Roll Call Examines Prospects for Health Care Legislation This Year in Congress

As presidential candidates debate their health care proposals, Congress is "unlikely to pass any major health bill," this year preferring instead "a bite-sized approach," Roll Call reports. Among issues targeted by lawmakers this year are changes to Medicare rules, mental health parity, health care information technology, comparative effectiveness and approval of generic versions of biotechnology drugs.

Senate Finance Committee Chair Max Baucus (D-Mont.) and ranking member Chuck Grassley (R-Iowa) are planning to push an omnibus health bill in April that would contain Medicare legislation aiming to curb a 10% cut to physician payments. Similar legislation was proposed last year by the committee, but it was killed by a presidential veto threat, according to Roll Call.

The package would further delay the physician payment cut, implement quality-of-care measures for physician reimbursements, create electronic prescribing rules and increase regulation on marketing of Medicare Advantage plans, according to a Baucus aide. Roll Call reports that it likely would include provisions to increase public disclosure of gifts to physicians from the pharmaceutical and medical device industries.

The committee would like to curb the physician payment cuts for 18 months, at a cost of about $13 billion; however, the "package could be in jeopardy because of pay-as-you-go budget rules," according to Roll Call. Democrats have proposed reducing MA plan payments to offset the costs, but the White House and Republicans oppose such a move. Roll Call reports that Congress likely will back a six-month freeze as it did last year. The current delay ends on June 30.

Another option, which would not be limited by pay/go rules, would be to add Medicare provisions to a second economic stimulus package. Karen Ignagni, president and CEO of America's Health Insurance Plans, said that if a follow-up stimulus package is created, it likely would contain health care provisions.

Baucus said, "It's difficult to do anything major legislatively in an election year," adding that the election will "suck the oxygen out of the debate on the Hill" (Langel, Roll Call, 3/9).

Kennedy Interview
In an interview with Roll Call, Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) spoke about the prospects for several issues related to overhauling the U.S. health care system. Kennedy said that "there are a number of things that are very important and that hopefully we'll still be able to get done," including mental health parity, tobacco legislation, health disparities legislation and genetic discrimination.

According to Kennedy, health IT would produce savings that "would be enormously important with a Democratic president implementing universal health coverage." He added that Sen. John McCain's (R-Ariz.) "health reform is not going to get us there."

Kennedy said SCHIP "may be revisited. But the general kind of debate and the discussion that was had last year -- the administration has soured the whole context." He added that SCHIP "had been compromised, and that's why George Bush had given it such strong support." According to Kennedy, the U.S. must have a universal coverage system. He added, "Everything is going in the wrong direction. We have some of the best hospitals and the best doctors in the world, but we haven't got a health care system. And it's measured in the fact that people are, 47 million (of them), going to the emergency rooms, at close to $500 a whack, which discourages people from going."

Kennedy also discussed the Massachusetts health insurance law, saying the reduction in no-cost care and increase in insured residents has resulted in "real savings," which could occur at the federal level if Sen. Barack Obama (D-Ill.) is elected president. Kennedy said health care will "clearly" be the issue of 2009. Although he does not believe there needs to be a "Democratic landslide" in the November election to pass comprehensive health care reform, "I just think we need additional Democratic votes in the Senate and a Democratic president that wants to lead them" (Kondracke, Roll Call, 3/10).

Opinion Pieces
Roll Call on Sunday published a series of opinion pieces written by lawmakers about health care. Summaries appear below.

• Rep. Joe Barton (R-Texas): "Many Americans are surprised that so many drugs and their ingredients come from foreign places, but the truly worrisome surprise is that the FDA is struggling to ensure that these medicines won't harm people who take them," Barton, ranking member of the House Energy and Commerce Committee, writes. Barton concludes that a "little common sense and some modest legislating can ensure that no matter which side of the planet our food and medicine come from, American families will be safe" (Barton, Roll Call, 3/9).
  
  
• Sens. Bob Bennett (R-Utah) and Ron Wyden (D-Ore.): "We stand with those who say we have waited long enough for a health care prescription for America," Bennett and Wyden write, adding that the Healthy Americans Act "represents the marriage of both Republican and Democratic ideals by providing universal health care coverage through a reformed marketplace." According to the senators, "The Healthy Americans Act would rewrite the tax code to give every individual a tax benefit for purchasing health insurance, pushing the health insurance industry to compete on innovation, price, benefits and quality." The senators conclude, "We call on all members [of Congress] to join our efforts and tackle one of the greatest challenges facing our country today" (Bennett/Wyden, Roll Call, 3/9).
  
  
• Sen. Richard Burr (R-N.C.): Every U.S. resident "should have access to quality, affordable health care," Burr writes, adding that "options should protect the doctor-patient relationship, provide choice and focus on prevention." Burr adds that legislation he introduced last year "would accomplish those goals" by providing "every American -- regardless of income -- with a flat tax credit that gives them freedom to choose the health care plans that best meet their needs" (Burr, Roll Call, 3/9).
  
