{"database": "openregs", "table": "congressional_record", "rows": [["CREC-1996-10-21-pt1-PgS12443", "1996-10-21", 104, 2, null, null, "THE CONTINUED IMPORTANCE OF HEALTH CARE REFORM AND MEDICAL RESEARCH", "SENATE", "SENATE", "ALLOTHER", "S12443", "S12445", "[{\"name\": \"Howell Heflin\", \"role\": \"speaking\"}]", null, "142 Cong. Rec. S12443", "Congressional Record, Volume 142 Issue 143 (Monday, October 21, 1996)\n\n[Congressional Record Volume 142, Number 143 (Monday, October 21, 1996)]\n[Senate]\n[Pages S12443-S12445]\nFrom the Congressional Record Online through the Government Publishing Office [www.gpo.gov]\n\n  THE CONTINUED IMPORTANCE OF HEALTH CARE REFORM AND MEDICAL RESEARCH\n\n Mr. HEFLIN. Mr. President, over the years, we have\nparticipated in many efforts to assist the people of Alabama and the\nNation in the area of health care, particularly in insuring adequate\nfunding for biomedical research programs. The various budget battles to\nensure that cancer research is maintained at the highest effective\nlevel became an annual effort during my tenure as a U.S. Senator.\n  During the mid-1980's, it became necessary for me to author several\namendments to various spending bills in order for important cancer\nresearch to be adequately conducted.\n  Cancer is a disease that knows no class, income levels, lifestyle,\nrace, or sex. It can strike anyone at any time, as evidenced by studies\nestimating that almost 1 million Americans develop this deadly disease\nannually.\n  In Alabama, important research through grants from the National\nInstitutes of Health [NIH] is being carried on at 13 universities,\nhospitals, and research institutes. Research particularly crucial to\nour efforts to conquer cancer is being done at the University of South\nAlabama in Mobile, the Southern Research Institute in Birmingham, and\nthe University of Alabama at Birmingham. These institutions are well\nknown for their important contributions to cancer research.\n  The cancer research community throughout America, and the world,\nknows that one of the true flagships of cancer research is the Cancer\nCore Center at UAB, which has been listed among the three top U.S.\ncenters for cancer research. It is one of the first centers recognized\nby the National Cancer Institute, and has experienced remarkable\ngrowth. In addition, it has developed some of the most sophisticated\nresources for basic science and clinical care in the southeast, and it\nis now a regional, national, and international resource for patient\ncare and research.\n  Through the National Institutes of Health, we have been successful in\ngetting funds to establish grants for sickle cell centers at UAB, and\nthe University of South Alabama. Sickle cells, or sickle cell anemia,\nis predominately an inherited, chronic blood disease where the red\nblood cells become crescent shaped and function abnormally. This is how\nit got its name. The pains from this disease are due to aggregations of\nsickle cells causing a temporary blockage of the small blood vessels.\nThese cells are subject to early destruction in the circulation,\ncausing a chronic anemia. Although it occurs primarily in people of\nAfrican heritage, with one out of 400 African Americans affected, it\nalso occurs in persons from Mediterranean and other countries. A\nclinical alert issued by health care professionals in January 1995 by\nthe National Heart, Lung and Blood Institutes announced an effective\ntreatment of an anticancer drug which showed a remarkable reduction\nwith regard to the complications of this disease.\n  In addition, other biomedical research is being conducted at Alabama\nA&M University, and Tuskegee University Veterinary Medicine program.\nBoth these historical black universities have received funds for\nbiomedical, as well as agriculture research. This includes my\nsponsorship of the amendment to the farm bill, providing $50 million to\nlegislation involving the 1890 land grant colleges, where Alabama A&M\nUniversity and Tuskegee University were the top beneficiaries.\n  In the mid-1980's, the Marshall Space Flight Center and the\nUniversity of Alabama at Birmingham [UAB] made a major contribution to\nour Nation's cancer research efforts by managing a program for protein\ncrystal growth experiments on the space shuttle. For years, UAB has\nbeen a world leader in this type of research, with their knowledge\nhaving been crucial in the development of new drugs to treat critical\nillnesses. I feel considerable pride that I changed a working\nrelationship between UAB and Marshall Space Flight Center. The\nrestrictions on gravity, however, created difficulties in growing\nprotein crystals large enough for detailed study. In space, where there\nis no gravity, it was discovered that these crystals can be grown many\ntimes larger than on Earth, thus giving researchers samples large\nenough for accurate atomic characterization.