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Executive Summary

Former Rep. Downey (D-N.Y.), new head of the health "cluster group" in President-elect Clinton's transition team, has a strong background in the human resources side of the HHS mandate. His direct experience on the health side has been more limited, but he has been an advocate of a single-payer health care system. During the 102nd Congress, Downey cosponsored the Universal Health Care Act, which was introduced in March 1991 by Rep. Russo (D-Ill.) as HR 1300. In particular, the legislation called for the creation of a single-payer health care system to be financed through a 6% payroll tax. Downey, 43, was named on Nov. 25 to lead the transition team's "cluster group" responsible for the areas of health, human services and housing. Downey is charged with advising Clinton on possible organizational and operational changes in departments including HHS. Downey also will be responsible for recommending candidates for top positions in HHS and its affiliated agencies, including the FDA commissioner, the administrator of the Health Care Financing Administration and the National Institutes of Health director. The choice of Downey suggests two nuances about the transition. First, it strengthens the image that Clinton has been cultivating of the new administration's determination to work with Congress. It also subtly states the influence of Vice-President- elect Gore in the area of health issues. Downey is reportedly a close associate of Gore from their work on Capitol Hill. First elected to Congress in 1974 at the age of 25 as part of the reform-minded post-Watergate freshman class, Downey most recently served as acting chairman of the Ways & Means Human Resources Subcommittee, which considers welfare and unemployment issues. In addition, Downey chaired the House Aging/Human Services Subcommittee and was next in line to assume the chairmanship of the full committee following the resignation of former Chairman Roybal (D-Calif.) in February. * In the Nov. 3 elections, Downey was defeated by Republican challenger Rick Lazio. During the campaign, Lazio emphasized Downey's 151 bounced checks at the House bank and his wife's position as House bank auditor. Downey did not take a leadership role on any health care issues (as the primary sponsor of legislation) in the 102nd Congress, but he did sign on as a co-sponsor to a number of bills. In addition to the Russo health care reform bill, Downey co- sponsored measures calling for family and medical leave, research on the morning sickness drug DES, Alzheimer's disease and breast implants, breast cancer screening, HIV and social security, and expansions of Medicare coverage. Downey's legislative record shows considerable action on other social issues that fall within the purview of HHS, such as welfare and services for the elderly. During the 102nd Congress, Downey was most active on the issue of unemployment compensation, sponsoring extension legislation that was included in the urban aid and tax bill eventually vetoed by President Bush. Downey will be working with former South Carolina Gov. Richard Riley (D), who is the transition team's assistant director for personnel and coordinates the "cluster groups" ("The Pink Sheet" Nov. 23, p. 16). A number of other Capitol Hill veterans will be joining the Clinton health team as members of either the cluster groups or health policy groups. Those who join the policy groups will be working with the director of the health transition team, Georgetown University's Judith Feder, and her deputy Atul Gawande, who were named to their posts Nov. 12 ("The Pink Sheet" Nov. 16, p. 11). * Christopher Jennings, an aide to Sen. Pryor (D-Ark.), is taking a leave of absence as deputy staff director of the Senate Special Committee on Aging. His primary function probably will be to examine the politics for a health care reform proposal. The Pryor committee's Staff Director Portia Mittelman also is said to be under consideration for a role as outside advisor to the transition team. Energy & Commerce/Health Subcommittee Counsel Timothy Westmoreland is expected to take a leave from the staff of the House panel chaired by Rep. Waxman (D-Calif.), to work on the AIDS policy group. He may be joined by fellow subcommittee counsel Ruth Katz, who also may participate in the transition as an outside advisor. Another former Capitol Hill veteran, Peter Knight, reportedly will join the Clinton transition effort. Knight was an aide to Sen. Gore (D-Tenn.) and ran Gore's presidential campaign in 1988. After the Tennessee Democrat lost the nomination, Knight joined the New York City-based start-up pharmaceutical firm Medicis. Charlotte Hayes, from Gore's current staff, is also expected to play a transition role. Bruce Fried, who served as chairman of the Clinton for President Health Care Advisory Group, is slated to join the transition team. Fried is is a lobbyist with the Wexler Group. He has represented the Catholic Hospitals Association. Another member of the campaign health committee, University of North Carolina health policy professor Kenneth Thorpe also is said to be joining the transition team. The national pharmacy associations are among the health- related industry and professional groups that have begun to prepare agendas for the incoming administration. The pharmacy groups are particularly important to watch in the Clinton transition because of their past support of Sen. Pryor's efforts in the pharmaceutical field. NARD, which may have the closest ties to the incoming administration through the Arkansas background of its Exec VP Charles West, is expected to circulate a policy document in the first week of December. The NARD document is almost certain to incorporate equal access and freedom-of-choice policies adopted at the independent pharmacy retailer association's recent convention in Seattle ("The Pink Sheet" Nov. 2, p. 17). For example, NARD resolved to support legislation "to guarantee equal access to independent pharmacy to the same price available to others, irrespective of practice setting" and measures that permit "full deductibility of health insurance premiums only for benefits that guarantee the consumer equal access to the pharmacy/pharmacist of their choice and that provide payment for complete pharmacy professional services." The American Pharmaceutical Association is also developing a position paper to present to the health transition team. The National Association of Chain Drug Stores, whose President Ronald Ziegler was a member of the Bush/Quayle health coalition ("The Pink Sheet" Oct. 19, In Brief), reports that it has met informally with staff of the health transition team and is planning more formal discussions in the future. High on the FDA issues list, being included in HHS transition materials for the Clinton Administration, is likely to be the import ban on the Roussel-Uclaf abortifacient drug, RU-486. Other FDA issues being considered for inclusion on the list are user fee implementation, mammography standards and food labeling regulations. The list is being prepared by an agency transition group that comprises six career FDAers headed by Deputy Commissioner for Operations Jane Henney, MD ("The Pink Sheet" Nov. 23, p. 17). A paper by two university policy analysts recommends that Clinton establish early in the transition period a "core science and technology team" to provide a focused, coordinated vision to his administration's overall science and technology goals, including funding. Entitled "Science and Technology in the Clinton Administration: Recommendations for Transitional Planning," the report was written by George Washington University's William Wells and George Mason University's Richard Bradshaw and presented at a Nov. 20 meeting sponsored by the American Association for the Advancement of Science. Bradshaw was a key technology policy advisor to the Clinton campaign. The report was submitted to the transition team during the week of Nov. 9. The paper says an initial task of the technology team will be to work directly with the Office of Management & Budget to shape the science and technology components of the administration's fiscal 1994 budget proposal. In addition, members of the core team, which would comprise 10-15 cabinet and executive office appointees, should be appointed as early as possible during the transition period so that they can participate in the budget development process and consider science and technology issues in the earliest planning stages of the new administration. The team should include the HHS secretary, the assistant secretary for health and the assistant to the president for science and technology.

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