Before President Clinton's signature on the balanced-budget bill was dry, Washington lobbying groups were scrambling to win seats on a new bipartisan commission studying long-term changes to Medicare.
The balanced-budget plan, signed into law earlier this month, creates a 17-member panel that must report back to Congress with recommendations by March 1, 1999. The panel is convening in December.
The commission is charged with several tasks, among them making recommendations to Congress on a "comprehensive approach to preserve the Medicare program" when the number of beneficiaries skyrockets about 2010. The bill calls for suggestions that would keep the Medicare Part A trust fund solvent through 2030.
Another goal of the commission-known formally as the Bipartisan Commission on the Effect of the Baby Boom Generation on the Medicare Program-is to "study the feasibility and desirability" of establishing an independent commission that would make decisions about annual Medicare spending and benefits. The American Hospital Association has pushed for such a commission for several years.
Recommendations of the panel must be approved by 11 of its 17 members. Congress is not required to act on or even consider the commission's proposals.
The bill calls for the 17 commissioners to be appointed by Dec. 1. Groups already have begun contracting with well-connected lobbying firms in Washington to push their candidates.
"I wouldn't be surprised if this turned into a process like the Academy Awards, where the judges get videos sent to their homes with a note that says `for your consideration,'*" said John Rother, director of legislation, research and public policy at the American Association of Retired Persons.
Competition for panel slots is likely to be cutthroat. When Clinton announced during the 1996 presidential campaign that he would appoint a commission to study quality in healthcare, the administration fielded hundreds of applications.
Reaction to the creation of the panel was generally favorable, although it is unlikely any group seeking a commissioner's slot would criticize the process openly.
"The Medicare program is in about as good a shape as the Mir space station, and there is no way anything will be done about it unless (Republicans and Democrats) are in it together," said Frederick Graefe, a healthcare lawyer with Baker & Hostetler in Washington.
Thomas Nickels, vice president of federal relations at the American Hospital Association, called the commission "a good first step." He added, however, the group's chances of success would be greater if the law required Congress to review and debate the group's recommendations.