Provider group lobbyists are finding that some of the Capitol Hill aides most knowledgeable about their issues are the ones most unfriendly to their call for a third round of Medicare payment increases, which could force an end-run around a key House committee to promote their agenda.
The lobbyists say aides on the House Ways and Means healthcare subcommittee, all of whom are new this year, have been questioning more sharply hospital groups' pitch to increase Medicare payments.
Such legislation would follow two bills enacted in the past two years that have increased projected Medicare payments by an estimated $50 billion over the next six years. The bills reverse payment restraints enacted under the Balanced Budget Act of 1997.
The American Hospital Association this year will make a pitch for increasing Medicare hospital payments by a projected $17 billion in the next five years. It argues that the extra money is needed to increase the wages of healthcare workers to attract more people to the field (March 26, p. 8).
Although they can't vote on legislation to increase Medicare spending, congressional aides are key to providing lawmakers with the background information and advice that can color their decisions.
With the aides on Ways and Means taking an increasingly combative stand, provider group lobbyists say it may be more important than ever this year for executives to meet with individual members of Congress.
"The staff are the professionals," says one healthcare lobbyist, who, like all interviewed for this story, asked not to be named. "The members listen to them. They listen to them intently."
The lobbyist says executives must explain to lawmakers how Medicare funding affects local providers and local communities; aides tend to examine Medicare only nationally. "Whom do you listen to?" the lobbyist asks.
But the source also notes that an increasing number of Capitol Hill staff members are challenging the push for higher Medicare payments.
That may explain why the AHA's annual meeting, scheduled to begin next week, will be punctuated with pleas for that local appeal. "The focus is going to be, what case do they have to make this year; what kinds of things do they have to bring to members of Congress about the issues of workforce (shortages) and deregulation," says Richard Wade, the AHA's senior vice president for communications.
The Ways and Means healthcare subcommittee aides include staff Director John McManus, formerly a healthcare policy aide in the office of committee Chairman William Thomas (R-Calif.); Deborah Williams, a former AHA policy expert who served briefly on the Medicare Payment Advisory Commission before coming to the subcommittee; Jennifer Baxendell, a Medicaid expert with the Senate Finance Committee and before that with the National Governors Association; and Joel White, formerly with the office of Rep. Jim Greenwood (R-Pa.), who serves on the House Energy and Commerce healthcare subcommittee.
Staff members within the full Ways and Means Committee contend that the four subcommittee aides are listening to providers' concerns but are raising reasonable questions about providers' claims to make sure that tax dollars are spent wisely.
"We're listening, and we're trying to get a handle on the impact of (the Balanced Budget Act) and in addition all the changes in '99 and 2000," says a staff official. "(Lobbyists) may be raising sharp questions" that may challenge providers' case, he adds.
In asking those questions, however, the aides may be more reflective of Thomas' stance than that of subcommittee Chairwoman Nancy Johnson (R-Conn.), who has declared that Congress will pass a Medicare payment increase bill this year (March 19, p. 9).
They may also test the AHA's case for higher Medicare fees to help increase wages paid to nurses and other workers who are now in short supply.
Another hospital lobbyist said the Ways and Means staff is just as likely to suggest ways to expand the healthcare workforce, such as spending money on programs funded in annual spending bills, other than by taking money from the Medicare trust fund.
"These guys are very smart and know that Medicare isn't the font of all funding," that lobbyist said.
Other lobbyists note that many lawmakers aren't talking about so-called "giveback" legislation, but want to talk about the long-term health of Medicare. "What they want to listen to people about is Medicare reform," said a managed-care lobbyist.
Whatever the case, the job of the subcommittee staff is often to say no to the many members of Congress who make fiscal requests on behalf of their members.
"Member offices play offense and committee offices play defense," said one former Capitol Hill aide who now serves as a healthcare lobbyist.