For the healthcare lobby in Washington, the new year promises to prove the old adage that everything old is new again.
After 2007 ended with a whimper and not the bang that many interest groups were hoping for, lobbyists for hospitals, physicians and several consumer groups plan to ready themselves for the same battles that landed them only short-term fixesor lessin what many considered a skeletal Medicare funding bill.
Its a little bit of Back to the Future, says Chip Kahn, president of the Federation of American Hospitals, who advocated for a handful of hospital-friendly provisions that didnt make the bill, as well as a broader expansion to a popular childrens health insurance program. The agenda starts offin terms of Medicarewhere the agenda ended last year.
In December, Congress approved and President Bush signed a bill that temporarily reverses what would have been about a 10% Medicare pay cut to doctors, and provides an extension of the $25 billion State Childrens Health Insurance Program through early 2009.
The bill also kept many provider payments intact and extended various rural health initiatives and other programs.
But analysts say that the short-term nature of many of the bills provisions, which were cobbled together by Senate leaders who had the difficult task of gathering enough support to ensure passage while the legislative session wound to a close, means that the very same debates over physician payments, funding for SCHIP, a proposed moratorium on doctor-owned specialty hospitals and more will be taken up again when federal lawmakers return to Washington later this month.
The lesson is one of timing, Kahn says. On the Medicare front, we learned that youve got to get started earlier, he says. The (Senate) Finance Committee had an intention to act, but they didnt have time to get a consensus. My hope is that everything will be done earlier this year.
One scenario is that the Senate will frame a legislative package in February that would be used as the impetus for negotiations with the House. Leaders in the House will likely stick to a series of Medicare provisions that were included in its Childrens Health and Medicare Protection Act legislative package, or CHAMP.
CHAMP would have added $50 billion over five years to SCHIP, but also included provisions that would have reduced hospital payments, replaced the physician pay cut with two years of positive updates and would have stopped a number of CMS regulations from going into effect.
To help pay for the bill, CHAMP included provisions that would have cut $50.4 billion in funding to the Medicare Advantage program as well as raised the federal tax on tobaccoboth of which proved unappealing to Republican lawmakers and to Bush.
House and Senate leaders have hinted that a new Medicare bill could include a longer-term physician pay fix, provisions that would require doctors to write prescriptions electronically, regulations on imaging payments and a potential demonstration project for a host of quality improvement and pay-for-performance programs. Provisions that greatly restrict physician ownership of hospitals would also take center stage in the legislative blueprint.
Its a mixed bag in terms of the outcome. Next years agenda is sort of this years agenda and a lot of these issues carry forward, says Richard Pollack, executive vice president of the American Hospital Association. The big issue now that no one is able to answer is what the (legislative) process will look like.
Several policy watchers say that Democratic leaders on Capitol Hill potentially could use a budgetary maneuver to produce whats known as a reconciliation bill to pay for a broader, more comprehensive healthcare bill. Under terms of reconciliation, committees that have jurisdiction over Medicare, including Ways and Means and Energy and Commerce in the House and the Finance Committee in the Senate, would be required to find offsetting program cuts to pay for the provisions in the bill. Each committee would then produce a bill that would get rolled into a larger, omnibus package.
The main benefit of the reconciliation process for Senate Democrats is that it wouldnt require 60 votes for passage, but rather could be approved by a simple majority. Still, thats not to say that the White House wouldnt veto a package, but the idea would be for the majority party to include several provisions favorable to Bush that would make a veto improbable.
As a legislative vehicle, reconciliation is certainly on the table, says a hospital industry lobbyist, who spoke on the condition of anonymity. Where you do things by unanimous consent or where you need 60 votes, youre going to have problems.
Democrats now hold a slim 51-48 majority over Republicans. The inability to muster 60 votes hindered the majority party most of last year, especially on SCHIP, and in part was to blame for the scaled-back Medicare bill.
Another factor that could haunt comprehensive healthcare legislation is the looming presidential election this year. Typically, theres less legislation rather than more in an election cycle, Kahn says.
And also, you have a president and a White House that think they were very successful last year, Kahn adds. Bush administration officials last year worked to quell any cuts to their most-favored healthcare initiatives, including Medicare Advantage and Medicares prescription drug program. That doesnt auger well for a lot of action this year. The president plans to be president until the very last day.