Congress adjourned last week until early next year after it stripped some Medicaid provisions from an immigration reform plan, pushed through a federal fiscal 1997 spending package and tied up some loose health policy ends.
The most significant change to the immigration bill removed a provision that would have barred current legal immigrants from receiving Medicaid benefits for five years.
Hospital groups had sought the change, claiming that ending Medi-caid coverage for legal immigrants would increase their uncompensated-care costs and result in more of those costs being shifted to the states. The Clinton administration agreed and worked to kill the provision in marathon negotiations with Republican leaders.
Another bill that was part of the negotiations was a spending measure for fiscal 1997, which began Oct. 1. The bill was necessary to avoid another round of government shutdowns because Congress had not passed many of the required spending bills before the start of the new fiscal year.
Hours after the Senate passed the spending legislation last week, President Clinton signed it into law. The massive spending bill grants modest increases to a number of health-related programs. Included were:
Medicare survey and certification funding, which will rise $11 million in fiscal 1997 to $158 million.
Health professions training funds, which will increase $34.3 million to $292.9 million.
The Agency for Health Care Policy and Research, which will see its budget rise to $143.6 million from $125 million.
Maternal and child health block grants, which will increase about $3 million to $681 million.
Several rural health programs were killed. The most significant was a program that gave $13 million in grants to rural hospitals to help them adjust to marketplace changes.
Congress passed several other health-related provisions in the waning days of its session.
It reformed the eligibility rules at Department of Veterans Affairs hospitals (See related story, p. 33). The House and Senate endorsed legislation eliminating rules that make it harder for many veterans to receive outpatient care.
The legislation also expands the VA's authority to contract with private-sector providers and keep money collected from third-party payers. The bill requires the VA to manage healthcare delivery through an enrollment system that reflects the priorities of its existing eligibility system. Veterans with disabilities related to their time in the service, former prisoners of war and poor veterans receive highest priority.
To prevent the eligibility reform measure from increasing the deficit, the bill caps VA appropriations for fiscal 1997 at $17.3 billion, about $250 million more than called for in the VA's fiscal 1997 appropriations bill, and at $17.9 billion for fiscal 1998. The bill authorizes $358.2 million in major construction projects.
Congress also passed a measure that instructs the Prospective Payment Assessment Commission, which monitors Medicare Part A issues for Congress, to study the impact of Medicare and Medicaid changes on large, urban, Medicare-dependent hospitals.
According to the National Association of Urban Critical Access Hospitals, which represents more than 200 large urban hospitals, the study is necessary to gauge the impact of recently enacted Medicaid and Medicare changes the NAUCAH claims have had the most severe effect on large, urban hospitals.
Congress also rejected several controversial healthcare-related bills, including:
Partial HCFA reimbursement for some Medicare-eligible military retirees who join Defense Department healthcare plans. Although such a proposal gained some momentum in the closing days of the congressional session, it ultimately was dropped because of resistance among Democrats on the House Ways and Means Committee.
Higher Medicare disproportionate-share payments for treating large numbers of poor people to a group of 28 hospitals. That would have been done by permitting the hospitals to reclassify from "rural" status to "other urban" status. HCFA decided last year to effectively eliminate the "other urban" category, which applied to urban areas with populations of fewer than 1 million. Because urban hospitals are reimbursed for disproportionate-share payments at a higher rate, the change cost the 28 rural hospitals about $23 million. The hospitals lost a court battle over the issue earlier this year, and they had been pressuring Congress to make the change. However, Clinton administration officials opposed the measure, and it was dropped at the 11th hour.