During a short lull in the usual congressional end-of-session activities like naming post offices and confirming judges, Sen. John Kyl (R-Ariz.) took the floor to push for the passage of a bill that would make it easier for seniors to contract with physicians outside the Medicare program.
"We believe the Congress should enact legislation that ensures seniors have the right to see the physician or healthcare provider they want," Kyl said.
He knew full well the measure wouldn't be passed this year. Actually it didn't even come up for a vote.
So what was Kyl doing?
Setting the stage for next year. In fact, before bugging out of Washington last week to campaign before the November elections, members of Congress laid the groundwork for action on a number of healthcare issues.
Making a statement. The most significant statement was probably made by Senate Democrats who forced a procedural vote on their managed-care regulation bill. Senate Minority Leader Thomas Daschle (D-S.D.) brought the measure up knowing that he lacked the votes for passage. However, by forcing the vote, he was able to get senators on the record. In fact four Republicans, all of whom are running for re-election in November-Christopher Bond of Missouri, Alfonse D'Amato of New York, D.M. "Lauch" Faircloth of North Carolina and Arlen Specter of Pennsylvania-voted with the Democrats in an otherwise straight party-line vote.
After the vote, Democrats vowed to bring the measure back next year.
Another area Congress is almost sure to address next year is Medicare managed-care reimbursements.
Over the past several weeks, health plans and HCFA have waged a bitter debate over Medicare health plan reimbursements. The American Association of Health Plans led the way, lobbying for HCFA to allow plans to resubmit their annual statements of benefits and beneficiary costs.
The plans also sought relief from a number of the regulations implemented as part of the federal Balanced Budget Act of 1997.
Some members of Congress who voted for the laws that the AAHP has criticized said further congressional action is needed to fix many of the problems.
As with many other issues, the congressional clock ran out before action was taken. However, the issue will almost surely be revisited next year.
Sen. William Roth (R-Del.), chairman of the Senate Finance Committee, introduced a bill to make some of the changes and said he hoped that "next year we can work together toward a more comprehensive solution to this issue."
Rep. Michael Bilirakis (R-Fla.), chairman of the House Commerce health subcommittee, requested that HCFA prepare a cost analysis of the economic impact of the managed-care regulations in the balanced-budget law with an eye toward changing those regulations next year.
Confidential matters. Another pressing concern for Congress will be passing patient-records confidentiality legislation. Under a 1996 health insurance reform law, Congress has until August 1999 to approve a records-privacy bill. If it doesn't, HHS can enact such standards through regulation, and Congress is reluctant to cede that authority to the Clinton administration.
Congress came closest to passing privacy standards in the House-passed patient-protection bill. The White House criticized those provisions, however, because they would pre-empt state privacy laws that restrict access to patient records for quality enhancement, accreditation and disease management.
Several stand-alone bills were introduced to address patient privacy. However, they often conflicted, and consensus did not emerge.
Finally, days before Congress adjourned for the year, Sen. Robert Bennett (R-Utah), who has been a leader on the issue, introduced legislation. Although he acknowledged that it would not pass this year, he said he hoped to set the stage for completing action next year.
Superseding state law, Bennett's bill would require providers and insurers to get authorization from patients to use individually identifiable patient records for payment, treatment and healthcare operations. The law allows health plans to revoke coverage if patients refuse to authorize such disclosures.
"I urge my colleagues to work with me next year to pass legislation that would give HHS clear direction and provide each American with greater protection of their health information," Bennett said.
Another contentious issue likely to reappear next year is legislation rescinding restrictions on providers' ability to sign private contracts with Medicare beneficiaries. Those contracts allow providers to accept payments from beneficiaries outside the Medicare system.
The balanced-budget law permits such contracts but requires providers to drop out of the Medicare program for two years. Legislation sponsored by Kyl and Rep. Bill Archer (R-Texas), chairman of the House Ways and Means Committee, called for eliminating the two-year dropout requirement.
Kyl conceded defeat on the measure months ago (June 8, p. 27). But in an orchestrated show of support, Kyl and 11 other senators took to the floor to push for its passage when Congress reconvenes.
Other issues that were brought up at the end of this year's session with an eye toward 1999 include:
Rural healthcare. Sens. Daschle and Max Baucus (D-Mont.) introduced a bill that would increase Medicare managed-care payments to rural areas and funnel additional funds into several rural health programs.
Home health. While Congress passed a measure to reform the new Medicare home health reimbursement system, some lawmakers vowed to take further action next year.