Senate, House Begin Negotiations Over Economic Stimulus Package

The Senate on Tuesday voted 61-37 to pass an $838 billion economic stimulus package with the support of only three Republicans -- Sens. Olympia Snowe (Maine), Susan Collins (Maine) and Arlen Specter (Pa.), the Los Angeles Times reports (Hook, Los Angeles Times, 2/10). After the vote, House and Senate negotiators began discussions to reconcile the differences between their versions of the stimulus package. Senate Majority Leader Harry Reid (D-Nev.) called the differences "fairly minor," and both Reid and House Speaker Nancy Pelosi (D-Calif.) on Tuesday said that they hope to pass a final stimulus package by the Presidents Day recess. However, the "negotiations are expected to be contentious," the Washington Post reports (Murray, Washington Post, 2/11). According to the New York Times, the "bills reflect differences in spending priorities amounting to tens of billions of dollars" (Herszenhorn/Zeleny, New York Times, 2/11).

Some of the differences involve the amount of funds for federal subsidies for health insurance under COBRA, as well as a provision to expand eligibility for the program that appears only in the House version. In addition, the Senate version of the stimulus package includes $1 billion less than the House version for health information technology. The House and Senate versions of the stimulus package also include different formulas for distribution of additional federal Medicaid funds for states (Washington Times graphic, 2/11). The House version of the stimulus package also includes a provision not included in the Senate version that would expand Medicaid eligibility for recently unemployed workers (Murray, Washington Post, 2/11).

Senate Democrats will need support from at least two Republicans to pass the final stimulus package, and the three Republicans who voted for the Senate version of the package are "monitoring negotiations" to determine whether they will support the final version, according to the Wall Street Journal (Hitt/Weisman, Wall Street Journal, 2/11).

Obama Calls for Bipartisan Negotiations
At a town hall meeting in Florida on Tuesday, President Obama called for congressional Democrats and Republicans to work together in negotiations on the final economic stimulus package, the AP/Long Island Newsday reports (Loven, AP/Long Island Newsday, 2/10). Obama said, "When the town is burning, you don't check party labels. Everybody needs to grab a hose" (CongressDaily, 2/10).

Health Care IT Provisions
House and Senate negotiators are "waging a battle" over the patient privacy provisions included in the health care IT portion of the economic stimulus package, the Christian Science Monitor reports. According to the Monitor, the "need for patient confidentiality could conflict with the effort to improve overall outcomes" because of limits placed on the information that researchers and physicians receive on the comparative effectiveness of various treatments.

The House version of the stimulus package would require health care providers and health insurers to inform patients of any unauthorized disclosures of their medical information, a provision that many in the health industry maintain could cost billions of dollars. The Senate version of the stimulus package would allow the HHS secretary -- who would consider cost issues -- to establish rules related to unauthorized disclosures of medical information (Marks, Christian Science Monitor, 2/11).

In related news, the New York Times on Wednesday examined how the "biggest outlay on initiatives" in the stimulus package is "essentially a technology industry wish list" (Savage/Kirkpatrick, New York Times, 2/11).

Effects for Federal Agencies, States
Two newspapers recently examined the effects that the economic stimulus package could have for federal agencies and states. Summaries appear below.

• Federal agencies: The House and Senate versions of the stimulus package would "represent a massive windfall for agencies across the federal government" and could lead to "improved health care services," among other efforts, the Post reports. For many federal agencies, the amount that they receive in large part would depend on which version of the stimulus package will pass, as the House version includes "considerably more" funds for federal agencies than the Senate version, according to the Post (Vogel/O'Keefe, Washington Post, 2/10).
  
  
• States: The stimulus package "could prove the difference between temporary solvency" for states and "drastic cuts to health care" and other programs, the AP/Kansas City Star reports. According to the AP/Star, the "lack of clarity" on which version of the stimulus package will pass has prompted some governors to develop budget plans based on estimates that could "change drastically before the bill is finalized" and others to wait to release their plans or develop plans that assume no funds from the package (Fouhy, AP/Kansas City Star, 2/10). The House version of the stimulus package includes $79 billion in direct aid to states, $40 billion more than the Senate version (Slevin/Richburg, Washington Post, 2/11).

Science Funds
Scientists who were "thrilled when President Obama vowed on his first day to 'restore science to its proper place' have veered from excitement to dread," as the Senate version of the economic stimulus package "weights the money to biomedical research and has much lower levels for the basic sciences," the New York Times reports. The Senate version of the stimulus package includes $17.8 billion for science and technology research and development, with $10.4 billion of those funds allocated for biomedical research at NIH. The House version of the stimulus package includes $13.2 billion for such research, with $3.9 billion of those funds allocated for biomedical research at NIH. In addition, the Senate version of the stimulus package includes $1.2 billion for the National Science Foundation, which finances basic research, compared with $3 billion in the House version. According to the New York Times, the "challenge, especially in the face of record federal deficits that could threaten future financing, is how to spend the money now wisely while not overcommitting to the future" (Chang, New York Times, 2/11).

