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November 17, 2008

Washington Health Policy Week in Review Archive 1ae5c021-cc04-411b-b5df-c6912b4cc4f0

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Analysis Finds Higher Prices, Fewer Drug Choices for Medicare Beneficiaries

By Mary Agnes Carey, CQ HealthBeat Associate Editor

November 14, 2008 -- Many Medicare beneficiaries will have fewer drugs to choose from next year and will pay more for them, according to a new analysis from the health care consulting firm Avalere Health.

As enrollment for the 2009 Medicare prescription drug benefit begins tomorrow, a combination of premium increases, reductions in the number of drugs covered, and higher copayments for beneficiaries in Medicare prescription drug plans could cause financial hardship for Medicare enrollees, said Avalere president Dan Mendelson.

Avalere found that premiums for Medicare's 10 most popular prescription drug plans (PDPs) will increase on average by about 31 percent next year, with increases ranging from as low as 8 percent and as high as 64 percent. The firm's data also shows that nine of the top 10 prescription drug plans have reduced the number of drugs covered by between four to 17 percent, with an average reduction of about nine percent.

"The basic theme is pay more, get less," Mendelson said in an interview. "A lot of these increases will come in the form of increased cost-sharing on drugs, copays, and coinsurance and the fact that formularies are tightening typically means that the drugs used to treat chronic illness are not covered as widely."

Jeff Nelligan, director of media affairs for the Centers for Medicare and Medicaid Services, called the Avalere analysis "flat wrong."

"The number of unique drug products increased by an average of 10 for [Medicare Advantage Prescription Drug Plans] and decreased by an average of one for PDPs after accounting for products that were no longer considered Part D covered," Nelligan said.

But even accounting for drugs no longer covered by Medicare does not explain formulary reductions in by as much as 17 percent in some of the program's largest prescription drug plans, Mendelson said.

The Avalere analysis found that Humana's Enhanced prescription drug plan, which covers about 1.4 million Medicare beneficiaries, will reduce the number of drugs offered by 17 percent while beneficiaries' cost-sharing for prescriptions will increase in 2009. In addition, beneficiaries enrolled in that plan will see their monthly premiums increase from about $23 to $38.

In a statement, Humana spokesman Jim Tuner said the company's 2009 PDP prices "reflect the experience we've seen over the past three years, and our expectations around what will most interest our members and potential members going forward."

Turner added that premiums for Humana's Standard and Enhanced plans, which he said are the company's most popular plans among beneficiaries, "are near the average for all plans and comparable to similar offerings from AARP, as the Avalere analysis shows."

While the top 10 PDPs will continue to charge low cost-sharing for generics, cost-sharing for higher-priced drugs—usually brand-names—will increase in many plans next year, Avalere found.

For example, the average tier 3 copayment for UnitedHealth's AARP MedicareRx Saver plan will increase by $8 while Humana PDP Standard, which previously charged 25 percent coinsurance on all covered drugs, reduced the tiers from four to three but will nearly double the coinsurance percentage for non-preferred drugs on tier 3 to an average of 45 percent, according to the report.

Among changes in formulary coverage, AARP's Medicare Rx Preferred will reduce the number of covered drugs by 7 percent in 2009 while the MedicareRx Rewards Value plan will cut its formulary by 10 percent, according to Avalere. The PrescribaRX Bronze plan will increase its formulary by 17 percent.

Mendelson said many plans underpriced their products when they entered the drug benefit and now are raising premiums and beneficiary cost-sharing to make up for past losses.

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Baucus Outlines Health Care Plan

By Drew Armstrong, CQ Staff

November 12, 2008 -- Max Baucus, the head of the powerful Senate Finance Committee, laid down a marker on a health care overhaul Wednesday, declaring his independence from other power brokers and signaling that Congress would not wait for the new president to move forward on the issue.

The 89-page document Baucus unveiled stakes out his own territory on the issue independent from Edward M. Kennedy, D-Mass., chairman of the Health, Education, Labor and Pensions Committee and also suggests that Baucus intends for Congress to take the lead.

Many details in Baucus' plan match with what President-elect Barack Obama proposed during the campaign but it also includes elements, such as an individual mandate to buy coverage, that break with the president-elect.

Obama has proposed offering health care access for all Americans, but without a requirement that they be covered.

