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Volume 12 Number 239 News: Medicare The House Dec. 13 is expected to take up a Medicare package that would increase physician pay in 2008, reduce payments to managed care plans and other providers, and extend funding for the State Children's Health Insurance Program into the fall of next year. With negotiations with Republicans on a Medicare bill at a standstill, Democrats will put a bill on the floor that likely will be approved by a partisan vote, but stand little chance of passing the Senate, where there is significant opposition to reducing payments to managed care plans. House Majority Leader Steny Hoyer (D-Md.) told reporters the bill would increase pay for physicians, reduce payments to managed care plans, and make changes to SCHIP policy issued in August by the Centers for Medicare & Medicaid Services. The SCHIP funding extension would go through Sept. 30, 2008. Details of the package were sketchy Dec. 12, and the bill was expected to go to the House Rules Committee late in the day. A document prepared by House Ways and Means Republicans said Democrats would give physicians a 0.5 percent pay increase in 2008, cut indirect medical education (IME) payments to managed care plans, and reduce payments to Medicare private fee-for-service plans. Without action by Congress, doctors' Medicare reimbursement will be cut 10 percent beginning Jan. 1, 2008. Managed Care, Other Cuts House Ways and Means Committee ranking minority member Jim McCrery (R-La.) told reporters Dec. 12 that the Democrats' package also would further drain the Medicare managed care stabilization fund. The document said the package also would contain cuts to numerous Medicare providers, including home oxygen providers and nursing homes, as well as implement a moratorium on Medicare reimbursement to specialty hospitals. The bill also will include policy changes for Medicare's prescription drug benefit, the document stated. The changes could create new rules expanding the types of drugs plans must cover, and expanding the number of seniors who qualify for low income benefits under Part D. Sources said Republicans may be offered a chance during floor debate Dec. 13 to offer an alternative bill in the form of a motion to recommit the Democrats' bill back to the committees of jurisdiction. House Republicans favor a scaled-down version of Medicare legislation, including increasing doctors' pay from negative 10 percent to zero percent, eliminate IME overpayments to managed care plans, phase out the managed care stabilization fund through 2012, and extend SCHIP funding through March 2009, according to the Ways and Means GOP document. If a Medicare bill is passed by House Democrats, it is likely to be changed when it reaches the Senate, lawmakers said. "They're not going to be able to roll a bunch of things that we don't agree with over us, which has been their methodology up until now," Sen. Orrin B. Hatch (R-Utah) told reporters Dec. 12. "If they're smart, they'll do what has to be done and that's it." Hatch said he envisions a "bare-bones" bill, with a physician pay increase and other provisions that would be much less sweeping than the bill under consideration by House Democrats, eventually passing the Senate. Second SCHIP Bill Vetoed Meanwhile, President Bush Dec. 12 vetoed legislation (H.R. 3963) reauthorizing SCHIP funding for five years, his second veto of SCHIP legislation this year. The president vetoed the first bill Congress sent to him (H.R. 976) on Oct. 3. Congress and the White House have been locked in a six-month struggle to reauthorize SCHIP. Bush has opposed the measures Congress sent to him, saying they cost too much, would provide coverage to higher-income children and adults, and allow coverage of illegal aliens. Congressional supporters of the legislation, including numerous GOP senators, have denied those charges, calling SCHIP a successful program that should be reauthorized with expanded funding. "This is indeed a sad action for him to take when so many children in our country need access to health care," House Speaker Nancy J. Pelosi (D-Calif.) told reporters Dec. 12. H.R. 3963 would provide $35 billion over five years for SCHIP, in addition to the $25 billion over five years already expected to be spent. The bill would have provided coverage for about 6.6 million children currently enrolled and an additional 4 million children. It would be funded by a 61 cent pack increase in the federal cigarette tax. Bush in a message to the House issued late Dec. 12 said H.R. 3963 "does not put poor children first and it moves our country's health care system in the wrong direction." "Ultimately, our Nation's goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage," the president said. "As a result, I cannot sign this legislation." "Because the Congress has chosen to send me an essentially identical bill that has the same problems as the flawed bill I previously vetoed, I must veto this legislation, too," Bush said. "I continue to stand ready to work with the leaders of the Congress, on a bipartisan basis, to reauthorize the SCHIP program in a way that puts poor children first; moves adults out of a program meant for children; and does not abandon the bipartisan tradition that marked the original enactment of the SCHIP program." "In the interim, I call on the Congress to extend funding under the current program to ensure no disruption of services to needy children," Bush said. House Democratic leaders said they would not attempt to override the veto, but would pass a program funding extension while they continue trying to get agreement on a bill reauthorizing funding for the program. Congressional supporters of SCHIP legislation for several weeks have been locked in negotiations with a handful of House GOP members to try to get them to switch their votes, to no avail.End of article graphic By Steve Teske
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