Vic Snyder on Health Care Democratic Representative (AR-2)

Voted YES on regulating tobacco as a drug.

Opponent's argument to vote No:Rep. HEATH SHULER (D, NC-11): Putting a dangerous, overworked FDA in charge of tobacco is a threat to public safety. Last year, the FDA commissioner testified that he had serious concerns that this bill could undermine the public health role of the FDA. And the FDA Science Board said the FDA's inability to keep up with scientific advancements means that Americans' lives will be at risk.

Proponent's argument to vote Yes: Rep. HENRY WAXMAN (D, CA-30): The bill before us, the Waxman-Platts bill, has been carefully crafted over more than a decade, in close consultation with the public health community. It's been endorsed by over 1,000 different public health, scientific, medical, faith, and community organizations.

Sen. HARRY REID (D, NV): Yesterday, 3,500 children who had never smoked before tried their first cigarette. For some, it will also be their last cigarette but certainly not all. If you think 3,500 is a scary number, how about 3.5 million. That is a pretty scary number. That is how many American high school kids smoke--3.5 million. Nearly all of them aren't old enough to buy cigarettes. It means we have as many boys and girls smoking as are participating in athletics in high schools. We have as many as are playing football, basketball, track and field, and baseball combined.

Voted YES on overriding veto on expansion of Medicare.

• Extends Medicare to cover additional preventive services.
• Includes body mass index and end-of-life planning among initial preventive physical examinations.
• Eliminates by 2014 [the currently higher] copayment rates for Medicare psychiatric services.

I support the primary objective of this legislation, to forestall reductions in physician payments. Yet taking choices away from seniors to pay physicians is wrong. This bill is objectionable, and I am vetoing it because:
• It would harm beneficiaries by taking private health plan options away from them.
• It would undermine the Medicare prescription drug program.
• It is fiscally irresponsible, and it would imperil the long-term fiscal soundness of Medicare by using short-term budget gimmicks that do not solve the problem.

Proponent's argument to vote Yes: Sen. PATTY MURRAY (D, WA): President Bush vetoed a bill that would make vital improvements to the program that has helped ensure that millions of seniors and the disabled can get the care they need. This bill puts an emphasis on preventive care that will help our seniors stay healthy, and it will help to keep costs down by enabling those patients to get care before they get seriously ill. This bill will improve coverage for low-income seniors who need expert help to afford basic care. It will help make sure our seniors get mental health care.

Voted YES on giving mental health full equity with physical health.

• Paul Wellstone Mental Health and Addiction Equity Act of 2008: Requires group health plans to apply the same treatment limits on mental health or substance-related disorder benefits as they do for medical and surgical benefits (parity requirement).
• Genetic Information Nondiscrimination Act of 2008: Prohibits a group health plan from adjusting premium or contribution amounts for a group on the basis of genetic information.

SUPPORTER'S ARGUMENT FOR VOTING YES:Rep. PALLONE. This is a comprehensive bill which will establish full mental health and addiction care parity. The Mental Health Parity Act of 1996 authorized for 5 years partial parity by mandating that the annual and lifetime dollar limit for mental health treatment under group health plans offering mental health coverage be no less than that for physical illnesses. This bill requires full parity and also protects against discrimination by diagnosis.

OPPONENT'S ARGUMENT FOR VOTING NO:Rep. DEAL of Georgia: I am a supporter of the concept of mental health parity, but this bill before us today is not the correct approach. This path will raise the price of health insurance, and would cause some to lose their health insurance benefits and some employers to terminate mental health benefits altogether.

The bill's focus is also overly broad. Our legislation should focus on serious biologically-based mental disorders like schizophrenia and bipolar disorder, not on jet lag and caffeine addiction, as this bill would include. There are no criteria for judicial review, required notice and comment, or congressional review of future decisions.

I would ask my colleagues to vote "no" today so that we can take up the Senate bill and avoid a possible stalemate in a House-Senate conference on an issue that should be signed into law this Congress.

LEGISLATIVE OUTCOME:Bill passed House, 268-148

Voted YES on Veto override: Extend SCHIP to cover 6M more kids.

CONGRESSIONAL SUMMARY: This Act would enroll all 6 million uninsured children who are eligible, but not enrolled, for coverage under existing programs.

PRESIDENT'S VETO MESSAGE: Our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. My Administration strongly supports reauthorization of SCHIP. [But this bill, even with changes, does not meet the requirements I outlined].

It would still shift SCHIP away from its original purpose by covering adults. It would still include coverage of many individuals with incomes higher than the median income. It would still result in government health care for approximately 2 million children who already have private health care coverage.