The centerpiece of Baucus' proposal, which he developed independently over the course of the 110th Congress, is the creation of a "health insurance exchange," where insurers could sell plans to the uninsured.

Baucus and Kennedy both appear ready to move first with their own proposals to overhaul the nation's health care system while the president-elect is still trying to figure out where the issue ranks on his agenda relative to the economy, energy, and other issues.

Still unclear is how Baucus and Kennedy will work together towards their shared goal. Both lawmakers have been meeting separately with private industry, advocacy groups, and other Democratic lawmakers to plan for an overhaul of health care policy.

Baucus said he received a "very, very complimentary call" from Kennedy, while Kennedy released a statement calling Baucus' proposal "a major contribution to the debate on health reform."

They will likely end up with competing visions, however, once Kennedy releases his own health care plan. "It seems like the Baucus guys have put a lot of time and effort into this," said a GOP aide. "He probably better reflects where the majority of the Senate would be, even though Kennedy is more closely aligned with Obama," said the aide.

Aides said there was no firm date by which Baucus would actually introduce legislation. The first step would almost certainly be the expansion of federally funded children's health insurance, known as SCHIP. The authorization for the program is up in March, and Baucus' plan proposes expanding eligibility to all children in households earning less than 250 percent of the federal poverty level.

Many parts of Baucus' plan were intentionally left vague, according to Baucus policy aides. Absent, for example, are politically sensitive details on how large a fine would be levied on large employers who do not provide health insurance, how many children would be covered under SCHIP, or even what the plan would cost or how those costs would be offset—all questions that will create fights among lawmakers and interest groups.

"This was a first step," said one Baucus policy aide. "Now we're going out for another round of stakeholder input," said the aide.

Baucus is already planning hearings, and announced a Nov. 19 hearing on health care and the economy that will likely be the first official forum for feedback on his plan.

It does seem certain, though, that the plan would not fully comply with pay-as-you-go budget rules, which require any new spending to be offset. "We're not going to fully offset the cost of the plan in the early years," said the aide.

"In the short term, health care reform will likely cost more than can be achieved in saving from all the quality improvements and financing changes," the plan reads.

Charles E. Grassley of Iowa, the Senate Finance Committee's ranking Republican, said in a statement that "paying for health care reform needs to be done in an intellectually honest way for the fiscal health of our country."

In presenting the plan, Baucus tied a health care overhaul to the economy, which Obama has said will be his first priority. "The health care system is broken for individual Americans, and it's killing our economy, too," Baucus said. "There's no way to really solve America's economic troubles without fixing the health care system."

Baucus' health insurance exchange would be a primary mechanism for covering the country's 47 million uninsured, along with an expansion of SCHIP and Medicaid.

Baucus said he expected the health insurance exchange to be phased in over a period of several years. While it was put in place, those 55 and older would be able to buy into Medicare early, a strategy designed to start covering some uninsured people and also, presumably, to help build political support for the plan.

In addition to covering the uninsured, the plan would also emphasize improved medical outcomes coupled with lower costs, would trim waste in federal health programs and would rebalance their financing.

"To fix our system, we have to deal with access, quality, and cost. We need to get everyone under the tent for health coverage, improve the quality of the care that our people receive, and address the rising costs of health care so our businesses can compete," Baucus said.

New Incentives
The fee levied on large employers who dropped coverage would be paid back into a pool that would help cover those still uninsured.

Medicare's payment mechanisms would also be redesigned. Currently, Medicare pays physicians on a per-service basis, meaning they get paid for every procedure they perform. Critics say this encourages them to perform a higher volume of procedures with less regard for low-cost, high-quality treatments. Along with increasing the number of primary care providers who often give early-stage treatments and preventive medicine, Baucus' plan would refocus physician payments on quality of care and outcomes rather than volume.

Baucus' plan also would take steps to refocus the health care system on primary care and preventive medicine. This would mean higher payments for primary care physicians, likely at the expense of higher-paid specialists like surgeons, cardiologists, and others.

The proposal also would focus on eliminating fraud, waste, and abuse in public health care programs and "address overpayments" to private insurers in the Medicare Advantage program, likely by cutting the payments to the plans.

"Careful reforms of medical malpractice laws" to help lower health care costs would be considered, Baucus said, "while ensuring the injured patients are compensated for fairly for their losses," according to the summary.

