If Congress Passes Medicare ‘Giveback’ Bill, It Will Be After Midterm Elections, CQ’s Goldreich Says

If the Senate approves any Medicare "giveback" bill this year, it likely would be after the November election and would cost no more than half of the $43 billion package sponsored by Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa), Congressional Quarterly reporter Samuel Goldreich says in this week's "Congressional Quarterly Audio Report." Baucus and Grassley probably will attempt to bring the bill directly to the Senate floor, but as he did earlier this month, Sen. Don Nickles (R-Okla.) likely will object to the procedural move, leaving health care groups "scrambling" to draft a "bare-bones" package during the lame-duck session after the election, Goldreich says. He adds that senators are not likely to support the bill at this point because it does not include a prescription drug benefit (Goldreich, "Congressional Quarterly Audio Report," 10/15). The 10-year Baucus-Grassley package includes smaller-than-planned cuts for hospitals and increases in payments for rural physicians, hospitals and home health agencies. Medicare+Choice plans would receive a boost in payments of 4% in 2003 and 3% in 2004. The bill also would reverse the expiration of $1.7 billion in temporary Medicare funding for nursing homes that expired Oct. 1. In addition, the package would expand a pilot program that uses competitive bidding for durable medical equipment nationwide. The plan also includes a provision that would allow Medicare to cover immunosuppressive drugs for organ transplants and would renew a five-year program that helps low-income seniors pay their Medicare premiums. The plan includes a two-year delay of payment caps for physical and occupational therapy and would expand coverage of cholesterol and lipid level tests. The package also includes additional funding for state Medicaid and CHIP programs (Kaiser Daily Health Policy Report, 10/4). Goldreich notes that a scaled-back bill might include funds for Medicare providers and might allow states to keep $2.8 billion in unspent CHIP funds. Further, such a bill could include increased payments for Medicare+Choice plans and boost payments to Medicaid programs, Goldreich says.

Abortion Debate Impacts FDA Vacancy
Goldreich also addresses the "flap" that could delay White House health policy adviser Mark McClellan's confirmation as FDA commissioner. Sen. Jeff Bingaman (D-N.M.) has placed a hold on the vote until the Bush administration provides a "satisfactory explanation" of why it has backed away from supporting a bill Bingaman cosponsored that would expand CHIP benefits to pregnant women to cover prenatal and postpartum care. The administration instead backs a proposed regulation that would extend CHIP coverage to fetuses but not pregnant women. Goldreich says that abortion-rights supporters believe the proposed regulation "confers legal status to fetuses separate from the women carrying them." He adds the only solution to the stalemate is "for one side to back down," which may not happen until "after the election and both sides can squeeze whatever political play they can out of the standoff." As a result, it may be as long as 21 months since the last FDA head, Jane Henney, resigned before a new commissioner takes office, Goldreich notes (Goldreich, "Congressional Quarterly Audio Report," 10/15).

Goldreich's report is available online.