Toomey urged to oppose ‘assault’ of Trump budget

To the Times: Dear Sen. Patrick Toomey: I am one of your 12.8 million supervisors in the state of Pennsylvania. I am also a physician-scientist in-training, and a consultant for a small business whose mission is to improve outcomes for cancer patients. The president’s budget proposal released today – including reductions in the NIH budget and deficit estimates predicated on repeal and replacement of the Affordable Care Act – is an assault on the interests of a majority of Americans and Pennsylvanians that will undermine efforts to improve public health. I ask that you reject the core philosophy this budget is built upon in order to support the NIH and help our citizens maintain access to medical care.

The National Institutes of Health fund over 57,000 research and training grants every year, and has long been an organization receiving bipartisan support. Since 1985, NIH-funded research has contributed to over 1.5 million peer-reviewed scientific research articles describing advances in understanding human disease. Improvements in life expectancy, and survival rates for debilitating illnesses including cancer, heart attack, and stroke can be directly attributed to these findings. One especially striking example is seen in a childhood blood cancer called acute lymphoblastic leukemia. Only 10 percent of children who were diagnosed in the 1960s lived for five years, and today this disease is curable in 90 percent of patients! Government-funded research has its fingerprints all over this statistic in particular, and is cited more broadly in about half of all new drug applications approved by the FDA. These data highlight the critical need for NIH programs in improving public health, but also the increasingly symbiotic relationship between academic research and the private pharmaceutical industry – federally funded biomedical research has become a major driver of economic growth in Pennsylvania and the United States. Allowing the proposed 18 percent budget cuts to NIH become law would diminish our ability, as physicians and scientists, to drive progress in disease control and prevention, and would also harm private firms who bring therapeutics to market for patients.

In addition to funding key research, a lesser known function of the NIH is to support training programs for young investigators like me. I am currently training to become a physicianscientist with both medical and research doctoral degrees. This means that I will use my clinical experience to identify research questions that I can study in the lab, then take laboratory findings back to the clinic to directly help patients with cancer. At 45 medical schools across the country, T32 training grants help students work toward dual MD/PhD degrees which allow them to integrate basic biomedical science with clinical medicine. Furthermore, individual fellowships and career development awards sponsored by the NIH provide muchneeded funding to early-career scientists who will become the next generation responsible for advancing knowledge of human disease. The age of investigators awarded their first independent research grant has been increasing in recent years, with no evidence of reaching a plateau, reflecting a need to invest further in young scientists. Cutting the NIH budget as the President has suggested would be counterproductive to this end, and would leave the United States trailing behind other developed nations in efforts to combat illness.

The other deeply concerning piece of the President’s budget from a public health perspective is the deficit reduction calculated from repeal and replacement of the Affordable Care Act. As you know, approximately 670,000 Pennsylvania residents enrolled in expanded Medicaid, allowing them critical new access to health care. This expansion has saved lives, and contributed to the health and economic wellbeing of our state. Repeal of federal funds to support this expansion would be a grave error that would ultimately reduce health care access to our most vulnerable citizens. Furthermore, safety net hospitals like Temple University – where I train – would be financially strained to care for additional uninsured patients for whom reimbursement is impossible. In addition, subsidies for individuals with incomes slightly higher the federal poverty line (as specified by Sec. 1402 of the ACA) are critical to maintaining access to health services. Repeal of subsidized individual insurance would lead to further Pennsylvanians who cannot afford coverage. Again, this scenario leads to increased overall health-care costs – especially at safety net institutions.

While I agree that the ACA is not perfect, selectively repealing measures designed to correct for adverse selection and moral hazard – i.e. the “individual mandate” – while leaving in place guaranteed issuance and coverage of preexisting conditions is antithetical to mainstream economic thought. To be perfectly clear, the individual insurance market cannot accommodate guaranteed issuance and pre-existing condition coverage without a robust individual mandate that balances risk for insurers. It would be highly irresponsible to support legislation that would reduce access and increase premiums so dramatically.

I understand and agree with the importance of free market economics in many contexts, however, health care poses a situation in which every classical free market economic assumption is violated. The role of the government in these situations is to address social welfare where market failures exist, and in many developed nations this has been realized in the form of a single-payer system. The ACA is derived from Republican principles that allow for a mix of government and private industry in health care, but the noble goal of providing access for all Pennsylvanians and Americans can only be realized if the economic principles underlying the ACA are understood and respected.

Sen. Toomey, you are in a unique position as a Pennsylvanian member of the Senate committee tasked to draft a Republican health-care bill, and vote on a budget for the coming fiscal year. From a public health perspective I ask that you support evidencebased policy to 1) ensure a robust continuing workforce of American scientists, 2) bolster support of, and collaborations between public and private entities to help our country remain competitive in biotechnology and medicine, and 3) help all Pennsylvanians and Americans maintain access to health care services. I will always make time to discuss these issues so please contact me if you would entertain a mutually informative conversation on how to move forward.