Hospital lobbyists are afraid that after the Nov. 7 election a lame-duck Congress won't feel any pressure to pass Medicare provider pay hikes.
Providers and their lobbyists have been urging Congress to repeal Medicare spending limits enacted under the Balanced Budget Act of 1997.
After Tuesday's election, however, Congress may feel free to ignore not only pleas from hospital executives who want a bigger update to their inpatient reimbursement but also appeals from Medicare HMO enrollees who have lost coverage or benefits because of low capitation payments.
"It adds a level of uncertainty that's not otherwise been present," said healthcare lobbyist Frederick Graefe, with the Washington law firm Baker & Hostetler. "It's by no means a certainty they'll pass it."
Meanwhile, new positive reports on the financial health of the not-for-profit sector by the rating agency Standard & Poor's, as well as reports of improved profits by investor-owned chains, could take some of the steam out of the Medicare-relief engine (Oct. 27, pp. 2, 3, 20). But healthcare lobbyists believe they still have a good case.
"Asking for a fair update is something that will occur regardless of financial performance," said Richard Pollack, executive vice president of the American Hospital Association.
After an increasingly hostile battle, President Clinton and Republicans called a temporary truce over budget and tax legislation as members returned to their districts to campaign for re-election. Congress has scheduled an unusual lame-duck session later this month.
Contained in the legislation is a package of payment increases for Medicare, Medicaid and State Children's Health Insurance Programs worth more than $30 billion for providers and beneficiaries between now and 2005. The House has passed the legislation, but the Senate has not.
President Clinton has said he will veto it because it increases Medicare HMO payments by too much in comparison with payments to other providers. Clinton also wants language barring plans from pulling out of the Medicare market for three years.
The legislation would give hospitals a number of payment increases, including an update to their Medicare inpatient payments in 2001 equal to an inflation measure called the hospital marketbasket index. That provision alone is worth $600 million in 2001 and $3.7 billion between now and 2005.
While rattled by the delay, provider groups said they were viewing the action as an opportunity to allow their members to speak directly to lawmakers in their districts as they wrap up election campaigns.
"We view these developments by the House and Senate . . . not as a setback but as a chance for the provider community and for Congress to regroup to take another run at passing (Medicare) legislation this year," said Herb Kuhn, vice president of advocacy at the Premier hospital alliance.
A new Congressional Budget Office said that because the provider payment relief package would close a loophole in Medicaid law that had allowed states to artificially increase their federal match, the total net cost of the measure is just $10.9 billion, down from more than $30 billion.