SUPPORTER'S ARGUMENT FOR VOTING YES:Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill protects health insurance coverage for some 6 million children who now depend on SCHIP. It provides health coverage for 3.9 million children who are eligible, yet remain uninsured. Together, this is a total of better than 10 million young Americans who, without this legislation, would not have health insurance.

The bill makes changes to accommodate the President's stated concerns.

1. It terminates the coverage of childless adults in 1 year.
2. It prohibits States from covering children in families with incomes above $51,000.
3. It contains adequate enforcement to ensure that only US citizens are covered.
4. It encourages securing health insurance provided through private employer.

Voted YES on adding 2 to 4 million children to SCHIP eligibility.

Proponents support voting YES because:

Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill provides health coverage for 3.9 million children who are eligible, yet remain uninsured. It meets the concerns expressed in the President's veto message [from HR976]:

1. It terminates the coverage of childless adults.
2. It targets bonus payments only to States that increase enrollments of the poorest uninsured children, and it prohibits States from covering families with incomes above $51,000.
3. It contains adequate enforcement to ensure that only US citizens are covered.

Opponents recommend voting NO because:

Rep. DEAL: This bill [fails to] fix the previous legislation that has been vetoed:

• On illegal immigration: Would the verification system prevent an illegal alien from fraudulently using another person's name to obtain SCHIP benefits? No.
• On adults in SCHIP: Up to 10% of the enrollees in SCHIP will be adults, not children, in the next 5 years, and money for poor children shouldn't go to cover adults.
• On crowd-out: The CBO still estimates there will be some 2 million people who will lose their private health insurance coverage and become enrolled in a government-run program.

Veto message from President Bush:

Like its predecessor, HR976, this bill does not put poor children first and it moves our country's health care system in the wrong direction. Ultimately, our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. As a result, I cannot sign this legislation.

Voted YES on requiring negotiated Rx prices for Medicare part D.

Proponents support voting YES because:

This legislation is an overdue step to improve part D drug benefits. The bipartisan bill is simple and straightforward. It removes the prohibition from negotiating discounts with pharmaceutical manufacturers, and requires the Secretary of Health & Human Services to negotiate. This legislation will deliver lower premiums to the seniors, lower prices at the pharmacy and savings for all taxpayers.

It is equally important to understand that this legislation does not do certain things. HR4 does not preclude private plans from getting additional discounts on medicines they offer seniors and people with disabilities. HR4 does not establish a national formulary. HR4 does not require price controls. HR4 does not hamstring research and development by pharmaceutical houses. HR4 does not require using the Department of Veterans Affairs' price schedule.

Opponents support voting NO because:

Does ideological purity trump sound public policy? It shouldn't, but, unfortunately, it appears that ideology would profoundly change the Medicare part D prescription drug program, a program that is working well, a program that has arrived on time and under budget. The changes are not being proposed because of any weakness or defect in the program, but because of ideological opposition to market-based prices. Since the inception of the part D program, America's seniors have had access to greater coverage at a lower cost than at any time under Medicare.

Under the guise of negotiation, this bill proposes to enact draconian price controls on pharmaceutical products. Competition has brought significant cost savings to the program. The current system trusts the marketplace, with some guidance, to be the most efficient arbiter of distribution.

Voted NO on denying non-emergency treatment for lack of Medicare co-pay.

• Allows hospitals to refuse treatment to Medicaid patients when they are unable to pay their co-pay if the hospital deems the situation to be a non-emergency
• Excludes payment to grandparents for foster care

Voted NO on limiting medical malpractice lawsuits to $250,000 damages.

Voted NO on limited prescription drug benefit for Medicare recipients.

Voted YES on allowing reimportation of prescription drugs.

Voted YES on small business associations for buying health insurance.

Voted NO on allowing suing HMOs, but under federal rules & limited award.

Voted NO on subsidizing private insurance for Medicare Rx drug coverage.

Voted NO on banning physician-assisted suicide.

Voted NO on establishing tax-exempt Medical Savings Accounts.

Limit anti-trust lawsuits on health plans and insurers.

OFFICIAL CONGRESSIONAL SUMMARY:

• Delineates the relationship between the antitrust laws and negotiations between groups of health care professionals and health plans and health care insurance issuers.
• Applies the "rule of reason" standard to negotiations between a health plan and two or more physicians.
• Awards attorneys' fees to a substantially prevailing plaintiff only when the defendant's conduct was unreasonable or in bad faith.
• Prohibits tying arrangements (linking the participation in one product line to participation in another) between a health plan and health care professional.
• Excludes from this Act any negotiations or agreements including Medicare, Medicaid, SCHIP, or other federal programs.

