What a difference a year makes in health care policy
By Robert B. Doherty
Last January, the 107th Congress began its first session under markedly different circumstances than today.
In early 2001, members of Congress openly questioned the new president's ability to exert influence over the legislative agenda because of the unusual and contested circumstances under which he was elected. By the end of the year, President Bush was enjoying a 90% approval rating and had achieved major victories on his education and tax cut initiatives.
A year ago, the Republicans were looking forward to controlling both the White House and Congress, a situation they had not enjoyed in 50 years. Within a few months, however, they lost their slim majority when Sen. Jim Jeffords (I-Vt.) defected from the party, and with him went their control of the Senate. Today, Sen. Tom Daschle (D-S.D.), not Senator Trent Lott (R-Miss.), holds the reins of power in the Senate.
In February 2001, Washington was debating how to spend the federal budget surplus. In January 2002, the argument is about who is to blame for bringing back budget deficits.
One year ago, no one could have imagined that terrorists could bring a halt to the business of Congress and kill thousands in New York, Pennsylvania and Washington. Only a few people in government were talking seriously about the threat of bioterrorism. But the Sept. 11 attacks changed Congress' priorities.
Given the extraordinary and unprecedented circumstances under which Congress was forced to operate, it should not be surprising that legislators had trouble accomplishing anything at all. Although many predicted a year ago that health care would be a top priority of Congress, lawmakers wrapped up the first session with little to show in terms of new health care laws. We saw no patient bill of rights, no Medicare prescription drug coverage and no help for the uninsured.
While the results were in many respects disappointing, substantial progress was made on key ACP-ASIM priorities. That progress has set the stage for what could turn out to be a much more productive second session for the 107th Congress.
Medicare issues received serious consideration last year. Here is a summary of how the College's major initiatives fared:
- Medicare fee schedule. Despite the College's best efforts, Congress adjourned Dec. 20 without taking up legislation that would have allayed the 5.4% across-the-board cut in the Medicare fee schedule that went into effect on Jan. 1, 2002. Two-thirds of the members of Congress co-sponsored legislation that would have blocked the cut, but it was not enough to persuade key congressional leaders to allow a vote before the recess.
Today, ACP-ASIM is working to translate this overwhelming support into a new bill that would immediately halt the 5.4% cut and restore payments to 2001 levels. We are also seeking a permanent solution so that Medicare payments won't be cut again next year.
The College is calling on internists nationwide to alert their congressional representatives about how the cut affects you and your patients. We also need you to impress upon your representatives the urgency of halting the cut. (For more information on what you can do to help, visit ACP-ASIM's Legislative Action Center at www.acponline.org/advocacy.)
- Regulatory relief. ACP-ASIM and our allies successfully persuaded the House of Representatives to unanimously pass a Medicare regulatory relief bill. The legislation would require carriers to provide physicians accurate information, reform the Medicare audit process and pilot-test less burdensome documentation requirements. We are now working to persuade the Senate to follow the House's lead.
- Prescription drug coverage. Medicare prescription drug coverage fell by the wayside due to the post-Sept. 11 shift in priorities. Although the budget deficit makes it unlikely that Congress will find the money to fund drug coverage, ACP-ASIM will still look for opportunities to achieve some incremental improvements in Medicare coverage and benefits. One option is a drug benefit that targets low-income beneficiaries and provides better coverage of preventive benefits.
Before Congress adjourned, Congress approved spending $2.5 billion on bioterrorism preparedness. Work was also proceeding on a separate authorization measure on how to spend the $2.5 billion on disaster preparedness. The second measure would direct funds to help ensure that the nation has adequate supplies of antibiotics and vaccines, and support training for health care professionals to diagnose and treat victims of biological and chemical attacks.
ACP-ASIM, however, is urging Congress to go beyond this modest "down payment." Legislators need to fund a comprehensive plan to prepare the nation for a potentially catastrophic attack involving chemical or biological agents.
ACP-ASIM advocated for tax credit proposals in House and Senate economic stimulus bills to help individuals who lose their jobs keep health insurance. Although measures to help the unemployed keep their health insurance had strong bipartisan support, the stimulus bill died. The main cause was partisan disagreement between the House and Senate about tax policy and how best to expand health insurance coverage.
The College will once again urge Congress to put aside partisan differences this session and act to reduce the number of uninsured Americans.
Both the House and Senate passed patients' rights measures that agree on nearly every point—except whether patients should be permitted to sue their HMOs. Still, the fact that bipartisan majorities agree on such things as access to specialty care and the need for a strong, independent appeals process suggests that legislators should eventually be able to break up the logjam on patient rights.
The College is urging Congress and the president to agree on a compromise bill that, at a minimum, provides basic protections nationwide and preserves the rights of states like Texas to enact their own laws to hold HMOs accountable, including the right to sue as a last resort.
The coming year
The events over the past year show how difficult it is to make predictions about Washington. What looks like a sure bet in February 2002 might look like folly a year from now.
Nonetheless, ACP-ASIM is approaching this year with confidence that we can get final approval on bills to cut Medicare red tape, halt the 5.4% cut in Medicare fees, better prepare the country for bioterrorism, reduce the number of uninsured and ensure patient rights.
Robert B. Doherty is ACP-ASIM's Senior Vice President for Governmental Affairs and Public Policy.
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