Thursday, December 20, 2007 Capitol
Hill Watch
House Passes Medicare-SCHIP Legislation; President
Bush Expected To Sign Bill, HHS Secretary Says
The House on Wednesday voted 411-3 to
approve legislation (S
2499) that would delay for six months a 10% physician fee cut and
extend SCHIP through March 2009, CQ Today reports. HHS Secretary Mike Leavitt said
that President Bush is expected to sign the measure (Armstrong, CQ
Today, 12/19).
The bill would increase Medicare physician
fees by 0.5% for six months and would extend several programs that provide
higher Medicare reimbursement rates to rural health care providers and
hospital laboratories. The measure also would extend SCHIP funding through
March 31, 2009. A summary distributed by the Senate Finance
Committee showed that the legislation would provide enough funding for
states to maintain their current enrollment levels. In addition, the bill
would extend for six months rural and low-income subsidies, as well as
payments for rehabilitative therapy under Medicare.
The Congressional Budget Office on
Tuesday estimated that the measure would cost $5.3 billion over five
years. The costs would be offset by $1.5 billion in cuts from a
"stabilization fund" created under the Medicare prescription drug benefit
to attract preferred provider organization plans to underserved areas;
$1.4 billion in reduced payments to hospitals for inpatient rehabilitation
services; and $1 billion in reduced payments for drugs administered by
physicians rather than taken at home by beneficiaries. In addition, a data
reporting requirement for Medicare Secondary Payer should reduce fraud and
abuse, creating savings for Medicare. Under the program, Medicare takes
over payment liability from private insurers after they have paid to treat
certain conditions over a specific period of time (Kaiser Daily Health Policy Report, 12/19).
Medicare Physician Fee Cut Outlook
The legislation does not
address future physician fee cuts, which means the 10% reduction will take
effect when the delay expires in June 2008 unless additional legislative
action is taken (CQ Today, 12/19). House Energy and Commerce
Health Subcommittee Chair Frank Pallone (D-N.J.) said that
he expects Congress in June 2009 to pass another short-term delay of the
fee cut because the White House is opposed to offsets that would stop the
cut for a longer period of time (Johnson, CongressDaily,
12/20).
According to CQ Today, the six-month delay
will force lawmakers "to deal with the issue again in the midst of a
presidential election, when neither party seems likely to budge much on
compromises that were difficult enough this time around" (CQ
Today, 12/19). The White House has strongly opposed any cuts to
Medicare Advantage and raising tobacco taxes to pay for a permanent fix,
Pallone said. "You can't raise taxes, even if it's tobacco taxes," Pallone
said, adding, "You can't dip into Medicare Advantage because that's a
special interest program that the Republicans don't want to cut. What am I
going to do? I don't want to cut Medicare" (CongressDaily,
12/20).
SCHIP Outlook
White House spokesperson Dana Perino in a
statement said, "With this (SCHIP) bill, we can be assured that children
will continue to have coverage, and Democrats won't be able to play
election-year politics with children's health" (Neikirk, Chicago Tribune, 12/20).
The measure
does not address an SCHIP policy directive announced in August by CMS that states must enroll
95% of children in families with incomes up to 250% of the federal poverty
level before expanding eligibility, The Hill reports. Acting CMS Administrator
Kerry Weems said that the Bush administration would not require states to
disenroll children from the program despite the requirement. House
Energy and Commerce Committee Chair John Dingell (D-Mich.) said that
Weems' statement contradicts the policy, adding, "Perhaps CMS officials
are reading their directive differently than the rest of us."
An
analysis by the Georgetown University Health Policy Institute's Center for
Children and Families found that 14 states provide SCHIP coverage to
children in families with incomes greater than 250% of the poverty level
and that they "will likely be forced to roll back their eligibility levels
at some point before August 2008 or assume new coverage costs with state
funds." Democratic Caucus
Chair Rahm Emanuel (Ill.) on the House floor Wednesday said, "Because of
the president's executive order, kids in those states will actually come
off the rolls in August." The National Governors Association on Monday sent a letter to
Congress asking it to "address the issue raised in the ... guidance issued
by CMS" (Young, The Hill, 12/20).
Emanuel said SCHIP
will be addressed this summer, when the new rules take effect. He said,
"What we can't resolve, the American people will resolve in November,"
adding, "This will be the first thing a Democratic president will get
done. We don't need March '09" (Johnson, CongressDaily,
12/19).
Broadcast Coverage
C-SPAN's "Washington Journal" on Wednesday included a discussion
with Rep. Tom Price (R-Ga.), a member of the House Education and
Labor Subcommittee on Health, Employment, Labor and Pensions, about
the SCHIP provisions in the bill ("Washington Journal," C-SPAN, 12/19).
Video of the segment is available online.
NPR's "All Things Considered" on Wednesday also reported on the
bill. The segment includes comments from Reps. Roy Blunt (R-Mo.), Emanuel
and Pete Stark (D-Calif.) (Rovner, "All Things Considered," NPR, 12/19).
Audio and a partial transcript of the segment are available online.