GOP Appears Willing to Compromise on Medicare Givebacks

Although Republicans have been "adamant about keeping" a Medicare and Medicaid givebacks provision (HR 5543) within a larger tax relief bill (HR 5542), they now are "openly saying the health provisions should be broken out and passed separately," CongressDaily reports. After a meeting of GOP leaders Monday afternoon, Senate Budget Chair Pete Domenici (R-N.M.) said that pulling out the givebacks provision -- intended to restore some $35 million cut by the Balanced Budget Act of 1997 -- was "something we talked about." And while Senate Majority Whip Don Nickles (R-Okla.) said he would be "reluctant" to reopen the package to "pacify Democrats," his "tone left far more room for compromise than Republicans expressed two weeks ago," CongressDaily reports. To appease Democrats, as well as President Clinton, who has said the provision allots "too large a share to managed care plans," Republicans might fold the Family Opportunity Act (HR 4825) into the givebacks measure. The $2 billion, five-year act would "make it easier" for families with disabled children to retain their Medicaid benefits. If Republicans "balk" at that bill's cost, a House leadership aide "suggested" that "sources of compromise could include some other provisions the House Commerce Committee unanimously approved in October that Republicans had "jettisoned from the final bill." Such provisions would simplify the enrollment process for Medicaid and the CHIP program, as well as make it easier to enroll low-income Medicare beneficiaries in programs that subsidize their costs "without forcing them to go to state welfare offices" (Rovner, CongressDaily, 12/5).

Agreement Will Be Reached
NPR's "Morning Edition" also reports on the fate of givebacks, noting that while both Democrats and Republicans say they want to complete the bill, the recent inaction has left health providers "frantic." Karen Ignagni, president of the American Association of Health Plans, said that patients are being hurt most as the debate continues. "You have now 1.5 million seniors who have been affected by plans being forced out. Clearly, there is an extreme problem within the system," she said. But Urban Institute economist Marilyn Moon, a former Medicare trustee, expressed doubt that all providers are in financial distress because of Medicare. She said, "My biggest concern is that a lot of hospitals ... essentially want Medicare to bail them out of problems that may have nothing to do with Medicare. I am always concerned when I hear commercials, for example, that say, 'We may have to close our neonatal intensive care unit if we don't get money for Medicare.' Well, Medicare really isn't intended to keep neonatal intensive care beds open." She added that it is unclear exactly which providers have been adversely affected by Medicare cuts as a result of the 1997 Balanced Budget Act. Moon said, "[W]e're making policy without very good information, except anecdotes." White House health policy adviser Chris Jennings said that Democrats and Republicans can be expected to compromise on the issue. "Clearly both sides will have to give something to get something. But there is no reason why an agreement can't be reached before Congress adjourns," he added (Rovner, NPR, "Morning Edition," 12/6). An audio file of this report will be available on NPR's Web site, http://www.npr.org, after noon EST Dec. 6.

Labor-HHS Agreement Near?
In other congressional news, Senate Appropriations Chair Ted Stevens (R-Alaska) said a deal on the Labor-HHS appropriations bill (HR 4577) might be possible by Dec. 7. The White House seems willing to accept less than the $112.7 billion earmarked for the bill, and a GOP House aide said that conservatives believe the final bill will not exceed $106.7 billion, a figure Republican conferees set before the August recess. Stevens noted that the "hang-up is still ergonomics" (Caruso et al., CongressDaily/A.M., 12/6).