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NEW FACES ON THE HILL: REP. CASTLE (R-DEL.) IS NGA HEALTH TASK FORCE VICE-CHAIRMAN; WASHINGTON SEN. MURRAY SEEKS LABOR CMTE. POST TO ADDRESS HEALTH REFORM

Executive Summary

Rep. Michael Castle (R), one of the new faces on Capitol Hill for the 103rd Congress, is Delaware's current governor and has held a variety of health-related posts, including co-vice chairman of the National Governors' Association Task Force on Health Care. The NGA task force was launched in August. Castle also chaired the governors' association Human Resources Committee for three years. He was elected by a 57% vote in the Nov. 3 general elections. Castle joins at least two other newly-elected House members who bring state perspective and experience in health policy to the first Congress that will serve during the Clinton Administration. They are Earl Pomeroy (D), North Dakota's current insurance commissioner, and Mike Kreidler (D), a state senator from Washington. All three could be logical candidates for openings on the Energy & Commerce or Ways & Means Committees. Castle has served as Delaware's governor since 1985 and as lieutenant governor between 1981 and 1985. He ran for Delaware's single at-large House seat because he was prohibited by state law from running for another term as governor. Castle, an attorney, has received an honorary medical degree from Philadelphia's Jefferson Medical College for his attention to health care issues. The National Governors Association has not issued a comprehensive national health care reform proposal. In appearances at congressional hearings this year, the governors focused on greater flexibility for state-based health reform; "one-stop shopping" for states to obtain waivers from federal rules, such as those in Medicaid, in order to conduct state demonstration projects; and increased federal funding to go along with federal mandates to states such as benefit expansions in Medicaid. Similarly, Castle's own "Congressional Agenda" calls for ensuring health coverage for children up to age 18, providing greater state flexibility in "managing health care needs," and abolishing the federal waiver process for welfare-related programs. North Dakota's Pomeroy has been his state's insurance commissioner since 1985 and served as the president of the National Association of Insurance Commissioners in 1990 and VP the year before. He has pledged to make health care reform a priority during his first term and within the past two years testified before congressional hearings several times on long-term care insurance and small market health insurance reform. Pomeroy has advocated insurance reforms to aid small companies and other small purchasers, overall state-approved budget limits for health spending and limits on state's liabilities for Medicaid costs. Pomeroy won his House race by a 60% margin. Pomeroy has issued a "three-point" health plan: establish insurance purchasing cooperatives for small employers, "immediately" develop electronic claims payment systems, and establish state-based cost containment "commissions." Washington's Kreidler received a Doctorate in Optometry from Pacific University and a Masters in Public Health from the University of California-Los Angeles and served in the Army Medical Corps in the early 1970s. Kreidler, who won a 53% vote in a four-way general election, will represent Washington's Ninth District, encompassing Tacoma and other cities in the southern area of the Puget Sound. Kreidler's political background includes eight years in the State Senate and a previous eight in the State House. In the Washington legislature's most recent term, he was the top-ranking Democrat on the Health and Long-Term Care Subcommittee and, aides said, held leadership posts on health-related committees during his entire state legislative tenure. While few other House freshmen match Castle, Pomeroy and Kreidler for hands-on experience, interest in health care reform was cited by at least a couple dozen House candidates. Among those providing somewhat detailed views is Peter Deutsch (D), who won his bid to fill southern Florida's newly-drawn 20th District, created through redistricting. Deutsch, a nine-year state legislature veteran, recommends a combination of tax incentives to employers to provide insurance, improved funding of preventive services and some form of cost limits on health services. In addition, Deutsch supports increased government funding for research on AIDS, diseases affecting women and contraceptives, and he expressed support for introduction of Roussel-Uclaf's abortifacient pill RU-486. He has advocated support for use of fetal tissue in research such as in the development of treatments for Alzheimer's disease. While numerous candidates spoke to a concern for health care reform during the 1992 campaigns, at least two health professionals lost their general election bids to join the House. One is John Herschler (D), a Wyoming physician who highlighted his health care background but lost to incumbent Rep. Craig Thomas (R). Also losing a House bid was Cheryl Knapp (D), a nurse running against incumbent Michael Bilirakis (R). Knapp had cited her support for the American Nurses Association's health care reform plan. However, Bilirakis, who has represented the Clearwater, Fla. area since 1983, also has some credentials in the health area. He is a member of the health subcommittees of both the Energy & Commerce and Veterans Affairs Committees. The two House incumbents who are also health professionals both won their re-election bids by comfortable margins. Rep. Roy Rowland (D-Ga.), a physician, won 56% of the votes in his district. Rep. Bill Brewster (D-Okla.), a pharmacist, won his race by a 75% lead. While the Senate newcomers elected Nov. 3 have less hands-on health experience than some of their House counterparts, health care surfaced as an issue in several Senate races. Perhaps most notably, Washington voters elected a new senator, Patty Murray (D), who has pledged to make health care reform -- including drug costs -- one of her top priorities. Murray already has expressed an interest in joining the Senate Labor & Human Resources Committee. Murray's health position paper cites her support for "cost containment mechanisms to regulate the high cost" of drugs, improved preventive care including immunizations, and a national health care commission to address costs and access. Support for some sort of program of universal health care coverage also has been expressed by California freshman Sen. Barbara Boxer (D) and Illinois incoming Sen. Carol Moseley Braun (D). Boxer, a House member since 1983, has been involved in health research issues. In April 1990, for example, she led a group of 14 California legislators who urged HHS to support testing of RU-486. Noting that several San Francisco-area researchers were considering sponsoring a clinical trial of the drug, the Californians urged that any resulting study protocol be reviewed by FDA solely on the basis of its "scientific merits." FDA has an import ban on RU-486 that has prevented the drug from being studied in clinical trials. Two years earlier, Boxer introduced House legislation that would generally ban use of animal acute toxicity testing to determine product labeling or safety requirements. The bill was aimed at LD[50] testing, in which researchers determine the dose that is lethal to 50% of test animals. An immediate question on the Senate side is who will fill the post of Clinton's running mate, Tennessee Sen. Albert Gore. Possible successors being mentioned on Capitol Hill and in local newspapers include Democratic Reps. John Tanner, Bart Gordon and Jim Cooper. A member of the House Energy & Commerce Committee, Cooper was active during the last Congress on Medicaid outpatient drug rebates and the Conservative Democratic Forum's health reform plan. Cooper is expected to play a larger role on health care issues in the next Congress -- whether in the Senate or House. One of his former staffers, Atul Gawande, has been the Clinton campaign's key health staffer throughout the campaign. Tennessee Gov. Ned McWherter (D) indicated at a Nov. 5 press briefing that he intends to appoint Gore's successor between Dec. 14 and Jan. 2. That would place the decision after the electoral college meets to officially declare Bill Clinton the president- elect but before the 103rd Congress convenes, thus giving the appointee seniority over the other new senators. Gore's successor would serve for two years until a special election is held.
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