Emergency Management Committee Report Released On Nov. 9, Rep. Peter King (R-NY) of the Committee on Homeland Security filed a committee report recommending the passage of HR 5351, the “National Emergency Management and Reform Act of 2006.” The bill would establish a Directorate of Emergency Management in the Department of Homeland Security and codify the functions of the Department in emergency situations such as a natural disaster or terrorist strike. The Department would include a Chief Medical Officer who would be responsible for advising the Secretary of Homeland Security on matters of healthcare response as well as serving as the point of contact for all medical preparedness functions of the Department. The Chief Medical Officer would also work with the Secretary of Health and Human Services to create emergency plans for medical facility evacuations and the safe and efficient transfer of health information records. The bill would also establish a National Advisory Council on Emergency Management that would include experts at the federal, state, local, and private sector levels who represent medical standards-setting organizations and especially those who have expertise in emergency response planning. To view the complete bill, please visit the following link: http://www.govtrack.us/data/us/bills.text/109/h/h5351.pdf. Election Wrap-Up and Outlook Democrats Take Control of House and Senate The Nov. 7 elections marked a shift in power from the Republicans to the Democrats in both the House and the Senate. Members will return on Dec. 4 following a two week Thanksgiving recess for a lame-duck session. It is expected that members will spend the session passing appropriations bills for 2007 and adjourn until the 110 th Congress begins on Jan. 5. Health Care Reform Issues Top Priority in New Congress, House Democrats Say
House Democrats pledged to make improving the nation's health care system a top priority when they take control from Republicans in 2007, with Medicare negotiation of prescription drug prices and expansion of federal funding for stem cell research being major elements in their agenda. Fresh from their victory in the Nov. 7 mid-term congressional elections, House Democratic leaders said they would push to improve the Medicare prescription drug program, including giving Medicare drug price negotiating authority and shrinking the so-called doughnut hole in coverage. Democrats said funding for closing the doughnut hole and paying for an increase in Medicare reimbursement for doctors could in part be accomplished by reducing payment to Medicare managed care plans. Democrats said a bill allowing Medicare to negotiate for lower prescription drug prices likely would be brought up within the first 100 hours of assuming power. However, several health care lobbyists and policy analysts believe that opposition by President Bush to Democrats' health care agenda and the likely difficulty of passing legislation in the Senate could translate into little actual health legislation becoming law in 2007. Much of the debate in Congress in 2007 will be to set the scene for the 2008 presidential election, they said.
Setting the Table
Democrats' health care agenda in the 110th Congress "will set the table for larger health care reforms" after the 2008 presidential election, said Neil Trautwein, vice president of the National Retail Federation.
"Big changes in the composition of the House and Senate will have a profound impact on national health policymaking in 2007 and 2008," the consumer advocacy group Families USA said in a Nov. 8 statement. "As a result, some issues--such as expansion of children's health care coverage and improvements to the Medicare Part D program--will receive a tremendous boost when the new Congress convenes in January. Other policy agendas, such as cuts to the Medicaid program and the promotion of health savings accounts, are likely to be relegated to the back burner." Congressional Democrats have long criticized the 2003 Medicare prescription drug law for preventing Medicare from negotiating lower drug prices with drugmakers, saying seniors' drug costs could be cut by price negotiations. Republicans have maintained competition built into the drug program is working to lower costs, negating the need for federal intervention. While Democratic leaders did not rule out working on health information technology legislation and proposals to eliminate scheduled Medicare payment cuts for doctors during a lame-duck session scheduled to begin Nov. 13, it appeared both those items would be shelved and revisited in the 110th Congress in January. Doctors' pay is scheduled to be reduced by about 5 percent in 2007 unless Congress intervenes. "I can't imagine it happening in the lame-duck," said Alston & Bird attorney and former CMS Administrator Thomas Scully.
IT, Doctor Pay Bills Likely Lost
Scully and others said Medicare payment increase legislation for doctors and health IT legislation likely would get lost, as GOP lawmakers struggle with organizing for the 110th Congress.
"All the eggs on the Republican side are totally scrambled," Scully said. Some major players on those two issues, such as House Ways and Means Committee Chairman William M. Thomas (R-Calif.) and health subcommittee chairman Nancy L. Johnson (R-Conn.), will not be back for the 110th Congress, and thus will have little incentive to produce legislation during a lame-duck session, said Joe Antos, a health and retirement policy scholar at the American Enterprise Institute. "Why should they struggle for basically nothing?" he said of lawmakers' desire to move legislation during a lame-duck session. Antos said health IT legislation (S. 1418, H.R. 4157) likely will be put off until late in 2007 or possibly longer, because incoming committee chairman and new members will want to familiarize themselves with the issue before crafting legislation. "It could be dead for a long time," he said. House and Senate GOP negotiators in September failed to reach a compromise on their bills, which contain several key differences. Since Democrats captured the House and possibly the Senate, "they believe the only thing Congress should do is pass a CR [continuing resolution] until March 1, [2007]," health care and tax lobbyist Frederick H. Graefe said. Several sources predict the lame duck session may last only a few days, followed by a CR continuing the operation of the federal government into next year.