\n  During my years in the Senate, I have been an ardent believer of our\nspace program. I feel this contribution by Marshall Space Flight\nCenter, and UAB is indicative of the benefits society can reap from a\nsuccessful space program. Likewise, I have helped in restoring funds\nfor the National Heart, Lung and Blood Institute [NHLBI] of the\nNational Institutes of Health. Discussions have been held with Dr.\nClaude Lenfant, Director of NHLBI, on many occasions regarding the\nresearch at UAB in the area of cardiology, led by Dr. Gerald Pohost.\nBoth Dr. Lenfant and I have had the distinction of testifying before\nthis Subcommittee on Appropriations for the Department of Labor, Health\nand Human Services and Education and Related Agencies of the Senate\nAppropriations Committee, regarding this research.\n  At UAB, the cardiology division is one of the leaders in the Nation\nin research and teaching in clinical diagnosis and treatment. With\nareas of special expertise in the treatment of sudden death,\ninterventional cardiology, cardiac transplants, and magnetic resonance\nimaging, the division continues to set the course for the future in\nbasic and clinical research, and for the treatment of all forms of\ncardiovascular disease.\n  Over the years, I have strongly supported appropriations for the\nNational Institutes of Health. My testimony before the subcommittee\nfocused primarily on the critical importance of funding for the\nNational Cancer Institute, the Centers for Research Resources [NCRR],\nand the National Heart, Lung and Blood Institute. In my opinion, NCRR\nnever received the attention it deserved.\n  I was convinced that the biomedical research technology program at\nthe University of Alabama's center was outstanding. It involves a\nunique, high-field magnetic resource image. This device has the\npotential to study the biomedical basis of human diseases without\nbiopsy. These magnetic resonance mehtods have the capacity to determine\ntissue viability, as well as to examine biochemical and metabolic\nprocesses underlying heart disease, transplantation, rejection, and\nother common cardiac maladies.\n\n  On several occasions, I visited the National Institutes of Health to\ndiscuss their programs and goals. I was most impressed with the\ncompetency and quality of their operations. NIH is responsible for\nplacing the United States in a position of preeminence in biomedical\nresearch and biotechnology. During my tenure in the Senate, it was\ndetermined that we could not let this prime example of excellence\ndeteriorate, especially when so many advances are being realized.\nSupporting the National Heart, Lung and Blood Institute\n\n[[Page S12444]]\n\nhas been one of my pet priorities. It provides leadership for our\nnational programs dealing with diseases of the heart, blood vessels,\nblood and lungs, and the use and management of blood and blood\nresources.\n  In 1989, Congress provided $640 million for heart disease research,\nand by 1994, these estimates had grown to $737 million. These figures\nare for heart disease research, and I am proud to have been a leader\nwith regard to providing Federal support in this area.\n  For the National Heart, Lung and Blood Institute, appropriations\nincluding grants and direct operations went from $10,725,000 in 1950,\nto an appropriation of $1.2 billion in 1994. Perhaps because of my own\nhealth, I have great faith in the work of the National Heart, Lung and\nBlood Institute. In fact, my own heart problems were solved with many\ntechniques developed under advance research which took place at UAB in\nBirmingham, and elsewhere in the country. Drs. Pohost and Roubin--my\nphysicians in Birmingham--took excellent care of me, and showed me how\nmuch our country can benefit from clinical research supported by the\nHeart, Lung and Blood Institute.\n  In February 1993, when the administration forwarded its budget\nproposal for 1994, it was $16 million less than the previous year's\nbudget. Immediately, I went to work with a group of my colleagues in\nthe House and Senate to increase the budget of the NHLBI to a more\nreasonable level of $1.27 billion, which was $75 million more than the\nadministration's request--an increase of $63 million over the 1993\nbudget. This set the stage for an annual increase. Also, this year, I\nurged Congress to establish a cardiovascular care consortium center to\nbe headed by Dr. Pohost at UAB. The Conference Report on Labor, Health\nand Human Services and Education Appropriations included a $2.5 million\nfor a project which the University Cardiovascular Care Consortium\n[UCCC] had proposed. It is called a best practices demonstration\nproject, and we were able to convince the Health Care Financing\nAdministration to endorse brief supportive language in the conference\nagreement to help ensure that this project recevies high priority.