Final Vote on $789B Economic Stimulus Package Expected Today

The House and Senate on Friday likely will vote on a $789B billion compromise economic stimulus package that includes a number of provisions related to health care spending, USA Today reports (Wolf, USA Today, 2/13). Among other provisions, the stimulus package includes:

• $87 billion in additional federal Medicaid funds for states (Benac, AP/Minneapolis Star Tribune, 2/12); under the provision, states will receive the funds over 27 months, during which time they cannot change their eligibility requirements for the program. The 27-month period started in October 2008 and ends Dec. 31, 2010 (Carey, CQ HealthBeat, 2/12).
  
  
• $24.7 billion for federal subsidies to cover 65% of the cost of health insurance premiums under COBRA for as long as nine months; the provision would apply to workers who were "involuntarily terminated" between Sept. 1, 2008, and Dec. 31, 2009, and whose annual incomes do not exceed $125,000 for individuals or $250,000 for families.
  
  
• $19 billion for health care information technology, with $17 billion for investments and incentives through Medicare and Medicaid and $2 billion for a discretionary fund for grants and loans (Reichard, CQ HealthBeat, 2/12); the provision also requires the federal government "to take a leadership role" to develop interoperability standards for health care IT by 2010 (Carey, CQ HealthBeat, 2/12).
  
  
• $10 billion in additional funds for NIH, with $8.5 billion allocated for research grants and $1.5 billion allocated to renovate research facilities (Reichard, CQ HealthBeat, 2/12).
  
  
• $2.3 billion for Department of Defense construction projects that seek to improve quality of life for service members and their families; the provision includes funds for construction of health and dental clinics on military bases and $481 million for new or expanded medical and social service facilities for wounded service members (Pincus, Washington Post, 2/13).
  
  
• $1.2 billion for the Department of Veterans Affairs to construct and renovate health care facilities and national cemeteries (Johnson, CQ Today, 2/12).
  
  
• $1.1 billion for research to compare the effectiveness of medications and medical devices; the provision would distribute the funds among the Agency for Healthcare Research and Quality, NIH and the HHS secretary.
  
  
• $1 billion for prevention and wellness programs (Carey, CQ HealthBeat, 2/12).

Other Medicare, Medicaid Provisions
The stimulus package would eliminate proposed reductions in Medicare reimbursements to teaching hospitals, a provision that would cost $191 million, and proposed reductions in payments to hospice providers, a provision that would cost $134 million. The stimulus package also includes adjustments to Medicare reimbursements for long-term care hospitals, a provision that would cost $13 million, and a temporary increase in Medicaid payments to hospitals that treat large numbers of uninsured or underinsured patients, a provision that would cost $460 million. In addition, the stimulus package includes a requirement to accelerate Medicaid reimbursements to nursing homes and hospitals, a provision that would cost $680 million.

The stimulus package includes $1.3 billion to extend a program that provides Medicaid coverage to individuals who make the transition from welfare to work and $550 million to extend the program that helps low-income Medicare beneficiaries cover the cost of Part B premiums. In addition, the stimulus package would eliminate out-of-pocket costs for American Indians and Alaska Natives enrolled in Medicaid at a cost of $134 million and extend or add moratoria on certain Medicaid regulations at a cost of $105 million (Reichard, CQ HealthBeat, 2/12).

Prospects
The House has scheduled a vote on the compromise economic stimulus on Friday, and the Senate plans to hold a vote later in the day or over the weekend, the AP/Boston Globe reports (Espo/Hirschfeld Davis, AP/Boston Globe, 2/12). House Minority Whip Eric Cantor (R-Va.) said that "we are suspecting a fairly unified Republican vote" against the stimulus package. However, according to Roll Call, as many as 30 House Republican might vote in favor of the stimulus package (Kucinich, Roll Call, 2/12).

"The timing in the Senate has been complicated by death, serious illness, religious consideration and a partisan split in the chamber that leaves no votes to spare for backers of the stimulus package," CQ Today reports. Sen. Edward Kennedy (D-Mass.), who remains in Florida for treatment of a malignant brain tumor, will miss the vote on the stimulus package; Sen. Sherrod Brown (D-Ohio) will attend a funeral for his mother on Saturday and might miss the vote; and Sen. Joseph Lieberman (I-Conn.), who observes the Jewish Sabbath between sundown Friday and sundown Saturday, also might miss the vote (Clarke et al., CQ Today, 2/12).

