his impact on the nation, and on health care in particular, was immense.

For more than 16 years Dingell led the powerful House Energy and Commerce Committee, which is responsible for overseeing the Medicare and Medicaid programs, the U.S. Public Health Service, the Food and Drug Administration and the National Institutes of Health.

As a young legislator, he presided over the House during the vote to approve Medicare in 1965. As a tribute to his father, who served before him and who introduced the first congressional legislation to establish national health insurance during the New Deal, Dingell introduced his own national health insurance bill at the start of every Congress.

And when the House passed what would become the Affordable Care Act in 2009, leaders named the legislation after him. Dingell sat by the side of President Barack Obama when he signed the bill into law in 2010.

Dingell was “a beloved pillar of the Congress and one of the greatest legislators in American history,” said a statement from House Speaker Nancy Pelosi. “Yet, among the vast array of historic legislative achievements, few hold greater meaning than his tireless commitment to the health of the American people.”

He was not always nice. He had a quick temper and a ferocious demeanor when he was displeased, which was often. Witnesses who testified before him could feel his wrath, as could Republican opponents and even other committee Democrats. And he was fiercely protective of his committee’s territory.

In 1993, during the effort by President Bill Clinton to pass major health reform, as the heads of the three main committees that oversee health issues argued over which would lead the effort, Dingell famously proclaimed of his panel, “We have health.”

Dingell and his health subcommittee chairman, California Democrat Henry Waxman, fought endlessly over energy and environmental issues. The Los Angeles-based Waxman was one of the House’s most active environmentalists. Dingell represented the powerful auto industry in southeastern Michigan and opposed many efforts to require safety equipment and fuel and emission standards.

In 2008, Waxman ousted Dingell from the chairmanship of the full committee.

But the two were of the same mind on most health issues, and together during the 1980s and early 1990s they expanded the Medicaid program, reshaped Medicare and modernized the FDA, NIH and the Centers for Disease Control and Prevention.

“It was always a relief for me to know that when he and I met with the Senate in conference, we were talking from the same page, believed in the same things, and we were going to fight together,” Waxman said in 2009.

Dingell was succeeded in his seat by his wife, Rep. Debbie Dingell, herself a former auto industry lobbyist.

Podcast: KHN’s ‘What The Health?’ A ‘Healthy’ State Of The Union

Health policy played a surprisingly robust role in President Donald Trump’s 2019 State of the Union address.

The president laid out an ambitious set of health goals in his speech Tuesday to Congress and the nation, including reining in drug prices, ending the transmission of HIV in the U.S. during the next decade and dedicating more resources to fighting childhood cancer.

Meanwhile, in Utah and Idaho, two of the states where voters last fall approved expansion of the Medicaid health program, Republican legislatures are trying to scale back those plans.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Anna Edney of Bloomberg News, Margot Sanger-Katz of The New York Times and Alice Ollstein of Politico.

Among the takeaways from this week’s podcast:

  • The Trump administration is proposing to change the drug rebates in Medicare so that consumers purchasing the medicines get more of the savings and the middlemen negotiating the deals get less. But that effort could lead to increased insurance premiums — a consequence that could have significant political repercussions.
  • Trump’s pledge to end HIV transmissions in 10 years was a bit of a surprise since the disease had not been much of a priority in earlier moves by the administration.
  • The efforts to restrict Medicaid expansion approved by voters in Utah and Idaho show the limitations of referendums and could impact a move to get a Medicaid expansion question on the Florida ballot.
  • An intriguing study this week showed that medications to treat cardiac problems saved Medicare money. The results were surprising because generally public health officials suggest that prevention is important to improve health but doesn’t necessarily save money.

Also this week, Rovner interviews KHN senior correspondent Phil Galewitz, who investigated and wrote the latest “Bill of the Month” feature for Kaiser Health News and NPR. It’s about a man with a minor problem — fainting after a flu shot — and a major bill. You can read the story here.

If you have a medical bill you would like NPR and KHN to investigate, you can submit it here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: NPR’s “Texans Can Appeal Surprise Medical Bills, But the Process Can Be Draining,” by Ashley Lopez

Margot Sanger-Katz: The Los Angeles Times’ “In Rush to Revamp Medicaid, Trump Officials Bend Rules That Protect Patients,” by Noam N. Levey

Anna Edney: Bloomberg News’ “Ketamine Could Be the Key to Reversing America’s Rising Suicide Rate,” by Cynthia Koons and Robert Langreth

Alice Ollstein: The Washington Post’s “’It Will Take Off Like a Wildfire’: The Unique Dangers of the Washington State Measles Outbreak,” by Lena H. Sun and Maureen O’Hagan

To hear all our podcasts, click here.

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