\n  Although we were not able to adopt the provisions of the consortium\nin the appropriations bill, I have joined several Senators in\ncontacting officials of the Health Care Financing Administration,\nurging the officials to move forward with a best practices\ndemonstration project on congestive heart failure that the Senate\nCommittee on Appropriations referenced in its fiscal year 1997 report.\nCongestive heart failure is the leading cause of mortality among\nMedicare beneficiaries. It is also the most costly diagnosis for the\nMedicare Program. A successful effort to develop and implement\nimprovements in the quality and cost effectiveness of heart failure\ndiagnosis and treatment would improve patient outcomes, thus reducing\nMedicare expenditures.\n  The most contentious battles in my fight for improving health care\nand disease prevention for all Americans involved the Medicaid Program.\nShortly after I took office in the U.S. Senate, officials of the\nAlabama Medicaid Agency contacted my office complaining that the Health\nCare Financing Administration in Washington was requiring the State of\nAlabama to return $10 million to the Federal Government. Apparently,\nthe State had authorized distribution of durable medical equipment,\nwhich at that time was not allowable under the Federal Medicaid\nregulations. The Medicaid Program is administered at the State level\nwithin certain general Federal guidelines. I was advised that the State\nof Alabama could ill-afford to lose $10 million from its Medicaid\nbudget. Therefore, my office successfully negotiated a settlement in\nfavor of the State of Alabama with HCFA officials involving this\ndispute of Medicaid funds.\n  As with cancer research, funding for Medicaid was virtually an annual\nbattle. When Congress considered the 1993 omnibus budget reconciliation\nbill, I urged an amendment which was adopted, thus giving relief to\nhospitals that treated a high disproportionate share of poor patients.\nThis legislative action resulted in the State of Alabama receiving\nannually $93 million additional dollars in Medicaid funds. This was\nbecause of the transitional amendment to the Omnibus Budget\nReconciliation Act.\n  During the summer of 1996, after the transitional period had passed,\na glitch again appeared in the flow of Federal funds to Alabama,\ncausing Federal officials to withhold about $94 million. I stayed in\nWashington during a recess period, endeavoring to work out a settlement\nof the issues between HCFA and the Alabama Medicaid Agency. We were\nable to negotiate a temporary settlement in this regard. The Alabama\nMedicaid Agency and my office negotiated with HCFA officials relative\nto a commitment by Alabama to comply with Federal requirements\nregarding patient's hospital payments, and to attempt to address HCFA's\nconcerns with its hospital payment system. HCFA released the funds\nbased on the State's commitment.\n  Problems occurred in the Medicaid Program because of the method by\nwhich Alabama finances its Medicaid Program through so-called\nintergovernmental transfers, a method of counting some funds from State\nand county hospitals as part of its Medicaid share. Alabama now\nreceives about $2.089 billion annually in Medicaid funding. This means\nthat Alabama's contribution should be over $800 million. However, the\nfact remains that Alabama's general fund has been appropriating only\nabout $140 t0 $150 million each year for Medicaid.\n\n  This year, two different supplemental appropriations in the amount of\n$10 million brought it up to a level of $169 million. The difference\nbetween this amount and the $800 million match has caused chronic\ndisputes between HCFA and the Alabama Medicaid Agency. Being able to\navoid putting up Alabama's Medicaid share in real dollars has been a\nmixed blessing. It has certainly saved Alabama's general fund from\ngoing into serious deficit, due to the rapid increase in overall\nMedicaid expenditures caused in part by additional services mandated by\nCongress. In turn, this has enabled the State to keep taxes low, and to\navoid having to shift funds from other needed services, including\neducation.\n  In September 1996, I was delighted when HCFA agreed to a request by\nthe State's congressional delegation to release $94 million in moneys\nthat had been withheld from the Medicaid Program in Alabama. Sooner or\nlater, Alabama is going to be required to find some additional money to\nput into Medicaid. Thus, finding a solution to our most recent Medicaid\ncrisis will not be easy, and I do not believe the answer we found will\nlast very long. Accordingly, we will need to start thinking about what\nwe are going to do with this fix expires.\n  Looking to the future, Alabama's Representatives and Senators in\nWashington must examine all Medicaid reform proposals with great care.