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Coming Close Only Matters in Horseshoes

As my father used to tell me, "Coming close only matters in horseshoes." And, the process of trying to pass legislation in Congress is definitely not the game of horseshoes. But, IDF’s Medicare IVIG demonstration project legislation did get "close" to being passed by the Senate at the close of the 111th Congress.

IDF’s volunteers have been pushing hard for the last several years to allow IVIG infusions in the home setting for Medicare patients.  Currently Medicare will only pay for the immunoglobulin, but will not pay for a nurse or other items and services that are needed to be safely infused in the home.

The original bill supported by IDF provided for a permanent fix of the home infusion problem.  Because the cost of a permanent fix was not known, that approach, unfortunately, did not gain “traction”.  In 2009 at the height of the health care reform debate, Senator Kerry (D. MA) filed an amendment both during committee consideration and the Senate floor debate to authorize a three year demonstration project.  Such a project would answer the “cost” questions and would provide IVIG home services to Medicare patients.  Senator Kerry was not able to offer the amendment last fall.

IDF’s attention in 2010 was to push for access to home infusion for individuals with primary immunodeficiency diseases.  The result was introduction of HR 5597 in the House,  sponsored by Congresswoman Matsui (D- CA), Congressman Kevin Brady (R-TX) and 34 other House Members.  The language of HR 5597 was identical to Senator Kerry’s filed amendment from the previous year.   IDF volunteers swarmed Capitol Hill on Advocacy Day in support of HR 5597 and over 1000 letters were sent to legislators through the IDF Action Alert system.  IDF volunteers also met with Congressional staff and Members in their home offices.

One of the things different this year was IDF’s penetration of the Democratic House leadership.  By October, we had the interest of the Majority Leader Steny Hoyer (D.MD).  Assistant to the Speaker, Representative Chris Van Hollen (D. MD) became one of our leading co-sponsors. Numerous meetings and conversations with them and Ways and Means and Energy and Commerce staff members raised the visibility of our issue.  Our legislation was now on the House Leadership’s radar screen.  By Thanksgiving, it was clear that the Senate would be the chamber to “drive” the actions of the “lame-duck session,” rather than the House.  Our attention turned to the Senate in earnest by early December.

IDF met with Senator Kerry’s staff, staff from both of the Senate’s health policy committees and finally with the Senior Health Policy staff person for Majority Leader of the Senate Harry Reid (D. NV).  It was during the meeting with Leader Reid’s staff person in early December that we had a breakthrough.  It would be a long-shot but Leader Reid and Senator Kerry thought it would be at least worth the try.  The plan was to put together a few very small Medicare issues (like our IVIG issue) together into what is known as a “unanimous consent” (UC) bill.

As its name describes, a UC bill must be passed by the entire Senate wtihout objection.  It is a way to speed up the business of the Senate by allowing non-controversial bills to be voted upon without debate. And then there is the “Christmas tree effect” which occurs when a Senator withholds support because he/she has legislation (an ornament, if you will) that they would like to have added to the UC bill or “hung on the Christmas tree.”

It appears that the tiny Christmas tree UC bill had too many ornaments and collapsed.  Thus was the demise of our IVIG legislation for this year.  The irony was that the House was ready to take it up if it had passed from the Senate and sent to the House.

The 112th Congress has now convened with 100+ new members of the House, several new Senators and a Party leadership change from a Democratic party controlled House to a Republic controlled House.

The good news is that IDF will not be starting from scratch.  Because of the recent IDF efforts and those of Senators Reid and Kerry, we are in a stronger position going in to the 112th Congress than just a couple of years ago. In the House, the key Energy and Commerce (E&C) committee will be chaired by Rep. Upton (R-MI6th) and new Chairman of E&C’s Subcommittee on Health, Rep. Pitts (R-PA 16th), both cosponsors of the IVIG bills.  Our very great and avid supporter Rep Kevin Brady (R.TX) will also attain greater seniority on the Ways and Means

IDF volunteers have made all of the difference in the world.  Every time when constituent pressure on a legislator was needed, IDF volunteers “stepped up”.  Without volunteer action, we would be nowhere.  We were close to success in the 111th Congress.  Now we just need a “ringer” in the 112th!!!

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The massive 2000+ page healthcare bill contained many many incredibly positive things for us. However, the difficulty we have encountered getting this unintentional consequence corrected is what scares me. No one has ever raised an objection to this legislation. The problem is it so major to us yet so minuscule in perspective to the government as a whole.