Daschle withdrawal could alter calendar for health care issues

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Tom Daschle’s withdrawal this week of his nomination for secretary of the Department of Health and Human Services (HHS) could significantly alter the calendar for health reform in the coming year, sources in Washington told Pharmawire.

With significant health proposals still included in the economic stimulus package – including funding for health information technology and comparative effectiveness research – a push towards health care reform was expected in the first half of the year.

The withdrawal could also delay the announcement of President Obama’s pick to head the Food and Drug Administration - though some sources said it remains possible the president will push ahead with that process given the magnitude of the agency’s current problems.

It was thought an announcement would be made this week, with both Baltimore health commissioner Dr Joshua Sharfstein and Duke cardiologist Dr Robert Califf rising to the top of the short list, according to sources. But it is also possible the administration will use the Daschle withdrawal to look at new candidates for the role, such as New York City health commissioner Dr Margaret Hamburg and former FDA commissioner Dr Jane Henney, they said.

But Robert Nicholas, a partner at law firm McDermott Will & Emery and former chief counsel to Vice President Al Gore, said he thinks the president is likely to push forward with the FDA job, despite the setback at HHS.

Industry sources said they were relieved Daschle had bowed out, pointing to his stance on comparative effectiveness, where he wanted to set up a Federal Health Board to evaluate such research, and his desire to push health reform through Congress quickly, giving less time for industry to respond. They hoped the new nominee would be less rigid in his or her views on these issues.

What’s more, the stimulus bill currently has USD 1.1bn allotted for comparative effectiveness research, of which USD 400m would be spent at the discretion of the secretary. It is now unclear how that money might be spent and how far the future secretary will go in setting up a new entity, either within HHS or outside the department, to evaluate the study results. Sen. Max Baucus (D-MT) said he would consider creating a public-private entity to oversee comparative effectiveness, as he has previously proposed, this news service reported yesterday.

Daschle’s announcement came after a weekend in which revelations about unpaid taxes and fees collected from health groups had fueled doubts about his confirmation. Still, his withdrawal came as a surprise to most, those interviewed said, and it would likely take longer than usual to find a new nominee.

In addition to the nomination for HHS, Daschle had been appointed by President Obama to lead the newly-created White House Office of Health Reform, which would have given him access to the president as he led the push for reform. It now seems likely that the two roles will be divided, said Nicholas, though he said it remains possible they will find someone who would be able to fill both roles.

”I do think this slows it down and pushes it back into summer or fall,” said Jayson Slotnik, an associate at Hogan & Hartson focusing on health regulatory issues. ”Congress is saying it has no effect and they like to think they run the show. But it seems hard to believe that, because you still need the administration.”

Slotnik pointed back to 2003 when then-secretary of HHS Tommy Thompson made repeated trips to Capitol Hill in order to help sell the Medicare Modernization Act. A number of Democratic sources said the current focus is on governors, with former Gov. Howard Dean of Vermont and Gov. Kathleen Sebelius of Kansas both mentioned. Rep. Rosa DeLauro (D-CT) and Govs. Edward Rendell of Pennsylvania and former Gov. John Kitzhaber were also mentioned.

Jeanne Lambrew, who has already been serving as the deputy of the White House Office of Health Reform and co-wrote a book with Daschle, could be promoted to fill that role, they said, should Obama decide to separate the two roles. It also remains to be seen whether key appointees like deputy secretary for HHS William Corr will remain in place, Slotnik said.

”Like everything else in this town, it’s a question of how do things coalesce and how do they move forward,” Nicholas said. ”And when you lose a critical player like Daschle it will have an effect, but how much of an effect depends on who comes in next.”

It is possible, Slotnik said, that the economy will continue to deteriorate and much of the health care agenda will be pushed all the way into 2010, especially without anyone as close to the president as Daschle to push the agenda forward. Baucus and Sen. Edward Kennedy (D-MA) have said they plan on pushing ahead with health care reform, and Rep. Henry Waxman (D-CA) has his own health priorities, Nicholas said.

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