For
the 435 members of the US House of Representatives and 34 of the 100
Senators, 2002 is an election year. As you no doubt would expect, election
years are simply different--more complicated--for Congress. Although
most Members of Congress start running for reelection the day after
they are elected, their concern about holding their seats is now growing
quickly and will crescendo in September, just before Congress adjourns
for the year.
Although
adjournment is less than six months away, few real workdays remain in
this year's session. No votes are taken on Mondays or Fridays, so Members
can be in their districts for long weekends. There are several extended
recesses this year so that Senators and Representatives can campaign--first
in their home-state primary elections and then in the general election,
to be held on November 5th. This year, they will take two weeks at Easter,
one week for Memorial Day, and one week for July 4th. Then comes August,
the traditional summer break. House Members will be away from Washington
for more than five weeks; Senators take just over four weeks.
What
are the priorities this year? As I said, except for the few House Members
who are retiring and the 66 Senators whose terms don't expire, being
reelected is the highest priority. And while reelection is the goal,
the means by which it is achieved are time-tested, tried-and-true. First
comes the money. Most Members of Congress, those who feel the least
insecure about reelection, spend as much time raising campaign funds
as they do anything else. The sad fact is that money translates into
media, which translates into votes. Second come the issues. Few things
are more important to a Member of Congress in an election year than
making certain that the voters in their districts have a clear understanding
of what the Member stands for and how s/he differs from his/her opponents.
Congress
takes many votes each year on bills that are never enacted into law.
The Members do this so that they can stake a claim to a position, and
point to voting for something that they believe in. Last year, the House
of Representatives passed Medicare reform legislation, which included
adding prescription drug coverage to the program. The bill had no hope
of becoming law, as Senate Democrats never gave it a second look, but
GOP House Members will campaign on this and will point to inaction on
the part of Democrats. So, much of this year will be used by Members
to distinguish themselves from their opponents while creating the illusion
of action.
This
year, perhaps more than ever before, working to make clear the differences
between the parties is important because the last half of 2001 was a
time when bipartisanship, real or pretend, was the order of the day.
Our nation was attacked; we had begun a military action in Afghanistan;
and, in Washington, we felt the increased insecurity that came from
the anthrax crisis. As a result of Congressional efforts to come together
and to support the President, there simply wasn't the opportunity to
clarify the differences. So, differentiation will be the hallmark of
the session of Congress.
Medicare
Will Get Much Attention--Little Action
No
block of the electorate votes as consistently as seniors. This fact
alone makes their issues--Social Security and Medicare--high on any
politician's agenda. This year is no different; Medicare will get much
attention. The President focused on Medicare reform and on adding prescription
drug coverage to Medicare as he originally did in his campaign. More
recently, in the 2003 budget he sent to Congress, he proposed spending
$190 billion over ten years to reform Medicare and add drug coverage.
For
more than five years, some say for decades, Congress itself has been
working to find a path that enough can agree on to reform Medicare.
Four years ago, the National Bipartisan Commission on the Future of
Medicare recommended reforming Medicare along the lines of the Federal
Employees Health Benefits Program. Congress has considered several bills
to enact proposals that include similar proposals every year. Because
Republicans are more supportive of reform that expands beneficiary choice
among private-sector health plans, the GOP-controlled House has passed
bills to do this each of the last several years. This year, the House
will up the ante on the President to the tune of $350 billion over ten
years.
In
the Democrat-controlled Senate, the majority is relatively content with
the Medicare program. They would like to see benefit improvements, including
a prescription drug benefit, but the basic government-administered pricing
system is a model with which they are comfortable. Last week, the Senate
Budget Committee reported out a budget that includes $500 billion for
health care, including Medicare reform, a drug benefit, and other health
spending.
While
there is big talk about reforming Medicare, across Washington there
are hundreds of small conversations about ensuring that current Medicare
provider and health plan payments are adequate. Fee-for-service physicians
received a cut of 5.4% this year, and the same will occur for the next
two years unless Congress acts. Not surprisingly, physicians are up
in arms. Health plans, many of which have been limited to annual increases
of 2%-3% for the last five years, argue that increases of this magnitude
simply cannot keep pace with annual cost increases of 10%, more or less.
