Kaiser Daily Health Policy Report
Ways and Means Health Subcommittee Chair Sees More Medicare Givebacks, Prescription Drug Legislation This Year
Senators Introduce Bill to Close 'Loophole' in Mental Health Parity Law
Senate Approves Bankruptcy Reform Bill Minus Health Measures
With Budget Increase, Florida County to Enroll Children on Waiting List for Healthy Kids
For First Time in Two Years, TennCare Enrollees Given Option to Switch Health Plans
Texas Senate Committee Drops Efforts to Simplify Medicaid in Budget Recommendations
HHS Approves Minnesota's Request for Expanded In-School Services for Medicaid-Eligible Students with Special Needs
Providers Call HCFA, Medicare Regulations Burdensome at Ways and Means Health Subcommittee Hearing
Hospitals Expand Emergency Rooms As Patient Visits Rise
Capitol Hill Watch
Patients' Rights Spurs 'Passionate' Debate in Subcommittee
[Mar 16, 2001]
Members of the House Energy and Commerce health subcommittee engaged in a "passionate and extensive debate" over patients' rights legislation yesterday, illustrating "how far apart both sides remain" on the issue, CongressDaily/A.M. reports. Discussions on the McCain-Kennedy-Edwards patients' rights bill (S 283) centered on some of the legislation's "most contentious issues," including whether employers should be shielded from lawsuits (Rovner, CongressDaily/A.M., 3/16). Some business groups have expressed concern about the McCain-Kennedy-Edwards bill because they say it would open employers to being sued by employees over denial of care issues (Kaiser Daily Health Policy Report, 2/7). Rep. Greg Ganske (R-Iowa), a co-sponsor of the House version of the McCain-Kennedy-Edwards bill (HR 526), said the bill would protect employers. "We made a good-faith effort to move towards employers on this, and once again, they stepped away and moved the goalpost," he said. Rep. John Shadegg (R-Ariz.) disagreed, stating that whether an employer is directly involved in a medical decision -- the "threshold for a lawsuit" under the legislation -- "is a question of fact," meaning that the bill would "subject employers to a process that would be decided by a jury." Other opponents of the bill added that lawsuits would likely prompt employers to stop covering their workers. Energy and Commerce Chair Bill Tauzin (R-La.) said, "We do not want legislation whose cure is worse than the problem." Federal or State Courts?
Lawmakers also addressed whether state or federal courts should hear lawsuits (CongressDaily/A.M., 3/16). Under the McCain-Kennedy-Edwards bill, patients could sue HMOs in state court for denial of benefits or quality of care issues and in federal court for non-quality of care issues, such as those involving violations of health plan contracts. The bill would cap civil assessments awarded in federal court at $5 million, but state courts could award as much in damages as state laws allow. However, under the recently introduced Breaux-Frist patients' rights bill, nearly all cases would be tried in federal courts (Kaiser Daily Health Policy Report, 3/14). Subcommittee ranking member Sherrod Brown (D-Ohio) said that allowing only federal courts to decide such issues would "strip power from the patient and restore unfair protections to health plans." Tauzin, however, said that Congress should "remain within the parameters" set by President Bush, who maintains that federal courts should hear all care denial lawsuits. Tauzin added that Congress should follow Bush's recommendations "both because they are right and because we need legislation he will sign in the end" (Rovner, CongressDaily/A.M., 3/16). To listen to an audio recording of this meeting, go to http://www.house.gov/commerce/hearings/03152001-110/03152001.htm. Note: You must have RealPlayer to listen to this clip.
