Federal lawmakers from the House and Senate, as well as White House officials, could be on a collision course over funding and provisions in a bill that would reauthorize and expand the State Childrens Health Insurance Program, according to sources close to discussions on the matter.
The three-way battle, which closely follows party lines, has created two widely different blueprints for must-pass SCHIP legislation, with the House planning to submit a roughly $90 billion package that not only expands funding for the Medicaid program by $50 billion, but also includes a raft of additional healthcare provisions. Meanwhile, a Senate blueprint for legislation plays it straight, with a $35 billion expansion of the program, according to multiple sources. Funding for both bills would be spread out over five years.
While funding for both bills would come from a proposed 61-cent increase to the federal tobacco tax, the Houses version would also slash payments to some Medicare Advantage plans. The Senate bill, according to sources, would not. In a closed-door meeting today, the Senate Finance Committee said it would instead rely on Medicaid best-price concessions from the pharmaceutical industry to help defray the additional cost to the program. The committee is expected to finalize a bill on July 17.
Under congressional paygo, or pay-as-you-go, rules, only offsetting funds can be used to finance new legislation.
If that proves to be the case, then the stage would be set for a contentious battle between Democrats and Republicans over a bill that nearly everyone on the Hill considers critical legislation. Adding to the pressure is an increasingly vocal White House, which in recent weeks has chided lawmakers for overstepping what the administration says is the original intent of the SCHIP program. The program is slated to expire on Sept. 30.
A draft proposal from the Energy and Commerce and Ways and Means committees in the House maps out a bill that would replace a scheduled 10% Medicare physician payment cut with a 0.5% increase in 2008 and 2009, and would repeal the sustainable growth rate formula.
Meanwhile, three of the nations largest physicians groups were on Capitol Hill to lobby Senate and House leaders to draft a bill that once and for all fixes the Medicare physician payment formula, creating stable, predictable and positive updates, John Tooker, executive vice president and chief executive officer of the American College of Physicians, told reporters.
The American College of Physicians, American Academy of Family Physicians and the American Osteopathic Association jointly told lawmakers that they would back a tobacco tax increase combined with other offsets, including those that would likely come from the adoption of a patient-centered medical-home platform, comparative-effectiveness programs and by tapping reserve dollars set aside to fund the Physician Quality Reporting Initiative. -- by Matthew DoBias