Healthcare special-interest groups and sympathetic lawmakers last week began a final push for revisions to Medicare payment policies and managed-care regulation as Congress neared consideration of key healthcare legislation.
In a week heavy on political spin and light on substance, Sen. Kay Bailey Hutchison (R-Texas) led the latest charge to aid hospitals that say they are struggling under Medicare payment policies imposed by the Balanced Budget Act of 1997.
Her legislation was the second measure to propose increases in Medicare inpatient payments and the first sponsored largely by Republicans. It would increase the inpatient update by 0.5 percentage points in each of the next three federal fiscal years, which are the last three years of cuts mandated by the budget law.
Hutchison's legislation follows a bill that Rep. Nita Lowey (D-N.Y.) proposed and New York Democrats largely sponsored. The measure calls for an increase of 0.7 percentage points next year.
The Hutchison bill was part of an effort to divert $1 billion more to Medicare providers in federal fiscal 2000.
Hutchison said her legislation was following the recommendations of the Medicare Payment Advisory Commission.
MedPAC, however, recommended the 0.5% increase only for fiscal 2000, which begins Oct. 1, to help hospitals eliminate any year-2000 problems from their information systems.
The MedPAC annual report on Medicare payment said of the Y2K adjustment, "This increase is not considered a permanent part of the allowance, and we will reconsider the level of this adjustment in subsequent fiscal-year analyses."
But Hutchison and her GOP co-sponsors said HCFA overreached in implementing the Balanced Budget Act and as a result put hospitals "on their knees."
However, regarding Medicare inpatient payment, Congress specifically laid out the update formula: 1.8 percentage points less than the hospital inflation index in 2000 and 1.1 percentage points less than the index in 2001 and 2002.
But Hutchison justified the charges against HCFA by saying the agency's interpretation of the budget law as it applies to home-health agencies and outpatient departments has resulted in larger payment reductions than Congress intended.
In seeking an extra $1 billion, Hutchison was in step with Senate Finance Committee Chairman William Roth (R-Del.), who made public a letter to Senate Republican Leader Trent Lott (R-Miss.) asking for $1 billion to $1.5 billion of the federal budget surplus to be used for Medicare fee increases in fiscal 2000.
The introduction of Hutchison's bill was just one of several events during the week that prodded Congress to change Medicare payment policies.
The American Health Care Association, which represents nursing homes, gathered about 200 people on the Capitol steps to push for increased skilled-nursing reimbursement.
"The fact of the matter is that the current reimbursement levels as developed by Medicare simply are not enough to preserve and ensure access to quality nursing home care for seniors," said Sen. Orrin Hatch (R-Utah), who is sponsoring a bill that would increase Medicare payments to nursing homes.
Thirty senators have signed onto Hatch's bill as co-sponsors.
"I would like to see 60 co-sponsors by the end of next week, and I hope you will help me reach that goal," Hatch told the nursing home employees.
Elsewhere on the Capitol grounds, the American Association of Health Plans rallied at least 50 Medicare+Choice enrollees, who also met with members of Congress to ask for increases in Medicare payments to HMOs. They said more health plans would withdraw from the Medicare market if the rates weren't increased.
Their health plans paid for their travel and hotel expenses as they lobbied Congress.
But Medicare+Choice plans were targets of criticism from the Clinton administration.
Appearing before an annual government affairs meeting of American Medical Association members, Vice President Al Gore slammed Medicare HMOs for reducing their prescription drug benefits. He released an HHS report that said 21% of plans have limited their drug benefit to $500 or less.
He used the report to justify the administration's call for a broad prescription drug benefit.
"The need for affordable prescription drugs is only going to be more important in the future," Gore said. "That's why we ought to ensure that all beneficiaries have a drug benefit."
Republicans responded with their own prescription drug plan. Addressing the same meeting, Rep. Michael Bilirakis (R-Fla.), chairman of the House Commerce Committee's healthcare subcommittee, announced that he had introduced legislation based on a plan he outlined in August.
Under his plan, the federal government would help the states subsidize drug purchases for low-income beneficiaries. In addition, seniors with high drug costs would receive a government subsidy when their purchases exceeded a set threshold.
The pharmaceutical industry didn't take it lying down either. In a report released before Gore's, Citizens for Better Medicare, a group largely sponsored by drug companies, said between 6 million and 9 million Medicare-eligible retirees would lose their employer-paid prescription drug coverage if President Clinton's Medicare reform plan were enacted.
The group, which is financing an advertising blitz against the Clinton plan, said employers would drop their drug coverage or encourage retirees to join the government plan. The plan would displace from $3 billion to $5 billion in current employer spending, according to the report, which PricewaterhouseCoopers prepared for Citizens for Better Medicare.
The AMA meeting was also a site for the promotion of patient-rights legislation. Members of Congress urged physicians to keep the heat on Congress to pass legislation sponsored by Reps. John Dingell (D-Mich.) and Charlie Norwood (R-Ga.).
"My advice is, in the next couple of weeks, talk to a lot of patients and tell them to phone your congressman," said Rep. Greg Ganske (R-Iowa), a physician, who's also a sponsor of the legislation.