House Committees Debate Jurisdiction over Medicare Reform

Republicans on the House Ways and Means and Energy and Commerce committees this week held a "pivotal debate" over which committee would "get the lead role" in the upcoming Medicare reform and prescription drug benefit hearings, CongressDaily/A.M. reports. Ways and Means now has sole jurisdiction over Medicare Part A (which covers hospital, home health, skilled nursing facility and hospice care) but shares authority over Part B (which funds doctors' bills and other outpatient expenses) with the Energy and Commerce panel. During debate over President Bush's proposed budget on March 27 and 28, chairs of both committees each threatened to have their members vote against the budget resolution unless the jurisdiction question "was resolved to their satisfaction." According to a resolution passed by the Budget Committee last week, each committee must report by July 24 "changes in laws within its jurisdiction [on] Medicare reform and prescription drugs," using an amount no larger than $153 billion over 10 years. Energy and Commerce Committee members said that because their panel has no jurisdiction over the source of the $153 billion (the Part A surplus), it could be "shut out of having any way to pay" for its proposal. As a result, Energy and Commerce members asked the Rules Committee to amend the budget resolution to add "Medicare reform and prescription drugs" to a list of programs that can be funded using the "strategic reserve fund," which is made up of general revenue surpluses. However, Ways and Means members "cried foul," saying that allowing "Medicare reform" to be funded with general revenue surpluses "could give the Energy and Commerce Committee a way to poach" the Ways and Means panel's "exclusive turf of Medicare Part A." Ways and Means health subcommittee Chair Nancy Johnson (R-Conn.) said that as it stands, the budget resolution "gums up" the committees' jurisdictional lines, adding that it is "inappropriate" for the Energy and Commerce Committee to claim jurisdiction. House Speaker Dennis Hastert (R-Ill.) brokered a compromise, ordering that language allowing the use of general revenue for "Medicare reform" be pulled. CongressDaily/A.M. reports that this action "presumably leaves the Ways and Means Committee with its exclusive power over Part A -- but the Energy and Commerce panel a way to finance its Medicare bill" (Rovner, CongressDaily/A.M., 3/29).

Johnson's Priorities
In an interview with CongressDaily, Johnson said that the "priority" of the Ways and Means health subcommittee is to pass a Medicare prescription drug bill, along with some Medicare reforms, such as improving preventive care and creating an independent board to negotiate with pharmaceutical benefit managers and govern Medicare+Choice. She said, "The bill we want to do puts in place modest management changes (to reflect) Medicare needs, including a few contracting changes. ... There's a lot more common ground with the Democrats this year." She added, "We're trying to be much more realistic and look carefully at the impact on seniors themselves. My concept of modernization is much broader" than the 1999 National Bipartisan Commission on the Future of Medicare, chaired by Sen. John Breaux (D-La.) and Rep. Bill Thomas (R-Calif.). However, she added, "We're not going to solve it all this year." For instance, she noted that various reforms, such as streamlining HCFA's administrative procedures, could "take longer to do." Johnson said she would like to include in the tax bill this year health insurance premium deductions, CHIP program expansion, increased access to Medicaid benefits for families with disabled children and health and long term care insurance tax credits (Fulton, CongressDaily, 3/28).