Senate Difficulties
Drugmakers were less than enthused about the possibility Democrats would move legislation allowing Medicare to negotiate for lower drug prices. "Critics infer that there are no negotiations in how prices for medicines are set. That's simply not true," the Pharmaceutical Research and Manufacturers of America said in a Nov. 8 statement.
"The negotiations are occurring--as they should be--between prescription drug plans, several of which already purchase medicines on behalf of tens of million of Americans, and pharmaceutical companies," PhRMA said. "That's the marketplace in action and that's how America's seniors will see true savings without compromising the search for future cures." The incoming chairman of the House Energy and Commerce Committee, Rep. John D. Dingell (D-Mich.), told reporters Nov. 8 that filling in the doughnut hole, allowing Medicare to negotiate lower drug prices, reducing what he termed overpayments to Medicare managed care plans, and introducing a Patients Bill of Rights bill would be high on his agenda. Incoming House Ways and Means Committee Chairman Charles E. Rangel (D-N.Y.) put forward a similar agenda; adding Democrats will advance proposals to reduce cut the number of Americans without health insurance.
Improving Part D
"We'll work to address the health care crisis in the country today and look for new solutions to cover the more than 46 million uninsured," Rangel said in a statement. "We'll start off looking for ways to improve the existing Medicare prescription drug program, allowing the government to negotiate for lower drug prices and making the program easier for beneficiaries to understand."
Dingell told reporters "there is strong evidence that there are very large overpayments to the [health] insurance companies" participating in Medicare. Cutting funding for health plans "could be the beginning to filling the doughnut hole," he added. The standard Part D prescription drug plan has a $250 deductible and 25 percent beneficiary coinsurance for the first $2,250 in drug costs. This is followed by the $2,850 coverage gap--or doughnut hole--during which no benefits are paid, although enrollees continue to pay premiums. After spending that amount, the beneficiary pays 5 percent of drug costs. Some Part D plan options have other coverage levels and deductibles, including coverage during the gap. The doughnut hole was incorporated in the Medicare drug law by congressional Republicans to help lower the cost of the program. Despite gaining control of the House and possibly the Senate, however, health care legislation would have to be signed by President Bush to become law, which likely will be a significant hurdle. Bush likely would block bills allowing Medicare to negotiate drug prices and stem cell research, as well as bills reducing funding for Medicare managed care plans, according to many analysts. But Paul B. Ginsburg, president of the Center for Studying Health System Change thinks that the inclusion of several health issues in a larger budget reconciliation bill could avoid a presidential veto of proposals to reduce managed care payment rates as a way to pay for a physician payment fix.
AHP Legislation Dead
Health care lobbyists and policy analysts said the Democrats' victory means the end of legislation pushed by Republicans in recent years, such as tax incentives to expand health savings accounts and to establish association health plans.
Bush in his fiscal 2008 budget proposal is expected to put forward Medicare spending reductions, but "they will be dead on arrival" in a Democratic Congress, said Graefe. "I'm prepared for a very severe budget on Medicare" from the White House, added Federation of American Hospitals President Charles N. Kahn III. Kahn said it could be difficult to move Medicare legislation in 2007, particularly in the Senate, where a bill to increase doctors' pay, for example, could attract numerous other amendments. That problem could be solved by including the fix in a budget reconciliation bill, however, he added. But several health care lobbyists and policy analysts said helping reduce the number of uninsured Americans may be a topic on which Democrats and Republicans could work together, although the federal budget deficit likely would prevent major proposals from becoming law. For example Henry J. Aaron, director of economic studies at The Brookings Institution, said that there were several bills introduced in the 109th Congress supported by liberal Democrats and conservative Republicans to provide grants to a few small states or regions within larger states to experiment with ways to increase health insurance coverage. One such bill under development by Sens. Russell D. Feingold (D-Wis.) and Lindsey O. Graham (R-S.C.) would cost about $3 billion a year, Aaron said. "Members of both parties . . . know that their constituents want something done on health insurance coverage," Aaron said. "This approach is one that could catch fire." Ginsburg agreed, saying the Massachusetts health care coverage bill, a compromise between Democrats and Republicans, could inspire Congress to produce bipartisan legislation. "It's inherently compromisable," he said of a health insurance expansion bill. "The real constraint is where are you going to find the money?" Families USA said the reauthorization of the State Children's Health Insurance Program will benefit from Democratic control of Congress, as will prescription drug reimportation. Medicaid also will be protected from further cuts under a Democratic Congress, the group said. |
