Tuesday, December 19, 2006

The 2007 Congressional Health Policy Agenda

The Congressional Agenda—Old Business

The current Congress is leaving a lot of work undone:
• A Health Information Technology (HIT) Bill – The old Congress will not be able to complete work on the House and Senate versions of a HIT bill. Before the election, they had hoped to be able to finish it during the “lame duck” session. It is now clear that won’t happen and the new Congress will start from scratch on the issue next year.

That means the Congress has not implemented a requirement that payers and providers will have to use the new ICD claim-coding system by 2010. It also likely means Democrats will be more worried about privacy protections and less worried about giving hospitals more control over the development and financing of the new systems as the Republican House bill would have done.

The new Congress will start from scratch on a new HIT bill.

Medicare Physician Fee Cuts – Republicans had hoped to find the money to waive the 5% physician fee scheduled to take place on January 1. Helping the docs out before January 1st is likely another casualty of the election. That is not to say the Democrats don’t want to help the physicians—they do. But the Democrats can’t get to it until early next year and when they do, it will be private Medicare plans that will likely produce the needed cash.

New Business in a New Congress
The old Republican favorites—expansion of health savings accounts, Association Health Plans, and medical malpractice reform—are out and new Democratic agenda items are in.

This is where many of the analysts are right—with a Bush veto and the 60-vote rule in a Senate that has 51 Democrats—it will be very difficult to do more than tread water on new non-budget health care proposals.

Here’s a look at the new agenda:

Medicare and the Drug Companies – House Democrats say they will pass legislation enabling Medicare to negotiate drug prices directly with the drug companies in the first 100 hours of the new Congress. They will. And then the bill will likely languish in a more divided Senate. If it does get past the Senate—which is not likely but not impossible either—Bush will veto it.

Drug Reimportation – This was a big Democratic issue during the election. I wouldn’t be surprised to see the Democrats couple drug reimportation and giving Medicare the power to negotiate drug prices into one bill all designed to attract a Bush veto for what are popular—if not controversial—proposals.

• A Patients’ Bill of Rights – You read it correctly. House Energy and Commerce Committee Chair John Dingell has this one on his list of things to do next year. Apparently, he didn’t get the memo this one is off the voters’ list of worries. It probably won’t get very far but there might be some HMO bashing hearings—perhaps focused on Part D issues.

The Uninsured – Now up to 46 million, look for the Democrats to tackle this issue more directly. That effort was helped by a health insurance industry proposal from America’s Health Plans (AHP) that called for the expansion of Medicaid for the lower income (which the Democrats liked) and the creation of tax credits to help others (which the Republicans liked).

However, the AHP proposal has a $300 billion price tag and no strategy for cost containment.

While that specific proposal won’t likely go very far in the near-term, the AHP did itself well by jump-starting a discussion about incremental solutions that combine both a private and public effort.

By being incremental and building on existing programs and ideas that both sides can embrace, the insurance industry proposal may become the seed that started a constructive discussion for the longer term.

Medicare Reform – The “Part A,” hospital portion, of Medicare is expected go into negative cash flow in just three years as the baby boomers begin to be eligible for the program.

Under Republican leadership, the likes of House Ways and Means Chair Bill Thomas have dominated the discussion with his market-based proposals and the 2003 Medicare bill.

Now, it will be the Democrats who will dominate the Medicare discussion with their agenda setting committee chairmanships. They give every indication of wanting to dive into the program and its various challenges from provider reimbursement to private plan payments.
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