Senate Majority Leader Harry Reid (D-Nev.) has sought to schedule a vote on the stimulus package before the weekend, but "it became clear Thursday evening that Republicans would not allow Reid to quickly bring the measure to a vote when the language is actually finalized," Roll Call reports. Sen. Tom Coburn (R-Okla.) said that a vote on the stimulus package is "not going to happen" until Senate Republicans "read the bill and read the report language" (Pierce, Roll Call, 2/12). According to Senate Majority Whip Richard Durbin (D-Ill.), the Senate likely will vote on the stimulus package on Friday evening, and an aide to Senate leaders said that the vote could occur around 7 p.m. (Schatz/Krawzak, CQ Today, 2/12).

Next Steps for Obama
After the expected enactment of an economic stimulus package, President Obama will have to choose "his next big push," which could involve efforts to reform the health care system or address the long-term financial stability of Medicare, Medicaid and Social Security, the AP/Philadelphia Inquirer reports.

Health care reform seems a "logical choice" for Obama, but he currently does not have an HHS secretary or a "point man" to lead the effort, according to the AP/Inquirer. In addition, although Obama has promised to hold a summit on entitlement reform, leaders of groups "heavily involved" with Medicare and Social Security said that they have not heard details about such a meeting and "don't know what to expect," the AP/Inquirer reports (Babington, AP/Philadelphia Inquirer, 2/13).

Editorial
"While it is beyond the scope of any one bill to counter the worsening recession," the compromise economic stimulus package "could have accomplished more than it did," according to a New York Times editorial. According to the editorial, the stimulus package "ended up including $70 billion for relief from the alternative minimum tax," a provision that has "nothing to do with stimulus or recovery," at the expense of "far more effective measures, such as aid to states for education and health care." However, "there is merit in this bill," as the stimulus package "significantly bolsters financing for unemployment benefits," which include federal subsidies to help cover the cost of health insurance premiums under COBRA, according to the editorial (New York Times, 2/13).

Opinion Piece
Almost "all experts agree" that comparative-effectiveness research, which would receive $1.1 billion under the compromise economic stimulus package, is a "necessary first step to reforming a broken health care system," but some critics raise concerns that such research is the "dangerous first step on the slippery slope toward European-style health care rationing," according to Washington Post columnist Steven Pearlstein. He writes, "This right-wing brushfire ... was a work of political arson by the country's drugmakers and medical device makers, which have the most to lose if there is solid research showing that some of their most expensive and high-margin products aren't really better than the low-priced spread."

In the event that "comparative effectiveness research is done badly, or if the results are used simply as an excuse to deny insurance coverage for all expensive treatments, then there would be plenty of reason to get out the pitchforks and storm Capitol Hill," but critics do not have "any shred of evidence that the professionals who do this research are incompetent or have any but the best intentions in trying to figure out what treatments are the most effective for patients," Pearlstein writes. He adds, "This little kerfuffle ... is a warning to the Obama administration that the coming battle over health care reform is likely to be every bit as vicious and divisive as the one that defeated the Clinton health plan, requiring not only care in designing the plan but the need to develop easy-to-understand data and compelling anecdotes that demonstrate in a compelling way how wasteful and ineffective our current system has become" (Pearlstein, Washington Post, 2/13).

Broadcast Coverage

• NPR's "All Things Considered" on Thursday reported on funds for NIH included in the stimulus package and their potential effects on biomedical research. The segment includes comments from Raynard Kington, acting director of NIH (Harris, "All Things Considered," NPR, 2/12).
  
  
• NPR's "Day to Day" on Thursday reported on recent reductions in Medicaid eligibility or enrollment in 12 states and the possible effects of additional funds for state programs included in the stimulus package. The segment includes comments from Diane Rowland, executive vice president of the Kaiser Family Foundation and executive director of the Commission on Medicaid and the Uninsured at the foundation, and Norman Williams, deputy director of California Department of Health Care Services (Weiss, "Day to Day," NPR, 2/12).