New Figures on Uninsured Unlikely To Spur Congressional Action, CQ’s Goldreich Says

U.S. Census Bureau figures being released on Sept. 30 that show that the number of uninsured in the United States rose to 41.2 million last year will elicit "a reflexive outpouring of rhetoric" in Congress, but "there isn't much chance that lawmakers will do anything about the problem" before the end of this year's legislative session, Congressional Quarterly senior reporter Samuel Goldreich says in this week's "Congressional Quarterly Audio Report." He says that Congress has not acted on the issue because members are divided between Republican plans to offer health insurance tax credits and association health plans and Democratic plans to expand access to public programs like Medicaid. The "only hope for action this year," Goldreich says, might be President Bush's $1.3 billion community health center proposal -- which the Senate approved in April and the House will address this week -- or a Senate-passed measure that would give states $9 billion over 18 months to help cover Medicaid costs. But both proposals, Goldreich notes, "have been held up in Congress as lawmakers engage in a game of fiscal chicken."

Medicare Payment Bill
Goldreich says that the $44 billion Medicare provider reimbursement measure drafted by Senate Finance Committee leaders likely will receive enough support to pass the Senate and reach a conference committee with the House, whose Medicare bill, passed in June, included a $30 billion provider payment package (Goldreich, "Congressional Quarterly Audio Report," 9/30). The Senate measure would decrease planned payment cuts to hospitals and increase payments to rural physicians, hospitals and home health agencies. Payments to Medicare+Choice plans would increase 4% in 2003 and 3% in 2004 (Kaiser Daily Health Policy Report, 9/27). Goldreich says that action on the legislation may not happen soon, as lawmakers are now "daring the other side to blink on the issue." Senators are "warning" that providers will have to cut services to seniors if Congress does not cancel the cuts, while Republicans "are daring Democrats to pass a provider bill and try to explain why the Senate is willing to bail out Medicare providers" without passing a Medicare prescription drug benefit, he states.

Medical Malpractice Liability, Abortion Providers
Goldreich says that two bills approved by the House last week but not expected to pass the Senate are "a sort of microcosm of the general gridlock on health issues at the moment." The first bill (HR 4600) would cap non-economic and punitive damages in medical malpractice lawsuits and limit fees for plaintiffs' attorneys in such cases; the second (HR 4691) would expand the federal "conscience clause" to allow providers who refuse to perform abortions on religious grounds to continue to receive Medicare and Medicaid payments. Both bills came to the House floor without an attempt at compromise negotiations, Goldreich says, adding that last week's votes gave lawmakers "a chance to demonstrate their support for important elements of the Republican and Democratic political bases" ("Congressional Quarterly Audio Report," 9/30). Goldreich's report is available online.