  
• Rep. Jim Cooper (D-Tenn.): "The question of mandates is not about whether we should have universal health care, but how to require individuals to buy health insurance," which "has been elevated to the forefront of Democratic presidential politics," Cooper writes, adding that presidential candidate Sen. Hillary Rodham Clinton (D-N.Y.) is "heavy on big government, forcing everyone to obtain health insurance quickly -- at least on paper -- and with strict penalties for noncompliance," and rival Obama is "lean on mandates except for young people up to age 18." Cooper concludes that the "real difference" is "whether you believe health reform should be bipartisan" because leading "with mandates" makes it "much less likely" to receive "any Republican support in either the House or the Senate" (Cooper, Roll Call, 3/9).
  
  
• Rep. John Dingell (D-Mich.): "As Congress works to address growing health care concerns, ensuring the safety of our nation's food and drug supply must be a top priority," Dingell, chair of the House Energy and Commerce Committee, writes. According to Dingell, "Americans trust the FDA to ensure that the drugs in their medicine cabinets and the food on their kitchen tables are safe," but "it appears this trust is misplaced." Dingell concludes that he and his colleagues "plan to correct these problems and ensure that the FDA is capable of performing its vital mission" (Dingell, Roll Call, 3/9).
  
  
• Sen. Mike Enzi (R-Wyo.): "With health care costs skyrocketing and the number of uninsured climbing higher and higher, it is no surprise that ... Americans cite health care as one of their top concerns," Enzi, ranking member of the Senate HELP Committee, writes. According to Enzi, health IT legislation is needed to put "power in the hands of patients, doctors and health professionals." He adds, "Improved health IT will eliminate duplicative tests and reduce medical errors." Enzi concludes that health IT legislation must be approved this year because "[m]oving from a paper-based health care system to secure electronic medical records will save lives and reduce skyrocketing health care costs" (Enzi, Roll Call, 3/9).
  
  
• Sen. Judd Gregg (R-N.H.): President Bush's proposal to reduce Medicare spending, as required by the Medicare "trigger," is "a reasonable one" that "tries to make the health care system more transparent by giving consumers more access to information about the cost and quality of their care, something that will improve efficiency and lower costs for everyone involved," Gregg, ranking member of the Senate Budget Committee, writes. However, he says Democratic opposition could kill the measure. According to Gregg, "As the nation begins to confront the looming $66 trillion entitlement crisis, potential solutions must be bipartisan in nature and given a clear path to a final vote, or nothing will come of them." He adds that a bipartisan task force he proposed with Senate Budget Committee Chair Kent Conrad (D-N.D.) "would be required to send Congress bipartisan legislative proposals that would be fast-tracked and guaranteed a final vote" (Gregg, Roll Call, 3/9).
  
  
• Rep. Rush Holt (D-N.J.): "Millions of Americans suffer from mental illness in some form -- conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning," Holt writes. Holt concludes, "It will be a landmark day when we realize that health is not just about fixing broken bones" and that it is "about having a healthy, complete individual from head to toe" (Holt, Roll Call, 3/9).
  
  
• Rep. James Langevin (D-R.I.): "[D]espite the fact that we spend more per capita on health care than any other industrialized country, we produce some of the worst outcomes by a number of important health measures," Langevin writes. According to Langevin, "Instituting meaningful, systemic reforms will require a fundamental shift in how we view employer-provided coverage and health care delivery." He adds that "we must change our perspective of health insurance as a privilege or benefit tied to employment" and instead "must consider it a right and responsibility to be shared by the community" (Langevin, Roll Call, 3/9).
  
  
• Rep. Frank Pallone (D-N.J.): "Medicare Advantage is the private insurance program that Republicans created to accomplish their nefarious goals" of "attempt[ing] to dismantle" the Medicare program, Pallone, chair of the House Energy and Commerce Health Subcommittee, writes. According to Pallone, "Congress should try again to end this wasteful subsidization of the insurance industry and refocus our attention on strengthening Medicare to better serve our seniors and disabled" (Pallone, Roll Call, 3/9).
  
  
• Rep. Jim Ramstad (R-Minn.): "[F]ar too many people don't have access to treatment" for alcoholism and other addictions in the U.S., Ramstad writes. Ramstad concludes, "It's time to pass treatment parity legislation because millions of Americans can't afford to wait" (Ramstad, Roll Call, 3/9).
  
  
• Sen. Sheldon Whitehouse (D-R.I.): Failure in the U.S. health care market is "nowhere more evident than in the lack of widespread implementation" of health IT, Whitehouse writes. According to Whitehouse, the U.S. needs to see its national health IT "as national infrastructure" and needs "national standards" to protect patient privacy, for interoperability and for data quality, and a "new entity must have the power to set these standards. A national health IT system also "will need startup capital" and "must be accountable to the public," Whitehouse writes (Whitehouse, Roll Call, 3/9).