Baucus also wants to explore "targeted reforms of the tax code" as it relates to health "to make incentives more efficient" and more fairly distribute benefits.

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HHS Transition Team Leaders Named

By John Reichard, CQ HealthBeat Editor

November 14, 2008 -- One former House staffer and one former Clinton administration official became the latest to be tapped Friday to manage the Obama administration's transition activities for the Department of Health and Human Services.

William V. Corr, a proponent of tough Food and Drug Administration regulation and a former staffer for California Democrat Henry A. Waxman — when he ran the Health Subcommittee of the House Energy and Commerce panel in the 1980s — was named an "agency review team leader."

Also named was Nicole Lurie, who served as principal deputy assistant secretary for health in the last two years of the Clinton administration. Lurie is an expert on public health and health care disparities and has written on bioterrorism preparedness issues. She is now with the Rand Corporation, a think tank that analyzes a variety of policy issues.

Lurie holds two titles at Rand: director of the Center for Population Health and Health Disparities and director for Public Health Preparedness and Infrastructure. Before joining Rand she was a professor of medicine and public health at the University of Minnesota. She also held the post of medical adviser to the commissioner at the Minnesota Department of Health.

Corr now serves as executive director of the Campaign for Tobacco-Free Kids, which espouses FDA regulation of the tobacco industry. From 1998 to 2000, he served as chief counsel and policy director for Senate Minority Leader Tom Daschle, D-S.D. (1987–2005). Before that he was chief of staff to HHS Secretary Donna Shalala.

Under Waxman, Corr handled FDA issues as well as those relating to access to health care. His work included the landmark 1984 legislation authorizing FDA approval of a wide variety of generic drugs. A graduate of Vanderbilt University's law school, Corr formed and directed primary care clinics in Tennessee and Kentucky in the mid-1970s.

The agency-specific transition managers announced Friday will develop information "needed to make strategic policy, budgetary, and personnel decisions prior to the inauguration," the Obama-Biden transition team said. "The teams will begin their efforts today, and will ensure that senior appointees have the information necessary to complete the confirmation process, lead their departments, and begin implementing signature policy initiatives immediately after they are sworn in," according to a transition team memo.

Overseeing transition activities for the departments of Justice, Health and Human Services, Veterans Affairs, and Housing and Urban Development is Tom Perez, currently secretary of the Maryland Department of Labor, Licensing and Regulation. He held various civil rights posts at the Justice Department during the Clinton administration and was director of the Office for Civil Rights at HHS under Shalala. From 2001 until last year, he was an assistant professor of law at the University of Maryland. He currently is an adjunct faculty member at the George Washington School of Public Health.

Named as a transition leader for bioethics issue was Jonathan D. Moreno, professor of medical ethics at the University of Pennsylvania. He is also a visiting professor of biomedical ethics at the University of Virginia.

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Stark Sees Passing Vetoed SCHIP Measure as First Priority

By John Reichard, CQ HealthBeat Editor

November10, 2008 -- First up on the Ways and Means health agenda next year will be "deferred maintenance"—passing measures opposed or neglected by the Bush administration such as the State Children's Health Insurance Program expansion vetoed by the White House"—and "rebasing" physician spending in Medicare to eliminate the need for costly temporary payment patches. So said Ways and Means Health Subcommittee Chairman Pete Stark, D-Calif., in an afternoon press briefing laying out the subcommittees' health care agenda for next year.

Though Stark said his panel stands ready to work with the incoming Obama administration on a major health care overhaul, he stuck to discussing other health care issues in the absence of any clear signal yet on how the new White House will want to proceed. Stark said he's heard from the Obama transition team that they expect to follow "regular order" on a health overhaul"—the textbook approach to legislation involving a bill introduction, followed by hearings, subcommittee and committee markups, floor action, and a conference between the two legislative chambers to resolve differences in their respective pieces of legislation. Stark said he thought the process would begin by considering the Obama proposal with an extensive series of hearings to follow.

"SCHIP is arguably the first because of the timing," Stark said, alluding to the March expiration of the current authorization for the program. "If we have a lame duck maybe we could get it through without a veto this time and get it taken care of." But Stark expressed doubt that a lame-duck session would occur this year. He also said that the terms of an SCHIP expansion might have to be changed given the possibility that with the downturn in the economy many more uninsured children would qualify for the program. In other words, sticking to the income eligibility criteria in the vetoed expansion might bring in many more children than anticipated when the bill was approved by the House and Senate, hiking its cost considerably. Stark said the income limits might have to be adjusted as a result.

