Healthcare provider issues took a back seat last week in the sputtering but still moving vehicle called Medicare reform. Stepping up the pace to beat an anticipated adjournment of Nov. 21, congressional negotiators focused their attention on the most significant but controversial provisions that so far have prevented agreement on a prescription drug benefit and market-based program reforms.
"Republican conferees are insisting on destructive changes" to Medicare, including a penalty in higher premiums for seniors who choose not to join a private managed-care plan, said Sen. Edward Kennedy (D-Mass.), who urged President Bush to take the lead in forging a compromise.
In addition to their ongoing battle over if and how to put Medicare in competition with private health plans, members of the House-Senate conference committee reconciling the two chambers' bills debated ways to contain the cost of Medicare once it includes a drug benefit.
Under one proposal discussed last week, general government revenue could finance no more than 45% of overall Medicare costs, triggering presidential action and a freeze on new Medicare benefits once that limit is reached.
Such a plan could have "serious consequences" in terms of payment reductions that might be needed to contain spending in future years, said Rick Pollack, executive vice president of the American Hospital Association.
According to Pollack and others, a proposal to link hospital payment increases to participation in the industry's voluntary quality reporting initiative has not changed since negotiators last considered it (Nov. 3, p. 8).
Separately, it was unclear if the committee made any progress on a Senate provision that would restrict physician referrals to specialty hospitals in which they own a stake. The AHA is pushing for that provision, which has both fans and critics in the conference committee.
Despite a slate of difficult issues to resolve, a tight timeline and ongoing partisan posturing, House Speaker Dennis Hastert said last week, "We are so close to getting it done. ... What we are trying to do right now is to find that narrow way between what we can pass in the House and what can pass in the Senate."