Committee Post Gives Texas Congressman Health Care Clout
Cover Story -- July 2004
By Ken Ortolon
Louisiana's loss appears to be Texas' gain. When U.S. Rep. Billy Tauzin (R-La.) resigned as chair of the House Energy and Commerce Committee in February, the House Republican leadership tapped Texan Joe Barton to take his place.
Political observers say that puts Representative Barton, a Republican from Ennis, at the head of one of the most powerful committees in Congress and makes him a major player in national policy on energy, telecommunications, and -- despite the committee's name -- health care. He is only the second Texan to chair the committee. The first was Sam Rayburn, who later became speaker of the House.
That, they add, could be good news for Texas patients and physicians.
"This is absolutely dramatic [for Texas], without question," said Peggy Tighe, lead lobbyist on Energy and Commerce Committee issues for the American Medical Association. "It's crucial because of who Barton is and how he operates."
Texas Medical Association President Bohn Allen, MD, one of Representative Barton's constituents who knows him well, agrees.
"Any state that has a congressman as the head of one of the major committees has a tremendous asset," Dr. Allen said. "We see this as a real opportunity for Texas physicians to have significant input in health policy developed by the Energy and Commerce Committee."
The Energy and Commerce Committee is the oldest standing committee in the U.S. House and has the broadest jurisdiction of any committee in Congress. Ms. Tighe says the panel has jurisdiction over roughly 80 percent of all bills that go through the House.
"It is an amazingly important committee," she said, adding that its chair holds tremendous influence over a huge range of issues.
The committee maintains principal responsibility for legislative oversight of public health, air quality and environmental health, telecommunications, consumer protection, food and drug safety, the supply and delivery of energy, and interstate and foreign commerce. In the health care arena, it oversees Medicare, Medicaid, the National Institutes of Health, the U.S. Centers for Disease Control and Prevention, the Department of Health and Human Services, and countless other programs.
Congressional observers say the panel impacts just about every aspect of physicians' professional lives from the time they apply for student loans, to the type of health care system they practice in, to how they get paid.
Representative Barton now has the opportunity to put his personal stamp on those programs. And, assuming the Republicans maintain control of the House and he continues to be reelected, he will have nearly seven years in which to do it. House committee chairs are limited to three terms, or six years. But Representative Barton will get an extra few months because he is serving out the end of Representative Tauzin's term as chair.
Representative Barton may have limited expertise in health care, but he is no stranger to medicine's issues. Dr. Allen says the representative has been a good friend of medicine.
"By and large over the years, medicine has had a good relationship with Congressman Barton," he said.
There are, however, a couple of exceptions. In the late 1990s, he supported an alternative to organized medicine's managed care reform bill. And, some Dallas-area physicians, particularly those who deal with respiratory illnesses, were not pleased with his attempt to exempt Ellis County from new, more stringent air quality standards.
"These two issues in no way should overshadow his excellent health care record," Dr. Allen said.
For example, during the past two years, he has been "one of the champions" in rolling back projected cuts in Medicare physician fees, thereby protecting access to care for elderly patients, Dr. Allen says. He also championed professional liability reform and has shown interest in addressing border health concerns.
Ms. Tighe also says Representative Barton played a crucial role in removing a provision mandating electronic prescribing from last year's Medicare prescription drug bill. AMA opposed the provision and took its concerns to Representative Barton and Rep. Kevin Brady (R-The Woodlands). The two wrote a letter to their colleagues that Ms. Tighe says changed the debate and persuaded the House to make electronic prescribing voluntary.
"What he did for us was absolutely critical in terms of the drug debate," she said. "We felt that they should not force this new regulation on doctors who already are beleaguered by lack of medical liability reform, managed care problems, and the like."
While Representative Barton is getting his feet under him in his new job, he has made one decision that could have far-reaching ramifications. Most federal programs created by Congress are authorized for a set period of time. Once that authorization expires, Congress is supposed to reauthorize a program before giving it more money.
"What's happened in the last 10 or 15 years is that a lot of programs, as their authorization has expired, haven't been reauthorized," Representative Barton said. "They just continue to exist without the law that empowered them being renewed."
That, however, is about to change, at least for programs under the jurisdiction of his committee. Representative Barton intends to conduct hearings on reauthorizing all of those programs, including health care programs whose authorization has expired. The first health care agency to be scrutinized will be the National Institutes of Health (NIH).
Representative Barton says fewer than 20 percent of programs run by NIH are currently authorized, yet Congress has doubled the agency's budget over the past five years.
"Technically, if a program is not authorized, we're not supposed to spend money on it. If the appropriators wanted to, they could zero-fund any unauthorized program."
Ms. Tighe says reauthorization of many of these programs never occurs because the process opens up controversial issues. NIH reauthorization, for example, was blocked several years ago because of a contentious debate over stem cell research.
But Representative Barton believes reauthorization is a "good government" issue that provides an opportunity to reexamine priorities from time to time. "We want, hopefully, to modernize the programs and see which priorities need to be increased and which programs perhaps have fulfilled their intent, see if there's some way to restructure them so you get more bang for the buck," he said.
Ms. Tighe says it is unclear how aggressively the committee will pursue the chair's reauthorization agenda, but adds that major program changes are not likely to be seen any time soon because of the political climate.
"With this year being an election year not only with the House and Senate but also with the White House, it's unlikely to go down that road," she said. "But the process is important to start now because looking at the way things get funded is something that this conservative member believes very strongly in."
