Congress is scheduled to reconvene this week and begin filling in the details of the federal balanced-budget blueprint the House and Senate approved separately last month.
According to congressional Democrats and Republicans, few contentious issues are outstanding.
But among the items likely to stir controversy are several healthcare-related matters.
Included are a GOP proposal that would allow Medicare beneficiaries to open medical savings accounts, the shape of the children's health insurance initiative, and how much restructuring of Medicare can really be accomplished as part of the budget (See stories, this page and p. 14).
Another area that remains unsettled is how big a bite will be taken out of Medicaid disproportionate-share payments, which provide extra Medicaid funds to acute-care and specialty hospitals that treat a large number of Medicaid recipients. Under the budget blueprint, projected Medicaid spending would be reduced by more than $20 billion from fiscal 1998 through 2002.
Since budget negotiators rejected a Clinton administration plan to limit per-capita Medicaid spending, few Medicaid savings avenues remain besides disproportionate-share payments. The Congressional Budget Office says Medicaid disproportionate-share payments will rise from $9.8 billion this fiscal year to nearly $14 billion in 2002.
The National Governors' Association has said it would not support more than $8 billion in reductions in Medicaid disproportionate-share payments over the five years of the balanced-budget plan. Provider groups haven't fought the $8 billion trim but are concerned about where the other $12 billion in Medicaid savings will come from.