While providers are working hard to sell Congress on increased Medicare payments, their voices are being drowned out by the clamor for adding prescription drugs to the Medicare benefit package.
Republicans and Democrats alike have seized on the drug benefit as this year's key healthcare issue for the November elections. While providers keep up a steady drumbeat of pleas for additional rollbacks of payment restraints enacted under the Balanced Budget Act of 1997, lawmakers are far more attuned to the interests of the electorate this year.
Since Congress returned from a two-week break in April, prescription drugs have defined Medicare politics. As a result, virtually no lawmaker is willing to oppose adding drugs to the benefit package. And some on Capitol Hill aren't interested in talking about any other healthcare issue for now.
"Unless you start a conversation with, `This is about prescription drugs,' nobody wants to listen to you," says Scott Styles, a lobbyist with the American Association of Health Plans.
Providers hope by keeping the pressure up through this spring and summer, they will still be in the game in September as Congress hurriedly drafts the fiscal 2001 budget before adjourning to campaign for the November elections.
"Can we in the hospital community make enough background noise that at the end of the day we're still in the mix?" asks Herb Kuhn, vice president of advocacy for the Premier hospital alliance. "People need to work hard and be patient."
Perhaps the biggest problem for providers is the simple fact that they have already won some budget-act rollbacks. Last year, President Clinton signed into law a $16.1 billion five-year package of Medicare, Medicaid and state children's health insurance provider payment increases.
Now hospitals want $25 billion more over the next five years, including $9.5 billion for increasing Medicare hospital inpatient payments at a rate equal to a hospital inflation factor known as the "marketbasket" index. Under the 1997 budget law, Medicare inpatient payments are to be set at 1.1 percentage points below the marketbasket in fiscal 2001 and 2002.
Not all is lost for providers, however. In a budget blueprint for federal fiscal 2001, Congress set aside $40 billion for both prescription drugs and Medicare reforms, which could give providers a vehicle for winning some relief, says Stephen Cooper, vice president with the lobbying firm R. Duffy Wall and Associates who represents home health agencies and Medicare+Choice plans.
Even if other providers remain in the hunt for extra dollars this year, many pitfalls await. Should a highly partisan Congress deadlock over a drug benefit, as many observers say will happen, many providers believe they'll be able to persuade Congress to use some of that money to boost Medicare payments.
The danger is that the drug debate could become so contentious that members won't want to propose any Medicare changes either out of frustration over the failure of the drug benefit or for fear of being branded as anti-senior.
On the other hand, should lawmakers succeed in passing a drug benefit, the cost easily could exceed the $40 billion Congress set aside for all Medicare reforms this year, leaving little or no cash available for providers.
Richard Pollack, executive vice president of the American Hospital Association, says Congress' willingness to help providers will depend on lobbyists' ability to build support for increased payments.
While partisan politics would be the culprit should Congress derail the drug benefit, Pollack says, hospital executives need to continue to show members of Congress, both Democrat and Republican, that increased Medicare payments will help their home districts.