And, hospitals, nursing homes, and home health agencies ... all claim
they need more.
So
where does this leave us? The American Association of Retired Persons
(AARP) wrote to Congress saying that it would be unconscionable to increase
payments to current providers (which would not result in any new benefits
or increased access) before it ensures that Medicare provides coverage
for prescription drugs. The AARP expresses wonder that Congress could,
in good conscience, increase provider payments while not ensuring drug
coverage, given the importance of drugs in modern medicine. In the end,
the stalemate on reform and drug coverage will not be broken. Payments
to providers and health plans are likely to increase, however, if only
modestly.
Legislative
Potpourri
Medicare,
especially Medicare+Choice payments that more closely reflect cost,
may be the most important legislative issue, this year, but it is not
the only issue of interest to Kaiser Permanente (KP). We are interested
in at least half a dozen other issues.
Patients Bill of
Rights
Patient
protection legislation has been such a hot front burner issue for five
years, it's surprising that it has not been enacted. After years of
debate, both Houses of Congress last year passed their own versions.
Then came September 11, and the issue seems to have disappeared. September
11 is not the only and perhaps not the major reason. Patients rights
legislation may no longer be necessary--many health plans have voluntarily
or in response to state laws come into compliance with most elements
of the federal legislation. Rising health care costs have made Congress
a little wary of legislation that would contribute to even more expensive
coverage. Still, largely private conversations go on between the White
House and the sponsors, principally with Senator Kennedy (D-MA). And
both parties would like to use the issue in the Fall campaign. The ultimate
outcome may depend on whether either party sees victory in compromise.
Bioterrorism
Major legislation to prepare the country to respond to future terror
attacks is working its way to completion. Both the Senate and House
passed bills last fall. The conference committee that is charged with
working out differences is meeting daily and should report out an agreement
within the month. The legislation will provide funds to states, local
governments, and hospitals for preparedness and will expand stockpiles
of pharmaceuticals used to respond to attacks as well as fund research
on new medicines. For KP, the principal issue of interest is a provision
that makes it easier for physicians licensed in one state to practice
in another where a public health emergency has occurred. The mechanism
in the House bill is a national registry that would allow physicians
to submit their credentials and licensing information so that, during
an emergency, state officials could turn to the registry to verify credentials.
Patient Safety
Congress is interested in legislation that might reduce medical errors
and near misses. The most commonly discussed design would establish
a national patient safety database, to which providers could submit
reports. Patient safety organizations, private-sector entities, would
be authorized to collect the reports, transfer the data to the national
database, and analyze provider-level, regional, or other aggregations
of patient safety data to uncover patterns and recommend potential responses
to reduce errors and near misses. This legislation is in the drafting
stage in the Senate Health, Education, Labor and Pensions Committee.
Senators Kennedy (D-MA), Frist (R-TN), Jeffords (I-VT), and Gregg (R-NH)
are most interested. On the House side, the Ways and Means and the Energy
and Commerce Committees will consider legislation in this area as well.
There is only a 50/50 chance for action this year.
Mental Health Parity
Last year, Congress acted to extend for one-year legislation requiring
that annual and lifetime limits on mental health coverage be identical
to coverage for physical conditions. The Senate also passed a bill that
would have required parity with respect to all treatment and financial
aspects, but the House did not agree to it. This year, Congress has
already acted to extend the penalties through the IRS code, which effectively
extends current law for one more year. A broader parity bill may be
considered later in the year.
Other Legislation
of Interest
Other things on which we are working include a proposal to change the
way that Medicaid pays for prescription drugs--which would probably
increase costs to Kaiser Permanente significantly; and reauthorization
of the Prescription Drug User Fee Act, which finances FDA's review of
new drug applications and which we would like to see provide significant
funds for postmarket surveillance.
.
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