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Volume 12 Number 244 Lead Report: Medicare By a 411-3 vote, the House Dec. 19 approved legislation (S. 2499) providing a six-month Medicare pay increase for physicians and extending funding for the State Children's Health Insurance Program through March 2009. The Senate approved the measure by unanimous consent Dec. 18. President Bush is expected to sign the legislation. The bill would provide doctors a 0.5 percent payment increase through June 30, 2008, cancelling a 10.1 percent cut scheduled to take effect Jan. 1, 2008. Congress will have to address the issue again in mid-2008 to avoid yet another payment cut for doctors from taking effect July 1, 2008. The measure contains numerous provisions extending current Medicare payment policy, including an extension to June 30, 2008, of the nursing home therapy cap exception. It also includes a permanent freeze at 60 percent of the compliance threshold for inpatient rehabilitation facilities, regulatory relief for long-term care hospitals, and extension of the qualified individual, or QI program. Political Reality The agreement also reflects the political reality that Democrats are not likely to get a bill passed and signed by Bush to reauthorize an expanded SCHIP program. Two such bills already have been vetoed by the president, and Democrats had hoped to limit the extension of SCHIP funding to Sept. 30, 2008, to force Republicans to vote on the program immediately before the 2008 elections. The House passed sweeping legislation in August providing numerous changes to Medicare policy, including a two-year payment increase for doctors, as well as $50 billion over five years for SCHIP reauthorization. By comparison, the bill passed by the Senate and and House this week contains no new policy, a six-month physician payment fix, and an SCHIP program extension. Democrats said the bill represented the best possible outcome, given the failure of the Senate to pass more comprehensive legislation and Bush's objections to congressional SCHIP bills and to cuts in Medicare managed care funding as a way to pay for a physician payment package. But they lamented that more was not accomplished. "What we have before us gives the lowest common denominator a bad name," House Ways and Means Health Subcommittee Chairman Fortney Pete Stark (D-Calif.) said during floor debate on the measure. "It lets [health maintenance organizations] and the insurance industry off virtually scot-free." "Something may be better than nothing, but this is barely something," added Rep. Lloyd Doggett (D-Texas), who called the bill the "chump act," an derogatory comparison to the broader Medicare/SCHIP bill passed by the House, the Children's Health and Medicare Protection Act of 2007 (H.R. 3162), known as the CHAMP Act. SCHIP Debate Much of the House floor debate on the bill revolved around the provision to extend SCHIP funding. Republicans said the funding extension until March 2009 could provide time needed to craft a bipartisan SCHIP agreement. Democrats said they were determined to bring back the CHAMP act next year. "It's sufficient to say that all's well that ends well," House Energy and Commerce Committee ranking minority member Joe Barton (R-Texas) said, referring to the failure of Congress to pass SCHIP reauthorization legislation (H.R. 3963). Barton said the extension could allow hearings to be held and draft bills produced to resolve the issue. "I hope that occurs over the next 12 months," he said. Ways and Means Committee ranking minority member Jim McCrery (R-La.) said Democrats face two choices next year regarding SCHIP. They can work with Republicans as suggested by Barton, or "They can try the same thing next year as this year and get the same result" and wait until a new president takes office. Democrats said they would continue trying to pass an SCHIP bill next year, and accused Republicans of obstructing attempts to pass a bill and comprehensive Medicare legislation in 2007. But they said passage of SCHIP reauthorization legislation may have to wait until 2009, when a new president takes office. "This will be the first thing a new Democratic president will get done," said Rep. Rahm Emanuel (D-Ill.) Emanuel said that, while the extension contains sufficient funding to ensure states do not run out of money in 2008, a Centers for Medicare & Medicaid Services policy stipulating states must first enroll 95 percent of children from families with incomes of less than 200 percent of the poverty level before enrolling higher-income children will result in children being disenrolled in 14 states, beginning in August 2008.End of article graphic By Steve Teske
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