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Volume 12 Number 238 News: Medicare Prospects this year for congressional passage of legislation increasing physicians' pay under Medicare and to make other changes to the program appeared to dim significantly Dec. 11, as an agreement between Democrats and Republicans remained out of reach, with time running out before lawmakers adjourn for the year. Talks between Democrats and Republicans in the Senate on Medicare legislation have broken down, in part, due to a threat from the White House to veto a Medicare bill that would be partially paid for by cutting Medicare managed care plans, lawmakers said. Senate Finance Committee Chairman Max Baucus (D-Mont.) Dec. 11, for the first time publicly, said a Medicare bill might not be approved by Congress this year, but may have to be addressed when Congress returns in January 2008. "Medicare may be pushed off until next year," Baucus told reporters. The prospects a bill will not be passed this year are "getting more likely because the White House made it clear, at least they say, that they will not agree to any [managed care] cuts. I don't know how accurate this is." The House Ways and Means Committee held a bipartisan meeting on Medicare and tax issues late Dec. 11, but members after the meeting provided little comment to reporters. House Ways and Means Committee Ranking Minority Member Jim McCrery (R-La.) told reporters, however, that talks with House Democrats on a Medicare package continue and a deal remained possible. That meeting followed an earlier one with Democratic leaders of the House committees with jurisdiction over Medicare and Medicaid, as well as with Baucus. Senate Finance Committee Ranking Minority Member Chuck Grassley (R-Iowa) was not at the meeting. Baucus had said he and Grassley together would bargain with the House on a Medicare package. Health and Human Services Secretary Michael O. Leavitt Dec. 4 told Baucus and Grassley that President Bush would veto a Medicare bill if it contains managed care (Medicare Advantage) cuts. Baucus said two legislative vehicles remained for attaching a Medicare bill: an omnibus spending measure, and a bill addressing issues related to the alternative minimum tax. Baucus said he favored the latter approach, but House Democrats said late Dec. 11 that Medicare language would not be attached to AMT legislation, scheduled to be on the House floor Dec. 12. The Senate has already passed an AMT bill. The prospects for passage of an omnibus spending bill remained clouded Dec. 11 over differences in spending levels between the White House and congressional Democrats. Managed Care Some lawmakers want to cut managed care payments to help pay for an increase in Medicare physician reimbursement in 2008. Unless Congress intervenes, doctors' Medicare pay will be reduced by 10 percent for 2008 compared to the current year. Democratic lawmakers are contemplating taking the doctor pay change for 2008 from the anticipated negative 10 percent, and making it a positive 0.5 percent update compared to the 2007 level. This would be paid for, in part, by cuts to managed care plans of about $15.5 billion over five years. Sources said Republicans favor a much smaller package than the six-page list of provisions prepared by Democrats. Baucus said he had contacted the White House to determine how firm Bush's opposition to managed care cuts is. He told reporters White House opposition to managed care cuts has damaged plans to move a Medicare package, but he said there could be enough wiggle room in the president's stance to allow some managed care reductions. "The White House may be ambiguous, they may be ambivalent, it just hard to know," he said. Baucus said it was possible to fund a pay increase for doctors without cutting managed care, but that would necessitate larger payment cuts to other Medicare providers. Lawmakers have been examining cutting payments to home oxygen providers, home health agencies, skilled nursing facilities, and other providers as part of a Medicare package. Sen. Kent Conrad (D-N.D.) told reporters Dec. 11 the White House would oppose all managed care cuts except those associated with indirect medical education payments to hospitals. Conrad accused the White House of not bargaining in good faith in opposing managed care payments. "This has been under discussion for weeks, and there is really pretty strong bipartisan agreement that there are abuses in [managed care payments] that at least ought to be rooted out. The White House is saying there are no savings anywhere? That is not a serious position." White House opposition to a Medicare package has thrown the development of legislation into disarray, lawmakers said. "It seems as though from nowhere came a threat from the president to veto" the Medicare package under development in the Senate, said House Ways and Means Committee Chairman Charles Rangel (D-N.Y.). "So all the things they wanted to do they backed off of." Conrad said the attempt to find a legislative vehicle for Medicare legislation was meaningless unless lawmakers first reached agreement on a Medicare package. "Before you hunt for a vehicle, you have to have an agreement," he said.End of article graphic By Steve Teske
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