"The next order of business that I feel we have to deal with is the physician reimbursement," Stark said. He said it will be "as much a budget issue as a technical issue as to how we design" a revised Medicare doctor payment approach. Under the current formula, it would take some $200 to $300 billion over 10 years to erase a yearly schedule of ever deeper cuts in physician payment levels. "We don't have that," Stark said.

The current formula is based on a target of yearly spending for physician care that Medicare regularly exceeds, building a backlog of debt that entails ever deeper cuts in future years to erase. But Stark and his aides said that problem will only grow worse because Congress won't allow cuts to occur, thereby adding to the pile of debt and deepening the cuts that must be made.

Basically, Stark says that rules of budgeteering must be changed to cancel the backlog of debt"—what Stark called canceling the "credit card debt." In return for canceling that debt Stark called for an approach that would set spending targets for six different categories of physician spending and that would be built on a promise that Medicare's physician spending outlays would be budget-neutral in the future. Stark hinted that there might be a provision in a physician spending measure to boost payments to primary care physicians. He said his staff is at work now on drafting legislation to address the physician payment issues.

Stark and his aides also indicated that an ambitious research program to spur adoption of health information technology and to harness that technology to compare the effectiveness of medical treatments would accompany physician payment changes. "Health IT" and "comparative effectiveness" are viewed by many analysts as techniques that eventually could reduce health spending growth.

Other "deferred maintenance issues" listed by Stark include changes to the Medicare Part D prescription drug program, such as low-income subsidies, marketing issues, and oversight of pricing.

Stark said he would then go after Medicare Advantage "overpayments," seeking to bring them down to payments levels in the traditional Medicare fee-for-service program. He indicated that while he would like to lower the overpayments to pay for an expanded and reauthorized SCHIP program, that tobacco taxes might be used instead.

On health IT, he said Ways and Means is working with the House Energy and Commerce Committee to hammer out a compromise package. He said he favored a program of boosting payments to providers using health IT and then penalizing them after several years if they had not adopted the technology. He suggested that a "date certain" is necessary for health IT because any health care overhaul would depend on having automated medical records.

Stark said he sees improved prospects for a health overhaul compared to the early 1990s because of broader support from the business community, including the U.S. Chamber of Commerce. Backing of the American Medical Association also improves overhaul prospects, he said.

As Obama's aides huddle over what their leading priorities will be, key lawmakers are beginning to weigh in on health care to state their preferences. Stark made a pitch for his own "Americare Health Care Act" (HR 1841), which would allow people with employer-based coverage to stick with their current plans while subsidizing the purchase of coverage for uninsured Americans with modest incomes. Employers would be required to fund premiums or pay a fee, and individuals would have to document at tax time that they had coverage. Senate Finance Committee Chairman Max Baucus, D-Mont., plans to unveil his principles for an health overhaul at a briefing on Wednesday.

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Study: U.S. Patients More Likely to Call for Health Care Overhaul

By Joanna Anderson, CQ Staff

November 13, 2008 -- Medical patients in the United States are significantly more likely to call for an overhaul of their country's health care system than patients elsewhere in the world, according to findings released Thursday by the Commonwealth Fund.

Revamping the health care system is one of President-elect Barack Obama's top priorities. Commonwealth Fund President Karen Davis said the incoming administration and Congress would present a window of opportunity in 2009 to build a high performance care system.

Davis tied what she called a health care crisis in the United States to the current economic downturn, noting that increased unemployment will leave more Americans without access to care and tighter family budgets will hinder affordability of care. "We can't afford not to reform our care system," added Commonwealth's Senior Vice-President Cathy Schoen.

The 2008 survey of 7,500 chronically ill patients in eight countries found Americans far more likely to forgo care because of costs. More than half of the U.S. patients questioned did not get recommended care, fill prescriptions, or visit a physician when sick because of the associated costs. That figure ranged from 7 percent to 36 percent in the other countries.

