The first joint hospital industry lobbying letter on Medicare payment issues in 2002 lacked a significant voice: the Federation of American Hospitals.
The federation, which represents for-profit hospital chains, didn't join seven other hospital groups in a recent letter to President Bush asking that he put no new caps on Medicare spending growth. If those budget constraints materialize, they likely would be in Bush's fiscal 2003 budget proposal to be sent to Capitol Hill on Feb. 4.
Hospital lobbyists fear such new caps because the federal budget deficit could be as large as $193 billion in fiscal 2003 if Medicare and Social Security surpluses aren't counted, according to the Senate Budget Committee. As a result of that deficit, Bush may want to divert Medicare spending to help fund antiterrorism activities.
"The reason we did not sign the letter is that it is broader than our agenda," said federation spokesman Richard Coorsh. He said the focus of the federation-whose hospitals tend not to sponsor home-health agencies or teaching programs-is solely on the Medicare inpatient payments.
American Hospital Association spokeswoman Alicia Mitchell said the federation's absence isn't significant. "We work together on a lot of things. We'll continue to work together," she said.
Even though the federation and its fellow hospital groups say the federation's absence from the letter isn't a sign of a split in the hospital-lobbying community, it does show how wartime will make advocacy more difficult. Healthcare lobbyists said the challenge is how to express opposition to potential budget cuts without appearing unpatriotic.
The letter asks Bush for:
* An update to Medicare inpatient hospital rates in 2003 equal to an inflation measure called the "marketbasket" index, now forecast at 2.9%.
* Reversal of scheduled cuts to Medicare subsidies to hospitals that serve a disproportionately large number of poor people, in addition to eliminating the cuts to home-health and teaching payments.
* Increasing Medicare payments to about 3,000 rural and small-market hospitals by changing labor-cost reimbursement formulas and equalizing their base payment rates with big-city hospitals.
The proposals are similar to the AHA's agenda for 2001, which had an estimated cost of $16.2 billion over five years.