American Hospital Association President Richard Davidson says the health insurance reform legislation that passed Congress earlier this month represents "a little bit of hope that Congress will have the courage to deal with some of the tougher issues."
Healthcare policy experts believe reforming entitlements, including Medicare and Medicaid, will take center stage next year no matter who is elected president or what party holds power in Congress. And 1997 may be a key nonelection year in which the White House and Congress can reach a reform consensus as it seeks to balance the budget by early in the next century.
For its part, the AHA has decided to try to move the issue of universal coverage, virtually dead since the Clinton administration healthcare reform proposal crashed in 1994, "back up on the national agenda," Davidson said. He made the remarks at last week's AHA convention in Philadelphia.
Though it has yet to be drafted, the AHA's new reform proposals "probably won't include employer mandates," Davidson said. That would mark a departure from the AHA's reform plan first released in 1991. That plan would have required all employers to offer coverage to their employees.
But most observers think Congress is unlikely to undertake any major private-market healthcare reform in the next session.
"I don't think you'll see any major activity next year on insurance issues; there might be some relatively minor tinkering around the edges," said Thomas Scully, president of the Federation of American Health Systems.
Robert Doherty, vice president of governmental affairs at the American Society of Internal Medicine, agrees that after passing the insurance reform plan sponsored by Sens. Nancy Kassebaum (R-Kan.) and Edward Kennedy (D-Mass.) earlier this month, Congress is unlikely to take up any insurance issues next year.
"I think there's going to be a feeling that `we did Kassebaum-Kennedy. Let's see how that turns out,"' Doherty said.
What is likely is that Congress will revisit Medicare and Medicaid spending reforms as part of a renewed effort to balance the federal budget.
That's because Medicare and Medicaid funding are two of the fastest-growing components of the federal budget, forecast by the Congressional Budget Office to rise between 7% and 11% a year for the next decade.
Gail Wilensky, vice president of health affairs at Project HOPE and the head of the Physician Payment Review Commission, said that after last year's bruising battle over Medicare reform, Congress will only pursue the issue if politics are put aside.
"I think it's 50-50 whether we'll pass a significant first step to reforming Medicare (in 1997)," Wilensky said.
Others say Medicare reform is inevitable.
"There will be a Medicare reform plan because (Congress) can't balance the budget without one," said James Scott, president of the Premier Institute in Washington.
Other issues that may get play next year are physician antitrust relief and medical malpractice reform.
According to Doherty, how Congress handles antitrust reform legislation will depend on how positively the healthcare community looks upon the guidelines being drafted by the Federal Trade Commission and the Justice Department. Those guidelines are expected to be released later this month.
Congress also is likely to again try to pass medical malpractice reform, said Frederick Graefe, a health lawyer with Baker & Hostetler in Washington.