The study also found that U.S. patients experienced the highest rates of medical errors, coordination problems, and high out-of-pocket costs. Roughly one-third of the Americans surveyed reported medical errors or poorly coordinated care, such as delays in access to records and duplicated tests. Meanwhile, 41 percent of U.S. patients spent more than $1,000 in the past year on out-of-pocket medical costs, compared with just 4 percent in the United Kingdom and 8 percent in the Netherlands. Schoen attributed those high out-of-pocket costs to the large number of uninsured Americans, as well as a substantial cost-sharing burden placed on those with insurance, she said.

The survey included adults diagnosed with at least one of seven chronic conditions in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States.

The findings also show that chronically ill patients in the United States often experienced long waits to see primary care providers, had difficulty accessing care after hours, and frequently turned to emergency rooms for care. One of five of the U.S. patients surveyed said they had gone to an emergency room for a problem they thought could have been treated by a primary care physician had access been readily available, according to Schoen.

While the study revealed poorly organized, duplicate, or wasteful care experiences for U.S. patients, it showed notably more positive experiences for Dutch patients. The authors attributed the contrast to the Netherlands' universal coverage system, strong primary care, and widespread use of electronic medical records.

In addition, the authors identified a number of challenges shared by all countries studied: enhancing primary care, assuring quality transitional care when patients are discharged from hospitals, and improving information flow when patients see multiple clinicians.

Davis called Wednesday's introduction of a health care agenda by Senate Finance Committee Chairman Max Baucus, D-Mont., a step in the right direction. Baucus' plan would expand coverage to all Americans, emphasize increased quality and lower costs, trim waste in federal health programs, and rebalance their financing.

Democrats are expected to pass a large expansion of children's health insurance early next year.
Drew Armstrong contributed to this story.

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Witnesses Urge $50 Billion Boost in Federal Medicaid Outlays

By John Reichard, CQ HealthBeat Editor

November 13, 2008 -- Gene Sperling, who served as a top economic adviser in the Clinton White House, joined with Gov. Janet Napolitano, D-Ariz., and other governors Thursday in calling for an increase of $40 to $50 billion over a two-year period in federal Medicaid spending. But two other witnesses who also testified at Thursday's hearing by the House Energy and Commerce Health Subcommittee differed with Sperling and Napolitano over adding Medicaid money to a new economic stimulus package.

Subcommittee Chairman Frank Pallone Jr., D-N.J., called the hearing to push for inclusion of Medicaid money in a stimulus package the House may take up next week, as well as added funding for the National Institutes of Health (NIH). But Pallone indicated after the hearing that he'll urge a more modest $14 billion Medicaid infusion over 18 months, noting that the opposition of President Bush to added federal Medicaid spending means any amount that is included will have to be relatively small. Pallone admitted that inclusion of added NIH money is less likely than the boost in Medicaid spending.

An economic stimulus package put off until early next year could create an opportunity for larger Medicaid spending, but a number of economists say Congress should act quickly to address the faltering economy.

House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev., are urging lawmakers to pass a new economic stimulus package including new aid for struggling automakers. But Pelosi and House Majority Leader Steny H. Hoyer, D-Md., say they won't bring the House back for a possible lame-duck session the week of Nov. 17 unless Bush and Senate Republicans allow a stimulus and auto industry aid to become law. That hasn't happened yet.

Sperling called the nation's fiscal outlook the worst he's seen in his career as a professional economist. "We have to start with the notion that we are in a demand crisis," he said. "I can't see where demand [for goods and services] is coming from next year." He is now a senior fellow with the left-leaning Center for American Progress Action Fund.

Hit by a double whammy of declining real estate values and shrinking retirement accounts, families everywhere are focused on one thing, Sperling said—how to reduce their spending. "For tens of millions of families who are observing a weakening labor market and dual hits to their home wealth and pension savings, there is only one conversation going on around these millions of kitchen tables: What are we going to cut back?"

Businesses see that happening and are shelving expansion plans and laying off employees, adding to the downward spiral of demand, Sperling said.

In recent years, inflation-adjusted income hasn't grown but families were able to spend more by using rising home equity values as ATM machines, he noted. But those ATMs have run out of cash with plummeting real estate values and hopes have been dashed that the combination of a falling dollar, cheaper exports, and strong demand for U.S. products in Europe would help the nation emerge from its current downturn.

"Where exactly is a surge in economic demand likely to come from in 2009?" he asked. The only realistic hope is for a big stimulus package, which Sperling said should follow in economic terms the military principles espoused by Colin Powell when it decides to undertake warfare: that it marshal an overwhelming force to quickly achieve a decisive victory. "This is a Powell Doctrine moment for stimulus," Sperling said, one that should aim "to have overwhelming force."

