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Copyright 1999 The National Journal, Inc.  
The National Journal

November 20, 1999

SECTION: HEALTH; Pg. 3405; Vol.31, No.47

LENGTH: 654 words

HEADLINE: Politics Galore, But Little Health Care Action

BYLINE: Spenser Rich


     Despite the mantra of both Democrats and Republicans that
they were determined to ''save'' Social Security and Medicare,
Congress did not pass reform legislation to shore up the
financial status of either program, or to provide prescription
drug coverage to Medicare beneficiaries. The issues were too
politically sensitive, and the insolvency crisis too far off in
the future, to pressure Congress to act this year.

     President Clinton proposed using the surpluses in the
Social Security trust fund to pay down the public debt, thus
reducing future government interest costs. Trillions of dollars
saved on interest payments would eventually be pumped into the
Social Security fund to extend its solvency to 2050.      Most Republicans had a different idea: Allow part of the
current Social Security payroll tax to be diverted into private
retirement accounts invested in stocks and bonds. After the
rhetorical smoke cleared, both sides deferred action, probably
until after the 2000 presidential election.

     Medicare reforms proposed by the White House called for
transferring general revenues to Medicare and allowing managed
care reforms
in the traditional fee-for-service program. A
bipartisan commission called for shifting elderly patients to
private health plans that would compete on price, with the
government paying a fixed portion of the premium. Democrats
objected that the plan would boost costs paid by the elderly. In
the end, nothing happened on any of the reform plans.

     However, amid furious lobbying by hospitals, nursing
homes, health maintenance organizations, and home health
agencies, Congress was poised at session's end to undo some of
the Medicare payment reductions that were enacted as part of the
1997 Balanced Budget Act.

     The 1997 law sought to save $ 386 billion over 10 years,
but the provider groups complained that the savings were turning
out far larger than projected. House and Senate conferees finally
agreed to restore $ 16 billion in Medicare payments over five
years, despite concerns by some health experts and members of
Congress that the giveback was unjustified.

     Meanwhile, the task of bridging an ideological chasm
between two versions of patients' rights legislation was put off
until next year. The Senate on July 15 passed, 53-47, modest
health care reforms backed by GOP leaders. Democrats said the
plan contained numerous loopholes sought by the managed care
industry and that it lacked strong enforcement provisions.

     In the House, a coalition led by Reps. John D. Dingell,
D-Mich., Charlie Norwood, R-Ga., and Greg Ganske, R-Iowa, pushed
through a more-sweeping patient protection bill that won the
White House's backing, and the votes of nearly all House
Democrats and 68 Republicans. The bill, approved 275-151 on Oct.
7, would cover virtually the entire private labor force, allow
patients to sue their health plans under state law, and let
physicians determine what treatments are necessary.

     The bipartisan House bill was attached to a GOP measure
(H.R. 2990) that would allow the self-employed to deduct health
insurance premiums from their taxes and that would expand tax-
exempt medical savings accounts. House GOP leaders declined to
name the dissidents as conferees for the House-Senate
negotiations that will take place on H.R. 2990 next year.

     Congress also failed to move legislation to protect the
privacy of patients' electronic medical records, so the Health
and Human Services Department on Oct. 29 proposed its own
regulations, as was required by law if Congress did not act. And
in the final hours of the legislative year, conferees agreed on a
compromise plan to help the disabled return to work while staying
on Medicare for an extended period.

LOAD-DATE: November 23, 1999

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