War in Iraq did not stop Congress last week from debating federal budget proposals, but momentum for Medicare reform and other domestic priorities could slow if the conflict continues indefinitely or if U.S. casualties are high.
President Bush is expected this week to submit to Congress a supplementary spending request of at least $75 billion to fund the invasion. With Congress focused on war costs and security at home, it may be too early to say when Washington will emerge from the fog of war and return in earnest to other policy priorities, including Medicare reform.
"The need for prescription drugs doesn't change if there's a war going on," a Senate leadership aide said last week. "It just means we need to be focused."
Lawmakers and their staffs contacted by Modern Healthcare agreed for the most part that domestic business would move forward even as the war in Iraq intensifies. Still, some expressed concern about timelines and the ability of Congress to push major healthcare legislation when U.S. troops are in harm's way.
"Even though the Congress is preoccupied with Iraq and security issues, it seems we could at some point deal with Medicare reform," Rep. Jim Davis (D-Fla.) told Modern Healthcare.
However, Davis added, a federal budget that cuts taxes, finances a war and pays for increased security "is not a good situation for Medicare."
As war in Iraq moved into its second day, the House voted 215-212 to pass a 2004 budget resolution that included $400 billion in new money to fund a prescription drug benefit but also called for Medicaid cuts of at least $93 billion over 10 years.
Centers for Medicare and Medicaid Services Administrator Tom Scully told reporters last week that the reduction in Medicaid "may sound like a lot" but could be a modest decrease historically speaking. "Will it be popular? No," he said.
Others expressed concern about the effect of competing priorities. "The added expense of a war will put one more thing ahead of urgent domestic priorities like adding a drug benefit to Medicare," said Ben Peck, a healthcare lobbyist for Public Citizen in Washington.
Earlier last week, lawmakers in the House Budget Committee passed a resolution that would have cut Medicare spending by some $215 billion over 10 years. But under pressure from Democratic lawmakers, as well as the American Hospital Association and other provider groups, Budget Committee leaders rescinded the Medicare cuts before the House vote.
Still, if Congress grants Bush's request for $75 billion to fund the early stages of the war, "that will cause members to think twice when it comes to spending additional dollars, whatever the issue is," said Tom Nickels, senior vice president of federal relations at the AHA.
Indirect medical education and disproportionate share payments, among other discretionary spending, could see new cutbacks as war costs come into focus, Nickels said.
The Senate fiercely debated a budget resolution of its own last week, with most controversy centered on a $700 billion tax cut. The Senate proposal, which hadn't passed the chamber at deadline, included a 10-year, $400 billion allocation for a Medicare drug benefit, $50 billion over 10 years to address the uninsured and $3.3 billion in 2004 to reform Medicaid. The House and Senate have until April 15 to reconcile their budgets and submit one version to President Bush.
Sen. John Breaux (D-La.), speaking last week at the Federation of American Hospitals' annual meeting in Washington, said that despite the ongoing war effort he expects a Medicare reform package to clear the Senate Finance Committee sometime this spring.
"If we can do that, I think there will be enough votes on the floor of the Senate to get it passed" this year, Breaux said of a drug benefit and other Medicare program changes that have been proposed by the Bush administration, including a new set of private-sector options for beneficiaries that would offer more complete coverage (March 10, p. 6).
Rep. Bill Thomas (R-Calif.), chairman of the powerful House Ways and Means Committee, said, "The idea that the Senate might actually engage is very exciting."