EXCERPTS FROM CONGRESSIONAL FINDINGS:

Congress finds the following:
1. A large number of Americans receive their health care coverage from managed health care plans.
2. The market power of insurance companies has increased tremendously since the early 1990's, due to mergers and acquisitions.
3. Health plans improperly manipulate the practice of medicine through such mechanisms as inappropriately making medical necessity determinations, and knowingly denying and delaying payment.
4. The intent of the antitrust laws is to encourage competition and protect the consumer, and the current per se standard for enforcing the antitrust laws in the health care field frequently does not achieve these objectives.
5. An application of the "rule of reason" will tend to promote both competition and high-quality patient care.
6. In any action under the antitrust laws challenging a health plan, conduct shall not be deemed illegal per se, but shall be judged on the basis of its reasonableness, taking into account all relevant factors affecting competition and proposed contract terms.

LEGISLATIVE OUTCOME: Referred to the House Committee on the Judiciary; never called for a House vote.

Rated 100% by APHA, indicating a pro-public health record.

The American Public Health Association (APHA) is the oldest and largest organization of public health professionals in the world, representing more than 50,000 members from over 50 occupations of public health. APHA is concerned with a broad set of issues affecting personal and environmental health, including federal and state funding for health programs, pollution control, programs and policies related to chronic and infectious diseases, a smoke-free society, and professional education in public health.

The following ratings are based on the votes the organization considered most important; the numbers reflect the percentage of time the representative voted the organization's preferred position.

Improve services for people with autism & their families.

Amends the Public Health Service Act to require the Secretary of Health and Human Services to:

1. convene, on behalf of the Interagency Autism Coordinating Committee, a Treatments, Interventions, and Services Evaluation Task Force to evaluate evidence-based biomedical and behavioral treatments and services for individuals with autism;
2. establish a multi-year demonstration grant program for states to provide evidence-based autism treatments, interventions, and services.
3. establish planning and demonstration grant programs for adults with autism;
4. award grants to states for access to autism services following diagnosis;
5. award grants to University Centers of Excellence for Developmental Disabilities to provide services and address the unmet needs of individuals with autism and their families;
6. make grants to protection and advocacy systems to address the needs of individuals with autism and other emerging populations of individuals with disabilities; and
7. award a grant to a national nonprofit organization for the establishment and maintenance of a national technical assistance center for autism services and information dissemination.
8. Directs the Comptroller General to issue a report on the financing of autism services and treatments.

Remove restrictions on estriol (menopause medication).

A concurrent resolution expressing the sense of Congress that the Food and Drug Administration's (FDA) new policy restricting women's access to medications containing estriol does not serve the public interest.

• Whereas menopause is often a challenging transition for millions of women that requires specialized medications and medical treatments;
• Whereas physicians prescribe a variety of pharmaceutical treatment options to treat women experiencing the symptoms of menopause;
• Whereas individual women respond differently to different treatment options;
• Whereas women's physicians determine on a case-by-case basis which treatment option is optimal for each woman;
• Whereas many physicians prescribe compounded estrogen and other bioidentical hormone treatments for patients for a variety of reasons;
• Whereas many physicians prescribe compounded estrogen treatments that contain estriol to treat menopausal and perimenopausal women;
• Whereas estriol is one of three estrogens produced by the human body;
• Whereas estriol has been prescribed and used for decades in the United States;
• Whereas the Food and Drug Administration (FDA) has announced that it will no longer permit compounding pharmacists to prepare medications containing estriol pursuant to a doctor's prescription;
• Whereas insurers are now denying women reimbursement for compounded medications containing estriol as a result of the FDA's announcement; and
• Whereas the FDA has acknowledged that it is unaware of any adverse events associated with use of compounded medications containing estriol:

Now, therefore, be it Resolved, That it is the sense of the Congress that--
1. physicians are in the best position to determine which medications are most appropriate for their patients;
2. the FDA should respect the physician-patient relationship; and
3. the FDA should reverse its policy that aims to eliminate patients' access to compounded medications containing estriol.

Provide for treatment of autism under TRICARE.

A bill to amend title 10, United States Code, to provide for the treatment of autism under TRICARE. Revises TRICARE (a Department of Defense [DOD] managed health care program) to authorize treatment of autism spectrum disorders, if a health care professional determines that such treatment is medically necessary.