Lawmakers want health-bill exemptions

WASHINGTON — The Nevada Cancer Institute, in Las Vegas, may not have a national reputation as a clinic or a research facility. But it does have the ear of its state's senior senator, Majority Leader Harry Reid. And that is why the 4-year-old institute could reap a big gain in federal reimbursements as part of the health-care overhaul.

After months of noisy public debates over big policy ideas such as universal coverage and a public-insurance option, the health-care legislation is getting down to the fine print. This is when powerful members of Congress customarily tuck in their pet projects, either to please their constituencies or as sweeteners to win the votes of lawmakers who may be sitting on the fence.

Sen. Blanche Lincoln of Arkansas, a wavering Democrat on the Senate Finance Committee, has proposed expanding Medicare coverage of home-infusion therapy, a treatment for a variety of purposes that is championed by a medical entrepreneur in her state. Sen. Orrin Hatch, a Utah Republican on the panel, is seeking a health-care tax break for any state that "begins with the letter U."

Few proposed amendments to the health-care bill before the Finance Committee better exemplify the process than one that would help out the Nevada Cancer Institute. Known in congressional parlance as a "rifle shot" — the narrowly focused tax or policy equivalent of a spending earmark — the proposal would provide more favorable Medicare payment rates to a handful of specific medical facilities.

Three — a hospital under construction in Cleveland, a center in Detroit and, apparently, another in New Jersey — are among some 40 "comprehensive cancer centers" that have received grants with that designation from the government's National Cancer Institute (NCI). The young Nevada institute has not earned that status. It aspires to it, though, its Web site says.

In addition to the favor of the top Senate Democrat, the amendment has the sponsorship of two other members of the party leadership, Sens. Debbie Stabenow of Michigan and Robert Menendez of New Jersey, suggesting it is a rifle shot with some velocity. A spokesman for Stabenow called the provision a "typical rifle shot."

The amendment would cover "certain hospitals" if they "received NCI comprehensive-cancer-care designation on July 27, 1978, Feb. 17, 1998, June 13, 2000."

The first date turns out to refer to the Karmanos Cancer Center in Detroit. A government-relations official there said the hospital had been seeking such an exemption for about six years through Stabenow and its local congressman, Rep. Sander Levin, a Democratic member of the House Ways and Means Committee. Levin is among the outspoken supporters of a public-insurance plan whom the president and Senate leaders may try to woo to a compromise.

The second date refers to University Hospitals in Cleveland, which is building a cancer hospital and has lobbied hard for such treatment.

The third date appears intended to refer to the Cancer Institute of New Jersey and an affiliate, Robert Wood Johnson Medical School.

A spokesman for the institute's local Democratic congressman, Rep. Frank Pallone Jr., said he believed the Stabenow-Menendez amendment covered that cancer center.

The amendment also covers one more cancer center, in similar code: "designated on June 10, 2003, as the official cancer institute of its state." That is the date the Nevada Legislature voted to assign that title to the Nevada Cancer Institute, then still under construction.

The substance of the amendment would exempt each of the centers from the Medicare "prospective payments" system, which compensates hospitals on the basis of diagnosis rather than treatments they provide. The exemptions would add to these centers' income and the cost to taxpayers, although, in an apparent nod to the few grant-making dates specified in the amendment, the authors note that it would be unlikely to add much to the price of the overall legislation, because it "is unlikely to affect a large number of hospitals."

Hospital officials pushing for the exemption argue that about 10 of the 40 comprehensive cancer centers already have exemptions, giving them a competitive advantage.

Jennifer McDonnell, a spokeswoman for the Nevada Cancer Institute, which has spent about $115,000 on federal lobbying fees this year, said the institute could not have sought the exemption in any way other than congressional action, because at present that is the only way for a hospital to attain it.