Administration Proposes FY 2000 Budget to Congress

In early February, President Clinton sent the Administration's proposed budget for FY 2000 to Congress. With a bottom line of $1.77 trillion, the budget calls for a 6.6 percent increase for the Department of Health and Human Services over the current fiscal year. At $400.3 billion, the HHS budget includes $333.1 billion for the Health Care Financing Administration alone, covering primarily Medicare, Medicaid and the Children's Health Insurance Program. Despite the increase, the budget does call for Medicare user fees on physicians and other providers, a provision strongly opposed by the American Academy of Family Physicians (AAFP). Additionally, while calling for increases in some domestic health programs, the budget would reduce others. The Agency for Health Care Policy and Research is slated for a 21 percent increase to $206 million in FY 2000. The budget for the National Institutes of Health would increase to $15.9 billion, with $50 million for the newly established National Center for Complementary and Alternative Medicine. Funding for health professions education programs, however, faces cuts of $50 million with no funds recommended for the Primary Care Medicine and Dentistry program, which includes family medicine education training grants. The AAFP will be testifying before the appropriations committees in Congress later this spring in opposition to the cuts.

FDA Approved 90 New Original Drugs in 1998

The U.S. Food and Drug Administration (FDA) approved 90 new original drugs in 1998, 25 of which were priority products that are considered by the FDA to be potentially exceptional public health values. The median approval time for the 90 new drugs was 12 months, 17 percent faster than in 1997. The median approval time of the 25 priority products was 6.4 months. Thirty of the new original drugs were new molecular entities, which are defined as agents that contain an active substance that has never before been approved for marketing in any form in the United States. Sixteen of the new molecular entities were priority drugs, which received an accelerated review because they represent a major advance in medical treatment.

The FDA also approved 32 biologic products. Biologic products cover a broad spectrum of new products, technologies, manufacturing methods, indications and premarket applications. According to the FDA, two major approvals in this category were basiliximab (Simulect), which is used to prevent organ rejection in de novo renal transplant recipients, and anti-thromocyte globulin, rabbit, (Thymoglobulin) for use to treat and prevent acute organ rejection. Other biologic product approvals included vaccines for Lyme disease (Lymerix) and rotavirus (RotaShield), and diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed (Certiva). More information on these products can be found on the FDA Web site at http://www.fda.gov.

Clinton Proposes $4 Million for Universal Newborn Hearing Screening

A new $4 million initiative to support grants to states to develop and expand universal newborn hearing screening has been proposed in the FY 2000 budget for the Health Resources and Services Administration (HRSA). According to HRSA, only nine states now have laws requiring hearing screening for all newborns. Specifically, HRSA states that the $4 million would fund grants to develop and expand statewide universal newborn hearing screening programs; link screening programs to intervention within the community service system; monitor the impact of early detection and intervention on child, family and systems; and provide technical assistance to states.

Hospital Association Establishes Award Honoring End-of-Life Care

At the annual membership meeting of the American Hospital Association (AHA) in February, the AHA announced the establishment of an award to honor innovative programs aimed at improving the care individuals receive in the last days of their lives. The Circle of Life Award: Celebrating Innovation in End-of-Life Care will total $25,000 and will be given annually to up to three exemplary programs for care of persons at the end of life. The awards are funded by the Robert Wood Johnson Foundation. The Circle of Life Award will be given to programs that are linked to direct patient care by hospitals and health care systems, hospices and nursing homes. Cosponsors of the award are the American Medical Association, the National Hospice Organization and the American Association of Homes and Services for the Aging. The application process will begin this month. More information on the award and how to apply is available on the AHA Web site at http://www.aha.org.

Rate of Minority Medical School Applicants in Some States Declines

According to data from the Association of American Medical Colleges (AAMC), the number of underrepresented minorities applying to medical school has dropped precipitously in California, Louisiana, Mississippi and Texas since the elimination of affirmative action in those states. The AAMC classifies underrepresented minorities as black, Native American, Mexican American/Chicano and Mainland Puerto Rican. The AAMC reports that “Fortunately, at the national level, the number of underrepresented minorities applying to medical schools did not suffer further appreciable reductions from last year; there were 4,516 underrepresented minority applicants in 1997 and 4,479 in 1998. Similarly, the number of minorities entering medical schools nationwide did not fall further; (1998) entrants numbered 1,865, compared with 1,754 in 1997. The peak enrollment occurred in 1994 when 2,014 underrepresented minorities entered medical school.”

Overall, U.S. medical schools have experienced a drop in applicants for the second year in a row. For 1998, the applicant pool declined almost 5 percent to 41,003. The AAMC believes that several factors playing a role in this decline include the natural ebb and flow of applicants; the strength of the job market; the perceived impact of managed care; and the continued impact of affirmative action.