If 2003 was a year of real action on major health policy legislation, 2004 may be a year of laying the foundation for future initiatives-notably on access to care-as well as the unfolding of important parts of the new Medicare law.
Congressional Republican leaders and the Bush administration, fresh off of their Medicare success, are turning their attention to a range of other pressing health policy issues, but don't bet the farm on any big bill signings this year. Yes, it's an election year, but this year that takes a back seat to Democrats' rage at the manner in which they were treated during the Medicare debate. That anger, which was palpable at recent press briefings, is why any GOP effort on healthcare, no matter how well-intended, will be squelched before it gets to the Senate floor.
In such a climate, Medicaid reform is on the road to nowhere, and medical malpractice legislation is following right behind. In a similar vein, Republicans are sure to block any Democratic efforts to amend the Medicare reform law.
There is some hope, albeit small, that a bipartisan measure on mental health parity might squeak through, and President Bush has indicated he would sign it.
All this doesn't mean there won't be some healthy debate on the big issues, particularly on access to health coverage for the 43.6 million Americans who lack it.
The need to address the plight of the uninsured will get a boost this week with the release of the last of a series of reports on reform of the U.S. healthcare system by the Institute of Medicine, a series that started with the famous To Err is Human report. The sixth and final installment, Insuring America's Health: Principles and Recommendations will dramatize the effects of a lack of insurance coverage on various populations.
Most of the current plans before Congress call for incremental solutions to the coverage crisis, including tax credits, association health plans and modest changes to current programs such as the State Children's Health Insurance Program. That approach seems to be the future, unless a Democrat with a grand plan wins the White House and Democrats sweep into power in Congress, both unlikely outcomes. (Howard Dean, the front-runner for the Democratic nomination, backs the patchwork approach.)
When it comes to access to healthcare, the implementation of portions of the Medicare legislation may be more significant this year. New rules will be written with huge implications for savings on current prescription drug costs and seniors' access to needed drugs. We will find out whether insurers and beneficiaries flock to or flee from the new Medicare discount cards, which will deliver $600 in benefits to each beneficiary until the full prescription drug benefit kicks in in 2006. And we will learn the effect of the new health savings accounts, a relatively little-noticed provision of the Medicare law.
The latter program may have the biggest immediate impact on providers and patients. Congress' Joint Committee on Taxation estimates 1 million people will sign up this year for the untaxed health savings accounts, which are available to those covered by plans with high deductibles. Private-sector organizations say that number may be far higher if the plans are aggressively marketed by insurers and banks and pushed by employers. The big question is whether such plans, which will draw healthier and more affluent workers, will have a serious adverse effect on employer coverage for the majority who need better traditional coverage. While there may be fewer chances for happy bill-signing ceremonies, 2004 is certain to be yet another year of furious and fascinating activity on the health policy beat.
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