Normally, lawmakers are in their districts for most of November. This year, they stayed in Washington until almost Thanksgiving, trying to hammer out legislation on bioterrorism, the uninsured and the economy.
Legislators also moved forward on mental health coverage and Medicare reimbursement, but those issues will continue to take a back seat to national security and economic issues.
Sens. Edward Kennedy (D-Mass.) and Bill Frist, M.D., (R-Tenn.) on Nov. 15 unveiled a $3.2 billion bill to combat bioterrorism. If passed, the bill would help beef up the country's capacity to respond to bioterrorism, protect the nation's food supply and enhance the coordination of federal activities.
Kennedy initially had wanted to spend $10 billion, but in an attempt to get Republican lawmakers to sign on, he sharply cut the size and scope of his proposal. Republicans have stated their preference to spend less than $5 billion, and while the White House would likely go along with a budget in that range, passage of bioterrorism legislation was stymied by the much more contentious negotiations over economic stimulus legislation.
Still, Bruce Fried, head of the health law group at Shaw Pittman in Washington, says there is reason to be optimistic about White House approval of some bioterrorism legislation.
Diane Rowland, executive vice president of the Kaiser Family Foundation in Washington, agrees.
"I would expect to see expanded financing," Rowland says. "We have let lag the public health infrastructure, and there's a real need" for additional funds.
Capitol Hill legislators also are concerned with helping Americans who have lost their health insurance due to the recession. As part of an economic stimulus plan, the House passed a bill that would provide $3 billion in block grants to states to help them extend coverage for the uninsured under COBRA.
The Senate, meanwhile, has yet to pass legislation as Democrats and Republicans fight over the size and shape of the package. A $73 billion Democratic stimulus plan, which included $30 billion to help the unemployed, including funding for health insurance, was blocked Nov. 14 by Republicans.
Rowland argues that because people are already out of work, it's crucial that Congress find a way to get the money into their hands quickly. Giving block grants to states, she says, would likely take time that lower-income and out-of-work Americans don't have.
Fried says that while some relief is likely to pass, it may not be enough for many unemployed Americans. COBRA, he notes, is generally expensive, and all proposals to date make individuals pay for at least 25% to 50% of the premium.
The American Academy of Family Physicians is lobbying hard to prevent the 5.4% drop in Medicare reimbursement scheduled for Jan. 1 from taking place. A cut next year would mark the fourth time in 10 years that Medicare physician payment levels have been reduced, according to the AAFP.
The AAFP, the AMA and other groups have been urging Congress for years to change the formula for reimbursing doctors, the product of which rises and falls based on the gross domestic product even though medical and general inflation may be rising at the same time.
"A lot of our members are looking at their bottom line and saying, 'How much longer can I stay in business?"' says Mary Frank, M.D., a family physician in Rohnert Park, Calif., and an AAFP board member. Franks says she receives about $48 for a 15-minute visit under Medicare while her overhead is $40, excluding doctors' salaries.
Seeking to redress the issue, Sen. John Breaux (D-La.) introduced the Medicare Physician Payment Fairness Act of 2001. Frank says the bill would allow Congress to tie reimbursement rates more to inflation.
But given that lawmakers are focused on anti-terrorism and economic stimulus legislation, the chances of the bill going far are not good, Frank says.
On another front, the Senate approved a bill that puts mental health benefits on parity with medical health benefits. The bill outlaws limits on the number of visits patients can make to therapists. Moreover, co-pays can't be higher than those for a primary care doctor.
Frank says, however, that there are few signs of activity on this issue in the House and further action is unlikely for some time.