11-08-1999
POLITICS & POLICY - MEDICARE 'GIVEBACKS': HOUSE PASSES $11.5B
IN RESTORATIONS
The Medicare Balanced Budget Refinement Act of 1999, the
"only Medicare legislation with a chance to pass Congress this
year," cleared the House with flying colors Friday on a vote of
388-25. The $11.5 billion "giveback" measure will restore across
five years some of the funding for hospitals, nursing homes and
home health care companies slashed by the 1997 Balanced Budget
Act (Love, AP/Philadelphia Inquirer, 11/6). Bill sponsor Rep.
Bill Thomas (R-CA) said, "It's a refinement bill, not a reform
bill. We still need to address prescription drugs. But this
very narrow, very shallow canoe that cannot support that
initiative today." The Wall Street Journal notes that the
Medicare measure does not go as far as either Republicans or
Democrats had hoped: President Clinton and Democrats pushed hard
this year for a prescription drug benefit, while many Republicans
"wanted a top-to-bottom restructuring to make the senior health
insurance program less bureaucratic" (Murray, 11/8). The
measure, $1.8 billion more than the $9.7 billion relief package
approved last month by the Senate Finance Committee, would
restore about 5% of the $200 billion in reimbursement cuts to
hospitals, home health and nursing homes in 1997. Leaders from
the House and Senate will meet this week to "hammer out a
compromise." CongressDaily/AM reports that Senate leaders are
"reluctant to bring the bill to the floor, because some senators
may try to add amendments that would significantly expand" the
program. If House, Senate and Clinton administration negotiators
are able to reach a compromise early this week, the measure will
likely be attached to another bill scheduled to move at the end
of this Congress, such as the tax extenders bill (11/8).
SPECIFICS FOR FACILITIES
Most of the money in the House bill would be restored to
teaching hospitals, rural hospitals and disproportionate share
facilities that "care for [a] large number of uninsured
patients." Home health and nursing home patients will also see
relief through a boost in Medicare fees. An incentive provision
for Medicare HMOs would provide larger payments and cash bonuses
if they agree to insure patients in underserved areas
(AP/Philadelphia Inquirer, 11/6). Under the measure, 62% of the
nation's teaching hospitals would stand to gain, while the
remaining 38% would lose out. California would stand to gain
nearly $130 million while New York teaching hospitals would lose
up to $103 million over the next five years (Holland, Albany
Times Union, 11/6).
SPECIFICS FOR PATIENTS
As for individual Medicare beneficiaries, USA Today notes
that patients treated at clinics or practices owned by hospitals
currently "can pay two or three times more for their care than
those who go to independent doctors or clinics. But buried in
[the bill] is a tidbit for consumers:" a $776 cap on out-of-
pocket expenses for Medicare outpatient care, "the same as
patients would pay if admitted to the hospital." Bill
co-author Rep. Pete Stark (D-CA) said the cap is "still not
enough. Beneficiaries should obviously pay less than if they had
to spend a day in the hospital. It's a step in the right
direction" (Appleby, 11/8). Other restorations:
o The $1,500 cap on speech and physical therapy combined would
be raised to $1,500 for each type of therapy;
o Medicare payments for pap smears would go up "to ensure
access to the latest technology";
o Medicare enrollees who lose HMO coverage when their plan
withdraws would have greater flexibility to enroll in
alternatives, such as a nearby plan or Medigap insurance.
(AP/Philadelphia Inquirer, 11/6).
MORE INSIDER COMMENTS
House Commerce Committee Chair Thomas Bliley (R-VA) said,
"Two years ago we made some very important changes that are
keeping a vital program alive. But some of the changes we made
went a little too far." Thomas Scully, president of the
Federation of American Health Systems, said, "It's a very good
bill. Is it massive assistance? No. But at the margins, it will
probably be very helpful" (Hosler, Baltimore Sun, 11/6). After
Friday's vote, Rep. Tom Coburn (R-OK) said, "Congress has saved
rural health care" (Myers, Tulsa World, 11/6).
KUDOS FOR THE HOUSE
Following Friday's vote, some organizations applauded the
House effort to restore Medicare funding. They include:
o American Association of Homes and Services for the Aging:
President Len Fishman thanked the House and said, "The
efforts of AAHSA and its members in ensuring that our
elected leaders in the House understood the unintended
consequences of the Balanced Budget Act on nursing home care
are reflected in this legislation. The Senate version of
this bill does include additional payments for
rehabilitation therapies, which would improve the
legislation passed today by the House" (AAHSA release,
11/5).
o The National Association of Community Health Centers, Inc:
Thanking the House, President and CEO Tom Van Coverden said,
"the leadership shown by the House of Representatives ...
will help ensure that millions of working Americans across
this country will have access to the affordable health care
services of their community health center" (NACHC release,
11/5).
o Health Insurance Association of America: President Chip
Kahn said, "HIAA applauds the House of Representatives for
passing ... the Medicare Balanced Budget Refinement Act of
1999, that will improve Medicare and help expand seniors'
private health plan options by restoring some funding to the
Medicare+Choice program. HIAA is also pleased that the
House of Representatives did not include any prescription
drug mandates on Medicare+Choice or Medigap plans which
would increase costs and make coverage less affordable for
seniors" (HIAA release, 11/5).
American Healthline
