CQ’s Goldreich Weighs in on Medicaid Deregulation, Stem Cells, Budget Surplus

In a new kaisernetwork.org Congressional Quarterly Audio Report, senior reporter Samuel Goldreich discusses the latest news in several health policy areas, including the following:

• Medicaid Deregulation: Although Democrats say a recent Bush administration decision to rewrite Clinton-era Medicaid patients' rights rules is an example of "heartless Republicans turning their backs on the nation's neediest," the move is more a "case of Bush responding to the most powerful lobbyists of all, the nation's governors," Goldreich says. The new rules give states more freedom to decide minimum Medicaid benefit standards. But Goldreich adds that the biggest change, "and the subject of the harshest attacks from Democrats," is that health plans will now have three working days to respond to patient appeals of coverage decisions, rather than the 72 hours stipulated in the Clinton rules. Democrats say the change means "any patient in need of emergency care over the weekend is out of luck," although an HHS spokesperson noted that for "real emergencies," patients have the right to emergency room care at any time.
• Stem Cells: Bush's decision to allow federal funding for research on embryonic stem cells derived from estimated 60 existing cell lines has "intensified" rather than cooled the debate over the issue, Goldreich says. The decision has drawn criticism from multiple sides, and Congress is expected to hold hearings on the subject in September. But the "political reality is that neither" those who want to broaden funding nor those who want to block it seem to "have the votes to change the policy in this Congress, and Bush has bought himself some time to let people see how it works," Goldreich says.
• Budget Surplus: New estimates that the budget surplus -- excluding Social Security -- has "all but disappeared" could change the health agenda in Washington, Goldreich says. Though lawmakers will likely debate for months whether Bush's tax cut caused the surplus to "disappea[r]," the tax cut is "locked in" and will not be affected. Instead, Goldreich says, the surplus decrease will "play out ... in the 13 appropriations bills, including the Medicare and Medicaid programs." While both programs have most spending set by law, Goldreich expects a "much tougher fight over add-ons" such as a Medicare prescription drug benefit or expanding state health insurance programs to the uninsured. Goldreich predicts that Bush will "revive" his Immediate Helping Hand proposal, which would give short-term block grants to states to cover prescription drugs for low-income seniors. He adds that Democrats will likely respond with a "stripped-down" drug coverage plan that will offer no other major Medicare changes and will "resist expanding money for private managed care plans to deliver prescription drug coverage or anything else."