The Senate approved early Friday morning the nomination of Mark McClellan to run the Medicare program after Senate Majority Leader Bill Frist agreed to pursue legislation permitting Americans to purchase lower-cost prescription drugs from countries such as Canada.
The unanimous voice vote took place about two hours after midnight. McClellan will move from heading the Food and Drug Administration to leading the Centers for Medicaid and Medicare Services, the behemoth agency responsible for delivering health care to 76 million poor, elderly and disabled Americans.
“The ground is shifting,” said Sen. Bryon Dorgan (D-N.D.), who forced the issue over drug importation by threatening to block the nomination. “The majority leader indicated he understands this is an inevitable position. Reimportation is going to happen; the question now is how, not whether.”
Staff members for Frist (R-Tenn.) emphasized that he made no promise to abandon his opposition to drug importation, though the behind-the-scenes maneuvering signaled the growing potency of the issue on Capitol Hill.
“The debate’s been around, but times change and people are changing their views,” said a senior aide.
In a hearing with McClellan on Thursday, Sen. John McCain (R-Ariz.) was even blunter in describing the shifting political dynamic.
“Despite the power of the pharmaceutical companies, we will pass … requirements for the ability to reimport drugs from Canada,” he said. “My suggestion is that you prepare for it and be part of the solution.”
Although it is illegal to bring prescription drugs from other countries into the United States, the FDA has generally not enforced the restriction, citing limited resources and a reluctance to prosecute senior citizens struggling to afford their medicines. Congress came close to legalizing the practice in last year’s Medicare prescription drug law, but the provision was knocked out by the White House and Republican leaders in final negotiations.
Since then, several members of Congress, mayors and governors have put fresh pressure on the Bush administration to open U.S. borders to licensed prescription drugs purchased elsewhere.
On Thursday, Sens. Trent Lott (R-Miss.) and John Cornyn (R-Texas) said they now support drug importation, often called reimportation because some medicines are manufactured in the United States, sold to a distributor in Canada and then shipped back to American consumers.
For senior citizens without drug coverage as well as municipalities and states strapped for cash, the savings of 30 percent to 70 percent have become irresistible. Lott, in explaining his reversal, said he could no longer defend the policy to his elderly mother.
A physician and economist, McClellan, 40, was a member of the White House Council of Economic Advisers and a senior health adviser to President Bush before he took over the FDA in autumn 2002. The brother of presidential spokesman Scott McClellan also worked in the Clinton administration as a deputy assistant secretary of the treasury.
In his new role, Mark McClellan will be charged with implementing the new Medicare drug program, estimated to cost $534 billion over 10 years.
Health and Human Services Secretary Tommy Thompson has said Lester Crawford will take over as acting commissioner at FDA, a role he served early in the administration.
