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GOVERNMENT & MEDICINE

On Capitol Hill, health care bills fall back

The patients' bill of rights may still receive some attention, but a Medicare drug benefit and health coverage expansion proposals face tough odds.

By Amy Snow Landa, AMNews staff. Oct. 1, 2001.

Washington -- The Sept. 11 attacks on the World Trade Center and the Pentagon immediately and dramatically altered the policy agenda in Washington, D.C.

Before the terrorist assaults, Congress and the White House had a full slate of health care issues they were hoping to resolve this fall -- the patients' bill of rights, a Medicare outpatient prescription drug benefit and the expansion of health care coverage to uninsured Americans. But there is now widespread acceptance that those issues have slipped far down the list of national priorities, at least for the time being.

President Bush and members of his administration are devoting much of their energy to the nation's immediate security and defense concerns, while on Capitol Hill the focus has narrowed as well. Congressional committees postponed indefinitely several hearings on health care issues that were scheduled for late September.

But despite the rapid rearrangement of priorities, Bush continues to seek agreement on important domestic issues, including a patients' bill of rights, White House Press Secretary Ari Fleischer said Sept. 17.

At a meeting soon after the attack, Bush reminded Cabinet members "that a patients' bill of rights remains important; that there are a series of initiatives that are pending up on the Hill that remain important," Fleischer said. Bush called for resolution on those issues.

Sen. Edward Kennedy (D, Mass.), a lead sponsor of the Senate measure, also would like to see patients' rights legislation enacted this year, according to his spokesman.

"If there's a willingness to show we can get things done on a bipartisan basis, the patients' bill of rights may be the opportunity to do that," said Kennedy's aide.

In the aftermath of the attack, both parties appear considerably more interested in taking action on a bipartisan basis, rather than getting mired in partisan disagreements. But whether the current mood will last through the fall and whether it will result in a patients' rights agreement remains unclear.

Rep. Charlie Norwood, DDS (R, Ga.), who sponsored an amendment to the House-passed measure with Bush's support, said he thought Congress and the White House still could and should reach an agreement on the patients' bill of rights this year. "It's closer than it has ever been," he said.

House and Senate leaders have not yet appointed members to the conference committee that will work out differences between the Senate-passed measure -- which is supported by the AMA and many other physician groups -- and the House version. But before the attacks, there had been conversations between the White House and sponsors of the Senate measure.

An agreement on patients' rights could come relatively soon if the White House and Senate leaders decide to quietly resolve their differences. On the other hand, the two sides may decide to put off negotiations on those issues that remain contentious.

Within this new and unpredictable context, the AMA is continuing to press ahead with its legislative agenda -- now with a heightened attention to the ability of the medical system to respond to future crises.

Other issues face tougher odds

Even before Sept. 11, the odds that Congress would reach bipartisan agreement this year on adding an outpatient prescription drug benefit to Medicare did not appear to be good.

But in the current environment, it appears all but impossible that Congress will have the energy or inclination to focus on working out the complexities of designing a drug benefit program. It would be "very tough," said Ron Pollack, executive director of the consumer group Families USA.

The Senate Finance Committee and the House Ways and Means Committee have not been able to agree on a Medicare drug benefit bill yet, finding it difficult to draft legislation that could gain bipartisan support. Republicans and Democrats have remained far apart in their views on how the benefit should be structured.

Proposals to expand health care coverage to some of the 39 million uninsured Americans face the same problems: Congressional committees are split mostly along party lines over which approach to take and have not yet reported out legislation.

The White House and congressional Republicans favor offering uninsured families and individuals tax credits for the purchase of health insurance, while many congressional Democrats support an expansion of Medicaid and the State Children's Health Insurance Program.

The Senate Finance Committee had planned to hold a hearing in late September to examine proposals for expanding health insurance coverage, but now the discussion has been postponed indefinitely.

Funding emerged as a possible obstacle to enacting health coverage and Medicare prescription drug legislation even before the terrorist assaults.

The Congressional Budget Office and the White House Office of Management and Budget issued reduced federal budget estimates in August. They indicated that Congress could be headed toward dipping into the Social Security surplus to cover government expenses.

This year's budget resolution earmarked $28 billion to expand health care coverage to the uninsured, but only if Congress does not tap the Social Security or Medicare trust fund surpluses.

Congressional approval of a $40 billion emergency spending package for anti-terrorism efforts will increase budget pressures further, making decisions on such high-ticket items as a Medicare prescription drug benefit even more difficult.

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Copyright 2001 American Medical Association. All rights reserved.

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