Economic Stimulus Package Likely To Cost $850 Billion, With Up to $90B for State Medicaid Programs

The economic stimulus package under development by President-elect Barack Obama and congressional Democrats likely will cost almost $850 billion, including up to $90 billion in additional federal funds for state Medicaid programs, the AP/Contra Costa Times reports (Taylor, AP/Contra Costa Times, 1/14). According to the Wall Street Journal, the stimulus package will include an estimated $87 billion for state Medicaid programs and $3 billion for Medicaid regulatory initiatives (Hitt, Wall Street Journal, 1/14). In addition, the stimulus package likely will include about $20 billion for health care information technology, with funds distributed to hospitals and physicians that adopt electronic health records through grants and higher Medicare reimbursement rates (Freking, AP/Contra Costa Times, 1/14).

As of Wednesday, congressional Democrats had not decided whether to include in the stimulus package $25 billion in federal subsidies for COBRA -- which allows recently laid-off workers to retain their group health insurance, provided that they pay 102% of the premiums (Clarke/Krawzak, CQ Today, 1/14). The package also might include an extension of the Transitional Medicaid Assistance program (Sanchez/Bourge, CongressDaily, 1/14).

Timetable
House Speaker Nancy Pelosi (D-Calif.) said that she hopes to announce the economic stimulus package on Thursday and have committees begin hearings and mark ups next week to complete work on the legislation by mid-February (Kane, Washington Post, 1/15). The House Appropriations Committee and the House Ways and Means Committee likely will begin mark ups on the stimulus package next week (CQ Today, 1/14). The Senate Finance Committee hopes to begin mark ups on the stimulus package on Jan. 22 (CongressDaily, 1/14). "After it is unveiled, the plan is likely to see vigorous debate," the Journal reports (Bendavid/Hitt, Wall Street Journal, 1/15).

EHR Privacy Concerns
In related news, privacy and civil liberties groups on Wednesday sent letters to Pelosi, Senate Majority Leader Harry Reid (D-Nev.), and Obama to encourage them to include privacy protections in any provisions in the economic stimulus package that seek to increase adoption of EHRs, CongressDaily reports. The groups -- which included the American Civil Liberties Union, Consumer Action, the National Association of Social Workers and Patient Privacy Rights -- said that such protections are needed to prevent unauthorized access to and sale of the medical information of patients. At a briefing on Wednesday, Ashley Katz, executive director of Patient Privacy Rights, said, "We all want to innovate and improve health care, but without privacy our system will crash as any system with a persistent and chronic virus will."

Sen. Olympia Snowe (R-Maine), Rep. Edward Markey (D-Mass.) and Rep. Lloyd Doggett (D-Texas) have expressed support for such protections. Markey in a statement said, "Without robust safeguards, the health IT systems we are planning for today could turn the dream of integrated, seamless electronic health networks into a nightmare for consumers."

However, America's Health Insurance Plans has raised concerns about the inclusion of such protections in the stimulus package. An AHIP spokesperson said that "it is vital that policymakers consider how this legislation will impact claims payment, quality control, and programs to coordinate care and manage treatment for patients with chronic conditions" (Noyes, CongressDaily, 1/15).