Several Factors Led to Failure of Medicare Provider ‘Giveback’ Legislation, CQ’s Carey Says

Congress recessed for the November elections without having passed a Medicare provider "giveback" bill due to a "mix of politics, of other priorities and of power struggles within Congress and between Capitol Hill and the White House," Congressional Quarterly reporter Mary Agnes Carey says in this week's "Congressional Quarterly Audio Report" (Carey, "Congressional Quarterly Audio Report," 10/21). The proposed $44 billion Senate giveback bill, cosponsored by Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa), includes smaller-than-planned reimbursement reductions for hospitals and increases for rural physicians, hospitals and home health care agencies. Medicare+Choice plans would receive a 4% reimbursement increase in 2003 and a 3% increase in 2004 under the legislation. The House passed a Medicare reform bill in June that included $30 billion in givebacks as well as a prescription drug benefit (Kaiser Daily Health Policy Report, 10/17). According to Carey, it is "unclear" if Congress will act on the legislation in a "lame-duck" session after the election. She states that "any bill will be a small one," adding that it would likely need to be part of a "must-pass measure" such as a spending bill. Carey also addresses questions about whether the Bush administration could act on givebacks if Congress does not. House Ways and Means Committee Chair Bill Thomas (R-Calif.) has said that it can address some provisions, while CMS Administrator Tom Scully has said that the administration cannot act if Congress does not.

Medicare Prescription Drugs, Other Issues
Carey says that given the "politica[l] popular[ity]" of a Medicare prescription drug benefit, it is likely that the next Congress will address the issue, but she adds that "the forces that stopped an agreement in the first place" in this Congress -- Republicans' desire to keep the benefit inexpensive and based in the private sector versus Democrats' wish to offer a more expensive, government-based benefit -- are "unlikely to change." Without resolution of those differences, Carey states, agreement is not likely. Carey also discusses congressional approval of bills to implement "user fees" for FDA approval of medical devices and to increase funding for community health centers, as well as the Senate's vote in support of Mark McClellan to head the FDA ("Congressional Quarterly Audio Report," 10/21).

Carey's report is available online.