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      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).
      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).
      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).  
      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).
      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,
   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,
   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).

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