By Karin Rives
When introducing his pick for the nation’s health secretary, Kansas Gov. Kathleen Sebelius, President Barack Obama repeated a warning he’s issued often in recent months: The nation cannot afford to fail to act on healthcare reform.
“Fixing what’s wrong with our healthcare system is no longer just a moral imperative, but a fiscal imperative,” the president said, adding that the job will require a person with a knack for bi-partisan problem solving. “Kathleen embodies such a commitment,” he said.
HHS Secretary-nominee Kathleen Sebelius is going through confirmation hearings this month. |
As of early April, Sebelius had yet to be confirmed as secretary of the Department of Health and Human Services (HHS). The Obama administration, which was quick out the gate with its first nominations, has been bogged down by the pressing economic issues of the day and chastened by the failed nomination of Tom Daschle for the health secretary post. This slowed down the appointments of several top government officials, including Sebelius and the Centers for Medicare and Medicaid Services administrator.
Should she be confirmed (and so far, the expectation is that she will be), the Kansas governor may bring some interesting policy changes to the table, based on her record from back home.
Drug reimportation redux?
In 2004, for example, Sebelius joined a consortium of states headed by then-Illinois Gov. Rod Blagojevich to participate in I-SaveRx, a now-defunct Canadian-run drug importation program. It was one of the nation’s first organized campaigns to channel inexpensive Canadian and European drugs to American patients. Sebelius has an ally in the Obama administration, which has said that “the importation of safe medicines from other developed countries” will be part of its mission to lower healthcare costs for Americans.
To what degree big-scale reimportation will be feasible remains to be seen, of course.
“If the U.S. passes a law allowing for reimportation of drugs, other governments would clamp down right now, because there aren’t enough drugs in their countries to supply a U.S. wholesale market,” said Calgary, Alberta-based Lewis Jorgensen, whose company was the pharmacy benefits manager for I-SaveRx before it cancelled the contract in December. “And big pharma has too many friends in the U.S. government to allow for that to happen.”
The states participating in I-SaveRx didn’t sufficiently market the program, which made it financially unsustainable, Jorgensen said. But he and his two sons and business partners now have a new company, Genesis Health Group Inc., which is doing brisk business exporting drugs to individuals in the United States.
Despite his skepticism about major expansion in reimportation, Jorgensen predicted that commerce will grow with a new administration in Washington. Under President Bush, he said, drug shipments worth tens of thousands of dollars were seized by the Food and Drug Administration. Such policies, he predicted, will end under Obama and Sebelius as long as the products are being used for personal use.
of reimportation, Jorgensen predicted that commerce will grow with a new administration in Washington. Under President Bush, he said, drug shipments worth tens of thousands of dollars were seized by the Food and Drug Administration. Such policies, he predicted, will end under Obama and Sebelius as long as the products are for personal use.
Gov. Sebelius does not appear to have much experience with the 340B program. Nevertheless, 340B advocates are hopeful that she and the Obama Administration will embrace the program in their effort to expand access to pharmaceutical care. “340B is a safe and proven option for helping patients obtain access to affordable medications”, said Ted Slafsky, executive director of Safety Net Hospitals for Pharmaceutical Access.
He and other 340B supporters hope the new administration will support innovative ways to expand the use of the 340B program – for example, by encouraging partnerships between 340B providers and state and local governments, and networks of hospitals and other 340B covered entities. The Bush administration viewed such initiatives with skepticism.
Bold proposals, political realities in Kansas
As governor and, before that, state insurance commissioner, Sebelius took several other steps to bring affordable healthcare to her constituents. As commissioner, she blocked the 2002 acquisition of the state’s largest insurer by an out-of-state company because she said it would increase premiums, an unusual and bold move. Then as governor, she proposed to open up the state’s Medicaid program to more uninsured Kansans and paying for it by raising tobacco taxes.
The Medicaid plan was stymied by the Republican-dominated state legislature, as was a several-year legislative effort Sebelius spearheaded to bring Kansans comprehensive healthcare coverage.
“She’s very smart and very focused, and she knows how to get things done,” said Dr. Robert St. Peter, president and chief executive of the Kansas Health Institute, a Topeka research organization. “But we haven’t really seen her unfettered by the political environment she’s operated in. Working, as she will, with a Democratic Congress, we may see things we never saw in Kansas.”
One gets a sense of Sebelius’ frustration reading her weekly governor’s column. “I endorsed the plan, as did many Republicans and Democrats…But the leadership and majority failed to move forward, so we made no progress,” she wrote Oct. 22, 2008, of the stalled healthcare reform, noting that the number of uninsured Kansas residents had risen three years in a row. “We cannot wait any longer…The time for real leadership and action on health care is now.”
If confirmed as health secretary, Sebelius would have a strong mandate to push for health reform not just for Kansas, but for the entire nation. “It was an offer I could not refuse,” she said.
Rural advocate takes HRSA top seat
HRSA Administrator Mary Wakefield is well-versed in national healthcare issues, including the 340B program. |
Over at the Health Resources and Services Administration (HRSA), new Administrator Mary Wakefield showed up for work March 10, only to hit the ground running. The Obama-appointed HRSA chief had a “packed schedule dealing with the Recovery Act, Omnibus 2009 Budget, FY 2010 Budget proposal, and other critical meetings for at least the next month or so,” an agency spokesman confirmed.
In her role as HRSA administrator, Wakefield will oversee the Office of Pharmacy Affairs and the 340B program at a time when the program faces several critical issues, including possible new guidelines on patient eligibility and on whether to allow children’s hospitals into the program.
A native North Dakotan and most recently director for the University of North Dakota’s Center for Rural Health, Wakefield is not new to the Washington policy world.
In the mid-1990s, she was the chief of staff for Sen. Kent Conrad (D-N.D.) and before that a legislative assistant for Sen. Quentin Burdick, another North Dakota Democrat. She left Capitol Hill to become a professor and director of the Center for Health Policy, Research and Ethics at George Mason University, where she stayed for five years before returning to her home state in 2001.
Her involvement in national health policy matters has also included work on a commission that advised President Clinton on consumer protection and quality in the healthcare industry, and on the Medicare Payment Advisory Commission. Through all her appointments, Wakefield has been clear about what she calls an urgent need to improve, modernize and equalize the U.S. healthcare system – with a special eye toward underserved rural areas.
That would be done by helping all providers adopt electronic medical records, by conducting comparative effectiveness research of drugs to determine which therapies work and which don’t, and by extending health insurance to all Americans, she told the Senate Budget Committee during a 2007 hearing on medical costs.
“What is needed is a coherent set of expectations, tools, and rewards for measuring and improving dimensions of health care that are essential to high performance,” Wakefield testified. “That means having metrics for health outcomes, access to care, efficiency and care quality.”
A friend of 340B
If her records are any indication, Wakefield may also push to expand the 340B program to new locales, such as certain rural hospitals that now don’t qualify for the program.
In 2002, she served on the National Advisory Committee on Rural Health when the group issued a series of recommendations for improving the healthcare safety net. Noting that the 340B program had already resulted in $1 billion in savings at that time, the committee asked the health secretary to “continue to support and enhance the 340B program.”
Innovative technology solutions can help expand the program, especially in rural areas, Wakefield wrote in a 2008 report she co-authored on North Dakota telepharmacies. By spring 2008, three established telepharmacies had opened up shop in the state under contract with federally qualified rural health clinics participating in the 340B program, the report said.