Before putting an end to one of the most partisan and divisive sessions in recent history, Congress reauthorized several Medicare programs that have been sought by hospitals for several years.
Congress also moved to reduce the employment cuts the Department of Veterans Affairs faced under Vice President Al Gore's "reinventing government" initiative.
And, several healthcare reform plans that sponsors hope will be the starting point for next year's debate were introduced.
Among the Medicare amendments approved by lawmakers before they adjourned on Oct. 8 were:
The reauthorization of the Essential Access Community Hospital program, designed to maintain rural hospital services, and the Rural Health Transition grant program, which assists rural facilities by paying for strategic planning and restructuring services.
A provision to ensure that non-prospective payment system hospitals aren't forced to accept diagnosis-related reimbursements.
Authorization for HHS to account for occupational mix in the hospital wage-index calculation, allowing Medicare to pay more to facilities that employ more highly paid workers.
The VA hospital system also got some good news. According to the reinventing government initiative, the VA would have faced an across-the-board 12% employment cut, translating to a loss of nearly 27,000 employees over the next five years.
However, Congress reduced those cuts to a maximum of 10,000 over five years and allowed the VA to reduce the number of nonfederal employees it carries on its books. According to Senate VA Committee Chairman Jay Rockefeller (D-W.Va.), the net effect will be a loss of as few as 2,500 positions.
The legislation also gives the VA more latitude in contracting with outside providers.
"Certain aspects of the VA's health delivery system could operate more like private-sector business," Mr. Rockefeller said.
In other congressional action, members of the House bipartisan reform group led by Reps. J. Roy Rowland (D-Ga.), Michael Bilirakis (R-Fla.), Fred Grandy (R-Iowa) and Jim Cooper (D-Tenn.) reintroduced their reform measure in an effort to set up next year's debate.
"There is no reason why this plan didn't pass this year," said Selby McCash, an aide to Mr. Rowland. "Both sides at different times were willing to look at a plan like this one, but never at the same time. By the time the Democrats were willing to accept this type of approach, the Republicans weren't."
The plan includes insurance market reforms and would allow firms with fewer than 100 employees to join insurance purchasing cooperatives. It also gives subsidies for low-income individuals and families, paid for primarily through Medicare spending reductions of $37 billion over a five-year period.
The group got some good news last week from the Congressional Budget Office, which found that the plan would extend health insurance coverage to 92% of the population by the year 2004, up from the current level of 85%. It also would reduce the deficit by $65 billion over 10 years.-