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Washington in Brief


"Fatheads", that's us. The word isn't just for insults anymore.

Rather, it's an apt description of new research revealing that fat is
implicated in some of the key chemical messaging pathways of the brain. As
the body's main warehouse for storing energy in a species whose evolution
often called for drawing on that energy to either fight or flee, fat cells
know their own importance too well to be set aside easily - that is why
losing weight is so hard, and why the impact of fatty tissue on organs and
arteries is a key factor in many diseases, from diabetes to high blood
pressure, heart attack, stroke and cancer.

The findings, as reported in the Washington Post and other publications,
are the basis of a decision by the Centers for Medicare and Medicaid
Services that in effect admits anti-obesity measures to its range of
covered treatments. The policy change, announced by Department of Health
and Human Services Secretary Tommy G. Thompson in Washington the week of
July 12, does not specify Medicare-covered anti-obesity treatments, but
opens the door to treating obesity as a disease. It does not describe
obesity as a disease, but rids guiding organizational documents of language
that stood as a ban on obesity treatment under Medicare, the federal health
program for the aged and disabled. Without the language in place, Medicare
has no basis in policy for denying obesity coverage, according to an expert
quoted by the Post.

Because of a strong tendency for Medicare decisions to set forth a pattern
later followed by private insurers and employers, obesity is considered on
its way to being treated as a disease throughout the health care industry.
It wasn't immediately clear what impact, if any, the decision would have on
IHS, but DHHS is its parent department within the federal government, and
as recently as July 9 Thompson called obesity a primary reason for health
woes among minorities including Indians, as it is among other Americans.


Secretary of Health and Human Services Tommy G. Thompson made a strong
commitment July 21 to get pending legislation to reauthorize the Indian
Health Care Improvement Act passed into law before the 108th Congress

"OMB has finally given us the green light to get things done," Thompson
told the Senate Committee on Indian Affairs. The Office of Management and
Budget historically reviews costly legislation for its fiscal impact on the
federal government.

Sen. Ben Nighthorse Campbell, R-Colo., the committee chairman, was
concerned that the working days of Congress in this presidential election
year have dwindled down to a precious few. Thompson ended the oversight
hearing with a spirited promise: "We're going to pass it this year Senator.
This is going to be our capstone."

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Both Campbell and Thompson will step down from their positions following
the 108th Congress and Campbell's urgency was palpable. "It is time we pass
this legislation ... I will suggest our staffs meet as soon as possible."

Thompson said his staff is available to meet with committee staff
instantly, a significant commitment in that finalizing complex law almost
always requires the active participation of federal experts who deal with
practical intricacies daily. Thompson left no doubt that cooperating with
the committee to refine the reauthorization law will be a top priority at
HHS over the month-long congressional recess expected to begin July 23,
according to Senate leadership. Rank-and-file lawmakers hope to recess even
earlier, the night of July 22.

Campbell said the support of President George W. Bush would also be crucial
to enacting the bill. In addition to Thompson, key Republicans who
advocated for the bill were Rep. J.D. Hayworth of Arizona, who testified
before the committee, and committee member Pete Domenici of New Mexico.
Hayworth and Thompson hailed the opportunity to pass important bipartisan
legislation. Tim Johnson, D-S.D., a committee member, added, "We have been
holding off and holding off on the possibility of marking up [reviewing for a vote, in parliamentary jargon] this bill. This legislation is critical

Reauthorization of the Indian Health Care Act will provide for the funding
of the Indian Health Service over time, rather than by year-to-year
appropriations as at present. Crucially in the eyes of every legislator who
spoke in its behalf, the bill will also provide IHS with flexibility and
updated strategies in dealing with diabetes and its causes. The pending
legislation includes provisions in support of traditional Native medicinal

As emphasized from start to finish of the oversight hearing, diabetes is
epidemic on reservations. "The problem seems to be growing faster than the
resources" for dealing with it, Campbell said.

Domenici said that despite increased federal spending on diabetes
prevention and treatment among tribes, there is no way to install dialysis
facilities at the rate of onset. "There are whole schools where dialysis
people go ... the most pitiful, pathetic thing you ever saw. ... The
problems ... are truly beyond what we understand."

Campbell added further testimonials to the pathos of dialysis clinics where
legions of Indian people gather for treatment - seeing a legless patient in
bed hits home, he said.

Byron Dorgan, D-S.D., noted that the reauthorization bill is just that - a
reauthorization, not an appropriation of funds. "Almost always the case
that there's a lack of resources," he said of health problems in Indian

Dorgan seemed to argue for a blank slate, suggesting that radical surgery
on the Indian health care system would be a step forward. "We just have to
stop and start over and go in the right direction."

But any such major overhaul seems much too far to go in the 108th Congress,
with its handful of scheduled working days in September. Campbell said that
meetings between his staff and Thompson's will begin "in a few days."