Realistic Expectations - Manton

Heather and I recently met with Rep. Marshall - the original sponsor of H.R. 2131, the Thomas J. Manton Early Detection and Treatment Act. I am going to assume that you are already familiar with the bill and what it is intended to do, but if you are not you should go to the NPCC website and look up more information. You can also get information such as the bill language and current status of the bill on Thomas (the legislative resource run by the Library of Congress).

The inside scoop is that the bill is actually getting some attention on the House Committee (which is good). We continue to add co-sponsors (also good) and we're up to 76 as of today - but you could find that out on Thomas, so it's really not earth shattering news.

The committee staff (the bill was referred to the Energy and Commerce Committee in the House) has examined the bill and is looking at it in two parts. Part one is a matching grant program to states and is viewed by the Committee as a relatively non-controversial program. This would be the screening portion of the bill.

The second part of the bill is a Medicare program. This is, of course, the treatment program. The committee views this as a more problematic issue for a couple of reasons.

• Problem #1: Cost and funding. Most States (most likely every State) would elect to participate in the treatment program which would require federal Medicare/Medicaid funds. There is a question of exactly how much this cost would be and until we accurately answer that question or give an educated guess to that answer this will be a difficult hurdle to jump. Congress has a procedure to create cost estimates created by the Congressional Budget Office (CBO), but our sponsors have been unable to compel CBO to create a report for this bill. Additionally, because of the way the current rules work on Capitol Hill (and this isn't a bad thing, politically speaking - just inconvenient for our purposes), if the Committee is going to markup the bill, there will have to be some sort of an "offset" to pay for the Medicare portion of this bill. An offset is achieved by decreasing budget authority for an activity in order to finance increases for another activity - the decrease is referred to as an offset. The fact that the committee must mark the bill up creates another problem.

• Problem #2: The problem with marking up the bill. A markup is a meeting of the Committee to consider a particular bill where changes may be required and considered and the bill can be voted on by Members of the Committee. The problem here is purely political. The fear among Committee staff is that opening the bill up to the markup process (which is required because of the mandatory spending invoked by the treatment portion of the bill) will allow other Members to offer amendments and "add-ons" that may or may not be germane (related) to the bill itself in order to advance their own political desires. This is problematic from a procedural point of view and the Chairman is concerned that not all of the amendments would be easy to deal with. Amendments like this also can cause problems for a bill when it comes to the floor for full consideration before the House of Representatives.

So, how do we get past these obstacles? Rep. Marshall and his staff continue to work to find a way to move this bill. They have talked about splitting it into two bills - one for the screening and one for the treatment - but this creates a situation that will never fully realize the program that is needed (IE. passing a program to provide matching grants to States for screening is relatively easy, but funding to cover Medicare payments for treatment is not and would never pass as a stand alone bill). The real answer relies in us - the prostate cancer community. If we can create overwhelming Congressional support (by adding co-sponsors), this will protect the bill and its programs from non-germane amendments and force the Committee the committee to find solutions to the other problems. That is why it is vitally important to continue to press Congress on this issue and raise awareness about prostate cancer on Capitol Hill. That is why we continue to meet with offices every week to discuss this as well as other issues. And it is why we ask you to write your Congressman and your Senators and ask them to co-sponsor the Thomas J. Manton Early Detection and Treatment Act.

Our collective voice on Capitol Hill cannot be ignored and we can succeed, but not without each other.