Whither Harkin-Hatfield?

The Harkin-Hatfield Fund for Medical Research amendment, introduced last spring by Sens. Tom Harkin (D-Iowa) and Mark O. Hatfield (R-Ore.) and attached to several healthcare reform bills debated in Congress, would set aside monies for medical research above the National Institutes of Health appropriation. The funds would be obtained through a 1 percent assessment on all monthly health insurance premiums and a voluntary income tax check-off. The biomedical-research community--joined by many members of Congress--was overwhelmingly in favor of the amendment. "The support for that bill this year was unlike anything I've seen," says Terry Lierman, president of Washington, D.C.based Capitol Associates Inc., a government-relations firm. But with health-care reform bills taken off the table, at least for the remainder of the year, there is no guarantee that the proposal will pass. Harkin and Hatfield both are considered friends of biomedical research. As chairman of the Senate Appropriations Committee Subcommittee on Labor, Health and Human Services, and Education, Harkin obtained an increase in the NIH budget from $7.89 billion in 1989 (when he took over the subcommittee chairmanship) to $11.34 billion in fiscal year 1995. Hatfield, the ranking Republican on the Appropriations Committee, was instrumental along with Harkin in setting up nationwide centers for Alzheimer's research five years ago. In addition, he wrote legislation setting up a national center for sleep research as part of NIH's reauthorization last year and has embarked on a campaign for a strategic plan for research on rare diseases. Both senators have pledged to continue their efforts to pass the Harkin-Hatfield amendment, either as part of a larger health-care reform bill or as a free-standing bill. Lierman calls the proposal "the only vehicle available to provide the funding necessary to avert the crisis in medical research." Other ways of allocating the money have become dead ends, he says: "There's a budget freeze. You can't get it into the appropriations process. And the president isn't going to propose any increase." Institute of Medicine president Kenneth Shine, who has had informal discussions with representatives of managed-care organizations, reports that they would be receptive to the bill if the money from the proposed fund were to go to clinical research--which would free up more NIH money for basic science. "There's a logic to the approach," he maintains. "It makes sense to them to have a small percentage of the health-care dollar support research when it's clinical research. "In fact, money has been coming out of patient care to support research, by paying it to hospitals to create overhead. What we're talking about is rationalizing what is already happening--patient care supports research." In the absence of a total national reform package, however, it is likely that the public will be leery of the proposal, some observers believe. If Harkin-Hatfield were not included in an aggregation of modifications to the entire health-care system, "passing that bill would be [viewed as] passing a tax," asserts Abbey Meyers, president of the New Fairfield, Conn.-based National Organization for Rare Disorders. "Nobody's going to vote for anything that would raise taxes. It has to be something that people don't see in their paychecks." Hatfield addressed this concern in a written response to a question from The Scientist: "Some will continue to see it as a tax rather than investment in cost containment. For those, let me reiterate that this is one tax the American people seem to support overwhelmingly, with Harris polls showing that 77 percent of Americans will pay $1 more per week in taxes for medical research [see below]." But Bruce L.R. Smith, a science-policy analyst at the Washington, D.C.-based Brookings Institution, says the proposal amounts to "adding to the cost of insurance." He contends: "It's adding to the cost of the system when the problem is to control the cost of the system. If NIH wants an increase in appropriations, let them go to Congress and ask for it, and debate it on its own terms." Roy Silverstein, president of the American Federation for Clinical Research, acknowledges that the proposal may be viewed as an additional tax. "There's a risk that people will see it that way," he says. "But anything that puts on the table the opportunity to increase funding for medical research is a risk worth taking." --B.S.

Whither Harkin-Hatfield?

Interested in reading more?

Become a Member of