\nSuch proposals offer States much greater flexibility in designing their\nMedicaid programs. This is clearly positive. If we do a good job, we\ncan offer more cost-effective services to Medicaid recipients. But we\nmust remember that the price of this flexibility may be that the\nFederal Government may at some point stop paying 70 percent of these\nhealth care costs. Alabama taxpayers will then have to pick up 100\npercent of the additional cost, including, for example, the nursing\nhome bills of our rapidly increasing number of elderly citizens. This\nis a big price to pay, and we had better be certain what we are doing.\n  In essence, the Federal Government should supply about 70 percent of\nAlabama's Medicaid funds and the State should supply about $700\nmillion. However, in actuality, the Federal Government is supplying\nabout 92 percent of the Medicaid fund, and the State is supplying about\n8 percent. The settlement we just reached would not only release $94\nmillion in 1996, but it would release about $94 million in each of the\nnext 5 years.\n  There is a movement in Congress to block grant Medicaid programs.\nHowever, it seems that the Federal Government would not block grant the\nalmost $2.1 billion that it is giving our State. It is likely that the\nFederal Government would only block grant $1.4 billion, which would\nrepresent the 70 to 30 percent ratio. This means the State would have\nto appropriate $170 million.\n  Therefore, if you add $1.4 billion in Federal shares, and $170\nmillion in State shares, you will reach a total of\n\n[[Page S12445]]\n\n$1.57 billion. This is $530 million short of what is currently being\nfunded for Alabama's Medicaid. There are no easy answers. There is much\nwork that remains to be done.\n  Additionally, in the area of public health education, I sponsored\nlegislation to establish two health facilities at the University of\nAlabama at Birmingham to honor two of Alabama's legendary Senators;\nnamely, the John J. Sparkman Center for International Public Health\nEducation, and the Lister Hill Center for Health Policy. With $5\nmillion in appropriations to the Lister Hill Center, and $4 million in\nfunds appropriated to the John J. Sparkman Center, both centers have\nbeen instrumental in developing research programs that address the\nneeds in public health in the United States, as well as other\ndeveloping countries.\n  Initiated in 1980, the John J. Sparkman Center for International\nPublic Health Education [SCIPHE] was provided initial support when\nCongress authorized funding for the establishment of an endowment at\nUAB. The endowment assures long-term support SCIPHE programs and\nactivities which should be conducted primarily onsite in developing\ncountries rather than at UAB or other academic institutions. Thus, the\nprimary mandate of SCIPHE is to promote and provide sustainable\ntraining strategies for public health professional in developing\ncountries.\n  The Lister Hill Center [LHC] for Health Policy is also a\ncongressionally endowed center, with a university-wide mission to\nfacilitate the conduct of health policy research, in addition to\ndisseminating the findings of that research beyond the usual academic\nchannels. It also fosters research primarily through the work of its\nscholars in the areas of health care markets and managed care, maternal\nand child health, management in public health organizations, and\nclinical health services research. Scholars with national reputations\nin an area pertinent to health policy are invited monthly to give\nseminars. These seminar series are free of charge and are open to the\nUAB community.\n  I was asked by officials at UAB, Auburn Veterinary Medicine School,\nNIH and the National Association of Bio-Medical Research Association to\npass legislation making it a Federal crime to damage or destroy medical\nresearch centers. One of the awards I am most proud of is the\nOutstanding Service to Science Award from the National Association of\nBio-Medical Research for passing such legislation as well as other\ncontributions I made to biomedical research.\n  I am proud to have played a small role in the promotion of health\ncare and medical research during my tenure in the Senate. No one can\nargue that this type of reform and research are crucial to the future\nof our Nation and the well-being of our citizens. I am also proud that\nmy home State is playing such an important role in this area.\n  While we cannot ignore the need for improving access to quality\nhealth care, we also cannot forget the importance of medical research,\nhealth education, and disease prevention.\n\n                          ____________________"]], "columns": ["granule_id", "date", "congress", "session", "volume", "issue", "title", "chamber", "granule_class", "sub_granule_class", "page_start", "page_end", "speakers", "bills", "citation", "full_text"], "primary_keys": ["granule_id"], "primary_key_values": ["CREC-1996-10-21-pt1-PgS12443"], "units": {}, "query_ms": 1.7566289752721786, "source": "Federal Register API & Regulations.gov API", "source_url": "https://www.federalregister.gov/developers/api/v1", "license": "Public Domain (U.S. Government data)", "license_url": "https://www.regulations.gov/faq"}