With all eyes focused on combating terrorism, Bush administration and congressional policy initiatives in many areas, including healthcare, have been placed on back burners.
"Everything is changed," says Susan Pisano, spokesperson for the American Association of Health Plans.
To take but one example, Congress in September was expected to begin negotiations to resolve conflicting Senate and House versions of the patients' bill of rights. But now Capitol Hill watchers are not sure when Congress will take up the matter.
There were, however, a number of healthcare developments in late August and early September. The administration decided to give health plans greater leeway in Medicare+Choice, a federal court enjoined President Bush from rolling out his drug discount card plan, and HHS granted states more flexibility in providing coverage for certain Medicaid recipients.
Centers for Medicare and Medicaid Services (CMS) head Tom Scully said Aug. 29 that the government will give plans more leeway in choosing where they will offer coverage. CMS, formerly HCFA, also will ease a requirement that forces plans to cover all eligible seniors in a given county. Finally, plans will have the option to cover seniors in a particular city without having to cover everyone in the same market.
The easing of regulations is in response to a mass pullout from Medicare+Choice by many plans around the country. Scully said he expects several hundred thousand seniors will look for new coverage as their plans drop coverage in the next few months.
While laudable, such efforts don't address the key problems of Medicare+Choice, says Pisano.
"This is a program that is over-regulated and underfunded," Pisano says, noting that plans have been operating with payment increases limited to 2% a year while costs have been rising by 10% or more a year.
While Sens. Rick Santorum (R-Penn.) and Charles Schumer (D-N.Y.) introduced a bill to address the funding issue before the Sept. 11 attack, "the issues of timing and priority have changed," Pisano says.
Bush had sought a quick win with his prescription drug discount card plan for Medicare recipients, which he announced in the summer. On Sept. 6, however, U.S. District Court Judge Paul Friedman stymied Bush's plans by granting an injunction sought in a lawsuit filed by drugstores in July. The retail pharmacists feared that the discounts would come out of their pockets. The drugstores argued that Bush's plan was unlawful because federal officials didn't plan to compensate them for the discounts.
Under the plan, Medicare recipients could join a discount card plan offered by companies that work with Medicare and meet certain standards. Discount amounts would be up to the companies. About 30 companies have expressed interest in participating so far.
The White House said it was not pleased with the temporary halt and that it would review its legal options.
"The president is dedicated to getting senior citizens prescription drugs and prescription drug coverage at as low a price as possible and as fast as possible," spokesperson Ari Fleischer said Sept. 7.
Even so, seniors still need a prescription drug benefit to get adequate coverage, says Patricia Neuman, vice president of the Kaiser Family Foundation. Unfortunately, that will have to wait, she says.
"Everybody (in Washington) has lost their sea legs, and it will take a while for these issues to re-emerge on the national agenda," she says.
Seeking to fulfill campaign promises to give states more autonomy, the administration launched the Health Insurance Flexibility and Accountability initiative, which gives states the ability to change Medicaid benefits for optional beneficiaries.
States wishing to change benefits for optional beneficiaries need to get a waiver from HHS and would also be required to set goals for reducing its uninsured population. While HHS has granted states the right to change Medicaid benefits on a trial basis in the past, HHS will now expedite waivers under the initiative.
Designed to allow states to expand Medicaid eligibility, the plan does not call for additional funding by the federal government or states. Such frugality may make the plan more politically palatable, but lack of funding may also stymie its success, says Cindy Mann, a senior fellow at the Kaiser Commission on Medicaid, a not-for-profit, nonpartisan organization.
"If you cover more people with the same amount of money, you're going to have cutbacks in service," says Mann. The funding limits also will put pressure on providers to keep their rates down, she says.