Looking to '05
Meanwhile, Representative Barton says Medicare and Medicaid likely will be among the top issues facing the next Congress. The committee will monitor the implementation of the Medicare prescription drug bill. Representative Barton was instrumental in including the discount drug card program in that bill, and he believes it will be a huge benefit to seniors.
"The main thing about [the discount card] is that it provides some benefit right away to seniors who use prescription drugs," he said. "Then over time as we kick in the rest of the drug benefit, it ought to make people on Medicare a lot less worried about their prescription drug costs."
The discount cards became available in June and give Medicare beneficiaries discounts of between 10 percent and 30 percent on prescriptions. (See "Take A Card," June 2004 Texas Medicine .)
While the committee will keep an eye on implementing the drug benefit, Representative Barton also wants it to tackle a permanent fix for physician payment. Currently, physician Medicare fees are based on a "sustainable growth rate" formula that adjusts fees up and down based on volume of services being delivered to Medicare beneficiaries. When volume of services exceeds projected targets, as they have the past two years, physician fees are reduced to keep overall costs within the sustainable growth rate.
"When we switched over from the simple fee reimbursement, fair and reasonable, 12 or 13 years ago, we just tried all kinds of different formulas and inflation adjustments and relative value scales," Representative Barton said. "We still haven't got it right. If we used the formula in the current law the last two years, we would have had cuts between 4- and 5-percent each year. So we've had two years in a row that we've overridden the formula and put in a modest increase -- 1 or 2 percent -- each of the last two years."
What's worse, the Centers for Medicare & Medicaid Services estimates the sustainable growth rate formula will reduce physician fees even further over the next several years.
"I know the physicians are not happy with it, and I know Congress is not happy with it," Representative Barton said. "But trying to come up with an adjustment or an alternative is not an easy thing to do."
Whatever change is mandated has to meet two goals, he says. "One is to come up with a system that's as fair as possible for reimbursement for physicians and the other goal is to try to make sure that the cost to the taxpayer and to the Medicare recipient is no larger than it absolutely has to be to get the best quality care."
Although the health subcommittee held hearings on the sustainable growth rate in May, Representative Barton says Congress is likely to pass a fix next year.
While he supports national medical liability reform, he predicts nothing will happen on that front while Senate Democrats are "beholden" to trial lawyers.
And, although momentum is building to allow reimportation of prescription drugs from Canada and Mexico and, he believes the Medicare discount drug cards will give seniors the price breaks they could get on reimported medications. Nevertheless, he is preparing a proposal for House leaders that would authorize reimportation of drugs in situations where the safety and efficacy of the drug can be guaranteed through a documented chain of custody. That proposal would give drug manufacturers some liability protection if a drug has not been handled properly while in foreign hands or has been substituted with a counterfeit drug.
"The primary concern in the House has been to make sure that prescription drugs that seniors and the average citizen get are really what they ordered, that they're pure drugs, they're safe, they're 100-percent real," he said. "Historically, we have resisted efforts to let any drug be reimported because we can't guarantee the safety and the efficacy of the drug."
Finally, Representative Barton plans to look closely at Medicaid and what states are doing to increase their federal Medicaid matching funds.
"We have a little bit of a similar situation under Medicaid as we have with physician reimbursement under Medicare," he said. "You want to cost share fairly with the states, and you want to provide the best health care you can for low-income citizens in each of the 50 states and the territories. A lot of the states have come up with some very creative ways to increase the federal share and lower the state share."
Ken Ortolon can be reached at (800) 880-1300, ext. 1392, or (512) 370-1392; or by email at Ken Ortolon.
Looking at Legislation Like an Engineer
Joe Barton was elected to the U.S. House of Representatives in 1984, filling the seat vacated when former U.S. Sen. Phil Gramm moved to the Senate.
Those who have followed his career say he was somewhat overshadowed by Senator Gramm early on, but has emerged as a major player in the House. He has served on the Energy and Commerce Committee for nine terms and chaired its energy subcommittee before becoming chair of the full committee.
Those who have seen him in action since becoming chair say they believe Representative Barton will run the committee like an engineer, which he is. He was graduated from Texas A&M University in 1972 with a degree in industrial engineering.
Representative Barton, 54, says his background gives him an analytical approach to lawmaking. "Engineers try to find the best solution and then try to implement it," he said.
Possibly the biggest surprise in his early tenure is the nonpartisan way in which he approaches his new job.
"I think people anticipated that he would be very partisan running this committee," said American Medical Association lobbyist Peggy Tighe. "And he's proven hearing after hearing that he's incredibly fair."
U.S. Rep. Gene Green (D-Houston), one of four Texas congressmen on the Energy and Commerce Committee, says he's worked closely with Representative Barton on energy and telecommunications issues in the past and says he is "forthright."
"If he's convinced something is right, he will stick with it," Representative Green said. "I'm looking forward not only to having a Texan as committee chair but also to dealing with health care issues with him and from a Texas perspective."
Representative Barton is a founding member and cochair of the Congressional Privacy Caucus and has worked to preserve financial and medical privacy. He has supported legislation to increase funding for diabetes and cancer research, and in 1997 was responsible for passing legislation to reform the U.S. Food and Drug Administration's procedures for approving medical devices.
Texas Medical Association President Bohn Allen, MD, says Representative Barton is the first to admit that he's no expert in the health care arena, as much of his previous work has centered on energy policy.
"He'll tell you right off the bat that he's not an expert, that he's an engineer, not a doctor," Dr. Allen said. "But he wants to learn, and he wants to talk to everyone he possibly can to teach him what he wants to know. He wants to know as much as he possibly can to make a good judgment."
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