Despite the apparent success of lawmakers in passing two different bills to renew the State Childrens Health Insurance Program last week, there are indications that the politically charged program is still at risk.
In addition, healthcare providers seeking to piggyback on the House bill with their own provisions are likely to be disappointed. Though President Bush has threatened to veto both the House and Senate bills, the House bill, called the Childrens Health and Medicare Protections Act of 2007, or CHAMP, is likely to need major revisions to have a chance of becoming law. That measure was passed 225 to 204, largely along party lines.
And the Senate bill, which passed on a 68-31 vote last week and is less costly, also could be tripped up in the short time left before the program sunsets on Sept. 30.
Political observers arent sure if a compromise can be reached. Its too early to tell, said Drew Nannis, spokesman for the AARP. Nannis said that AARP officials are going to wait to see how the bills do when members of the House and Senate try to assemble versions of the bills to be voted on by the other respective chamber.
SCHIP, which covers about 6.6 million children from low-income families, currently is funded at $25 billion over a five-year term. In his fiscal 2008 budget, President Bush called for $5 billion more over five years, effectively bringing the total to $30 billion over that period.
But members of Congress want considerably more. The Senates SCHIP bill, passed Aug. 2, adds $35 billion in funding, for about $60 billion over five years. Meanwhile, the House bill funds the program at an additional $50 billion, putting the total at more than $75 billion over five years for the childrens program. Because of other Medicare provisions tacked on to the bill, its actual price tag is closer to $100 billion.
The CHAMP bill includes a clearinghouse of other Medicare provisions that directly affect how hospitals, physicians and other providers get paid. Under a provision in the bill, for instance, inpatient and outpatient hospitals would see a one-year, 0.25% reduction in their marketbasket updates for fiscal 2008, which federal accountants said would save Medicare $1.4 billion over five years. And another provision would freeze the inpatient rehabilitation rule, or 75% rule, at 60%, effectively stopping its full implementation.
Moreover, the CHAMP bill seeks to cut funding to the Medicare Advantage program to help pay for the added spending in other areas, a move strongly opposed by Americas Health Insurance Plans. The Congressional Budget Office estimates Medicare Advantage plans would lose $50.4 billion over five years.
AHIP said that the House bill, with its cuts to the private health plans that operate within the Medicare program, would mean that some
3 million seniors could lose their coverage, saddling others with higher out-of-pocket costs.
For that reason, AHIP praised the Senate bill, which relies mainly on a new tax on tobacco to pay for the expansion of the SCHIP program. The Senate has acted to ensure the health security of millions of low-income children, said Karen Ignagni, president and CEO of AHIP, in a written statement.
Other CHAMP bill provisions would reduce payments to nursing homes. Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care, said the bill would cut $2.7 billion in Medicare nursing home benefits over the next five years, and $6.5 billion over the next 10 years. History shows that when Medicare funding is stable, quality improves, but when Medicare funding is unstable, quality is at risk, he said in a written statement.
Still another provision would strip the Joint Commission of its deeming status and give the HHS more oversight of the agency. But Joint Commission officials said that the provision, as written, wouldnt work and, at worse, could actually prove detrimental to patient safety and pile on added costs.
Physicians, however, have more to cheer for. Under the CHAMP Act, the looming 10% physician payment cut for 2008 would instead be replaced with two years of positive updates, both at 0.5%. The bill also extends a host of expiring provisions for rural healthcare providers.
The (bill) will ensure that two of our most vulnerable populations can get in and see the doctor by renewing the federal healthcare coverage program for poor children and stopping steep Medicare cuts to physicians caring for seniors, Edward Langston, board chairman for the American Medical Association, said. By increasing the tobacco tax and eliminating overpayments to insurance companies offering private Medicare plans, Congress has found two appropriate ways to pay for these important national healthcare priorities.