Editorials

• Orlando Sentinel: It is "hard to argue" that disease prevention, electronic health records and flu preparedness funding cut by the Senate is "unworthy," but it is "also hard to argue that they belong among temporary spending in a stimulus package," a Sentinel editorial states. The editorial continues that these programs would create "relatively few jobs." Obama in his news conference this week stated that "Americans should judge the success of his economic policies first on how many jobs they save or create," the editorial notes, adding, "That's all the more reason for him to prod Congress toward a stimulus package that's reserved for well-targeted measures" (Orlando Sentinel, 2/11).
  
  
• Wall Street Journal: "In theory, electronic medical records are among the few stimulus ideas that might do some actual good," but "[i]nstead of building on a voluntary public-private standard-setting body created by the Bush administration, the stimulus bill codifies it as a federal office" that "will soon be deciding which platforms are up to code and shutting down competitors," a Journal editorial states. The editorial continues that the Democrats' "real political goal is to make a down payment on national health care," as the "stimulus actually makes it harder for doctors, hospitals and pharmacies to use health IT" because of the privacy provisions attached to the package. According to the Journal, large insurers already have begun implementing health IT systems, but "[t]he plug could get pulled from such efforts because the faux privacy provisions are so onerous." The editorial continues that "[i]n its pure form, the primary purpose of health IT is to organize all [individual health] data in a useful way, so we can get a better sense of health trends and outcomes." However, according to the editorial, "The true political goal is cost control. For the Pete Stark Democrats whose ambition is Medicare for all -- no exceptions -- giving government exclusive control over electronic health information and reporting is a step toward 'comparative effectiveness' research," which "in turn will be used to impose price controls and deny some types of medical treatment and drugs." It concludes, "If three Republican Senators are going to help pass this stimulus, the least they can do is demand that this stalking horse for government-run health care is out. We need to debate this in the open, not slip it into legislation under false cover" (Wall Street Journal, 2/11).
  
  
• Washington Times: "Secreted in the House version of the stimulus bill the president is trying to rush through Congress is the germ of a major overhaul of the American health care system," and one provision "causing increasing concern is the future role of the National Coordinator of Health Information Technology, who will be in charge of collecting and monitoring the health care being provided to every American" through a "centralized, federal database," according to a Washington Times editorial. The editorial continues, "The purpose of the database is to help increase health care 'quality, safety and efficiency.'" According to the editorial, "the bill appears to institutionalize a body free of political influence to make the hard choices regarding how these efficiencies will be realized -- what care will be limited and who will be denied what services." It states, "There is no telling what metrics will be used to define the efficiencies, but it is clear who will bear the brunt of these decisions," adding, "Those suffering the infirmities of age, surely, and also the physically and mentally disabled, whose health costs are great and whose ability to work productively in the future are low." The editorial concludes, "The efficiency-based approach to health care reform is a betrayal of the compact between those who are most capable of work and those who are least capable of defending themselves. And we have come a long way from what was supposed to be a 'targeted, timely and temporary' stimulus bill" (Washington Times, 2/11).

Opinion Pieces

• Rep. Joe Barton (R-Texas), Washington Times: The "good idea" of "advancing the use of electronic health records somehow got recast as an economic boon," Barton, ranking member on the House Energy and Commerce Committee, writes in a Washington Times opinion piece. He continues, "Bonus payments to health care providers for using electronic records make sense, ... but how in the world are payments that start in 2011 going to re-invigorate the 2009 economy?" Barton writes, "Similarly, the stimulus bill proposes to help the unemployed hang on to their health insurance, and then misfires when it tries to do the job," noting that the provision would have included "'unemployed' millionaires." According to Barton, another "worry" about the package is that "it will increase the federal share of Medicaid by more than $87 billion over the next two years," adding, "[W]ouldn't states be far better off if Congress simply helped them eliminate the estimated 40% of their Medicaid expenditures that are either criminally fraudulent or simply wasteful?" Barton writes, "I think the ultimate flaw in the stimulus bill is that beneath its celebration of change, it does not provide more freedom, more innovation, more efficiency and more accountability. It's just business as usual on a grand scale" (Barton, Washington Times, 2/11).
  
  
• Marc Stier, Philadelphia Daily News: It is true for individuals and the U.S. health care system that "[s]ometimes it's impossible to deal with a medical crisis without addressing the underlying chronic problems," Stier, Pennsylvania state director of Health Care for America Now, writes in a Daily News opinion piece. He writes that the country faces three "chronic" problems: the "rising cost of care," that "private insurance often fails us," and that "more than 45 million Americans don't have insurance at all." According to Stier, "We can't restore prosperity in the long term if we don't solve our chronic health problems." He adds that the Medicaid funding, COBRA subsidies, Medicaid for all unemployed and health IT funding are "important measures that begin to address our health care problems." However, he states, "Even if these provisions stay in the recovery bill, as they should, it will still be only the first step in dealing with our chronic health care problems" (Stier, Philadelphia Daily News, 2/11).