Bush, Senate Democrats Remain at Odds as Bioterrorism, Stimulus Bills Head for Floor Debate, CQ’s Goldreich Says

President Bush and Senate Democrats remain at a "standoff" over bioterrorism and economic stimulus measures, even as versions of both bills head to the Senate floor for debate this week, Congressional Quarterly senior reporter Samuel Goldreich says in this week's "Congressional Quarterly Audio Report." Though Sens. Edward Kennedy (D-Mass.) and Bill Frist (R-Tenn.) have agreed to spend about $3.4 billion on the bioterrorism measure, the source of that funding remains an issue, with Bush threatening to veto any spending beyond the $40 billion allocated in an emergency measure after the Sept. 11 attacks on the World Trade Center and Pentagon. Democrats and some Republicans, however, say more money is needed, as the recent anthrax letters surfaced after the emergency measure had been passed. Goldreich also notes that HHS Secretary Tommy Thompson now says vaccinating every American against smallpox could cost the government far more than originally estimated. Goldreich predicts, "I think Bush ultimately will accept spending additional money for bioterrorism, but it will be mixed up and balanced by trimming other spending or tax cuts in the economic stimulus bill."

Economic Stimulus Stalemate
On the stimulus front, the Senate is expected this week to begin debate on a $67 billion package that narrowly passed the Finance Committee last week. That plan includes $26 billion to help laid-off workers through an extension of jobless benefits, temporary federal Medicaid matching grant increases and the creation of a 75% subsidy of COBRA premiums. Under COBRA, unemployed workers can continue their employer-sponsored coverage by paying 102% of the premium. Bush backs a $12 billion Republican-sponsored plan that has passed the House, which includes block grants to states to help the uninsured with health coverage. Goldreich predicts that there are "enough [Senate] centrists who support a federally funded mandate of extended jobless benefits" that Bush and Congress will ultimately agree on a bill, but added that "the only question is whether there will be another million people out of work by the time" such agreement is reached.

Medicare
Goldreich also reports that several Medicare-related issues are surfacing as Congress completes work on appropriations bills:

• A Senate Governmental Affairs hearing on Nov. 15 will examine payments for ambulance services, which might "provide momentum in both chambers to improve fees paid for" such services in rural areas.
• Physicians are "seeking relief" from a 5.4% cut in next year's Medicare rates. The cut stems from the fact that the formula used to calculate physician payment is tied to the "slumping economy."
• Hospitals are "trying to rewrite" a recently issued final rule that cuts next year's Medicare payments for some high-technology devices and other outpatient services.
• Insurers are "looking for a boost" in Medicare+Choice payment rates.