To that end he called for spending a minimum of $300 to $400 billion over an 18-month period. Sperling said even if that's $100 billion to $200 billion too much, the economic risks involved are small compared with that of a prolonged global recession. He said he could easily justify spending $75 to $100 billion of that over 18 to 24 months on fiscal aid to the states, with half of that for a temporary increase in the Federal Medical Assistance Percentage (FMAP), the share of Medicaid spending borne by the federal government.

Napolitano said that 35 to 40 states will ultimately face budget shortfalls in 2009 because of declining revenues from the economic downturn. "These states will accumulate deficits of at least $140 billion through fiscal 2010," she predicted.

Napolitano said the federal government should boost FMAP by $25 billion a year for two years to help states cope with rising Medicaid enrollment fueled by job losses and prevent cuts in health care services caused by declining revenues. She added that lawmakers should change the Medicaid statute to automatically boost federal Medicaid spending during economic downturns.

"There is broad consensus that an early enough, long enough stimulus during an economic downturn can ameliorate some of the downturn's worst effects. There is also consensus that temporary FMAP increases are one of the best ways to stimulate the economy," she said.

Napolitano was testifying on her own behalf and not on that of other governors. But the National Governors Association released a paper Thursday that called for a similar, if somewhat smaller, amount in added FMAP spending. Congress should boost FMAP outlays by a least $20 billion a year for two years, the governors said.

However, Raymond Pinard, a Boston-based print business owner who testified on behalf of the U.S. Chamber of Commerce, testified that the "best way to protect health care benefits and reduce health care costs incurred by states is to provide incentives for the private sector to create jobs." He said that tax breaks in the economic stimulus package signed into law earlier this year hastened his company's $2.25 million purchase of a printing press that created a number of new jobs with health care benefits.

"I am also aware that some of the proposals you are entertaining are helping states with their Medicaid obligations or providing additional funding to NIH for research. While these are interesting proposals, as an employer I feel that you will get more bang for the buck by considering a second round of tax incentives crafted for small businesses to invest and expand instead," he said.

Alan D. Viard, a resident scholar at the American Enterprise Institute, said that the need for a stimulus package is uncertain but that if one is adopted "increases in the federal Medicaid matching rate should not be included because they are an ineffective means of boosting aggregate demand."

"It is tempting to argue that increased spending on a specified item—medical care, alternative energy, defense, business investment, or anything else—will create jobs. It is always easy to see the large number of workers who will be employed to produce the specified item. But, it is also necessary to see the jobs displaced elsewhere in the economy, as an increase in spending on the specified item forces a reduction in spending on other goods and services."

Sperling agreed that "it absolutely is not a way" to permanently increase jobs but said a stimulus is a way to stop a painful downward cycle. "I'm just extremely, extremely worried," Sperling said, adding that he's never before advocated a stimulus package exceeding $150 billion.

In terms of added NIH spending, Pallone asserted that it provides "real, direct economic benefits at the local level including increased employment, growth opportunities for universities, medical centers, local companies, and additional economic stimulus for the community."

Ron Pollack, executive director of the advocacy group Families USA, testified that "every dollar invested in NIH generates more than twice that amount in state economic input." It is "an investment that can stimulate state economies while helping ensure that we maintain our preeminence in biomedical research." According to a Families USA analysis, $22.8 billion in NIH grants and contracts to universities and other research organizations in 2007 generated a total of $50.5 billion across the states in new business activity.

Raynard S. Kington, acting NIH Director, testified that stagnant funding for the agency comes at a critical time when biomedical science is on the threshold of many new medical breakthroughs. It also threatens the career development of a cadre of young researchers who could help convert NIH discoveries into major advances, he suggested. On the other hand, added spending leads to new technologies, patents, and businesses generating economic activity, he said.

Rachel King, CEO of the biotech firm Glycomimetics, testified that the current downturn puts many emerging biotech firms "in a precarious position where they must continue their development projects, but are unable to attain additional financing from investors. Adding money for NIH would improve the investment climate for emerging biotech firms, said King, who testified on behalf of the Biotechnology Industry Organization (BIO). BIO is urging the inclusion of an added $1.9 billion in NIH funding as part of a stimulus package.

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