The battle of the budgets began in earnest last week as the passage of budget resolutions with widely divergent views on Medicaid in the Senate and House set up a collision course between the two chambers.
The Senate's $2.6 trillion fiscal 2006 budget resolution, which passed on a 51-49 vote, included an amendment sponsored by Sens. Gordon Smith (R-Ore.) and Jeff Bingaman (D-N.M.) that eliminated $14 billion in Medicaid cuts proposed by the president over five years and replaced them with a commission to study Medicaid.
The House version, which passed on a vote of 218-214, includes $20 billion in Medicaid cuts over five years. The fate of Medicaid funding will be hashed out later by a conference committee. Already observers are saying the Medicaid issue is divisive enough to potentially derail budget talks.
Seven Republicans joined 44 Democrats in voting for the Smith-Bingaman amendment, sending a strong message to the Republican leadership and the White House that members of both parties are uneasy about cuts to the healthcare program that covers 53 million Americans. Healthcare providers are equally apprehensive about the prospect.
"I think there are a number of members in Congress who don't want to take a vote on cuts to Medicaid," said Anne Ubl, vice president of legislative affairs for the American Hospital Association. The AHA has said previously that averting Medicaid cuts is at the top of its legislative agenda.
The Medicaid cuts could still be revived when the House and Senate meet in conference committee to write a compromise budget, but Rep. Joe Barton (R-Texas), the House Energy and Commerce Committee chairman, said the Senate's rejection of Medicaid cuts makes it very difficult to "get my members to want to tackle it."
For providers, the Senate's version represented a significant victory. President Bush's budget had included $60 billion in cuts to the program over a 10-year period.
The Smith-Bingaman amendment "creates a process to more thoughtfully approach Medicaid reform," said Georges C. Benjamin, executive director of the American Public Health Association.
Because it is still early in the process that determines spending levels for the federal government for fiscal 2006, the fight to stave off Medicaid cuts is far from over.
One possible compromise by the conference committee could cut Medicaid by less than the $20 billion targeted by the House but still offer some spending reductions, a prospect Benjamin does not favor. "I'm not prepared to take any cuts in Medicaid right now," he said.
Senate Budget Committee Chairman Judd Gregg (R-N.H.) said avoiding Medicaid spending cuts this year would likely signal that Congress would also avoid cuts to the program in the future, especially since next year is an election year for some members.