Ways and Means Health Subcommittee Chair Sees More Medicare Givebacks, Prescription Drug Legislation This Year
[Mar 16, 2001]
Rep. Nancy Johnson (R-Conn.), chair of the House Ways and Means Subcommittee on Health, said yesterday that she expects Congress to pass another Medicare "giveback" bill this year and also "hopes to have legislation on the floor to reform Medicare and add a prescription drug benefit" by August, CongressDaily reports. Congress last year restored $35 billion over five years to providers and insurers for cutbacks that resulted from the 1997 Balanced Budget Act. Johnson said that while this year's giveback legislation would not "be as extensive as last year...there are a few essentials that have to be done," including delaying or canceling a scheduled 15% cut in funding for home health agencies. On the prescription drug front, Johnson said that any benefit should be "universal, voluntary, integrated into Medicare and affordable to both seniors and taxpayers." Finally, she said that Medicare reform needs to be undertaken with a shifting emphasis towards preventive care and management of chronic conditions. "Medicare law is about treating illness. That's not what medicine's about today," she said. Still, Johnson acknowledged that members of the subcommittee are "a long way from settling" on a reform bill (Rovner, CongressDaily, 3/16).
Senators Introduce Bill to Close 'Loophole' in Mental Health Parity Law
[Mar 16, 2001]
Sens. Paul Wellstone (D-Minn.) and Pete Domenici (R-N.M.) have proposed legislation that would require companies that offer mental health benefits as part of a health plan to provide equal coverage for both mental and physical health, the AP/St. Paul Pioneer Press reports. The bill does not require employers to offer insurance with mental health benefits, but it does require employers who do offer such benefits to provide mental health parity. The bill is designed to close a "loophole" in the Mental Health Parity Act of 1996, also sponsored by Wellstone and Domenici. Under that law, health plans that offer mental health benefits are permitted to establish "annual and lifetime" limits on mental health hospital stays and outpatient services. Wellstone said, "Clearly, we can do much better. This [new bill] would be a huge step forward." However, Richard Coorsh, a spokesperson for the Health Insurance Association of America, a trade association representing insurers, said, "We oppose these types of mandates because mandates, no matter how well intended, raise the cost of health coverage for consumers and employers." Wellstone and Domenici said the bill will save money that is currently being lost to "decreased worker productivity and wages" (Frommer, AP/St. Paul Pioneer Press, 3/16).
Senate Approves Bankruptcy Reform Bill Minus Health Measures
[Mar 16, 2001]
The Senate, on an 83-15 vote, approved bankruptcy reform legislation on March 15, as Republicans "fought off" amendments favored by consumer groups and some Democrats, including a provision to ease the new restrictions for those with debts resulting from medical bills, the Washington Post reports. The bill (S 420) would "make it harder" for individuals to file for Chapter 7 bankruptcy, which allows individuals to "wipe out most of their debts," and force more to file for Chapter 13 bankruptcy, requiring them to repay a portion of their debts over five years (Day, Washington Post, 3/16). According to consumer groups, the legislation would buoy credit card companies "at the expense of vulnerable debtors," who may have to file bankruptcy due to medical bills, job loss or divorce (Shenon, New York Times, 3/16). In recent days, Senate Democrats have proposed a number of amendments to "tempe[r]" the bill but have been "rebuffed almost every time" (Gordon, AP/Washington Times, 3/16). Among amendments rejected by the Senate last week was one sponsored by Sen. Paul Wellstone (D-Minn.) that would have allowed those filing for bankruptcy due to "disastrous" medical bills to have "a better chance" of erasing their debts in court than those "filing for other reasons" (Kaiser Daily Health Policy Report, 3/8). Abortion Language a Sticking Point?
The Senate vote comes two weeks after the House approved similar legislation (HR 333). According to the Post, the Senate vote "virtually ensures" that the bill, which President Bush has indicated he will sign, will become law this year, "possibly within weeks" (Washington Post, 3/16). However, the two houses must still work out some differences between their bills, such as whether to keep an amendment included in the Senate version that would prevent individuals convicted of violence against abortion clinics from avoiding legal damages by declaring bankruptcy (New York Times, 3/16). The House's version of the bill does not include the abortion-related language (Kaiser Daily Reproductive Health Report, 3/2). According to the Times, "Republicans [in conference committee] are expected to try to strip" the final legislation of the language (New York Times, 3/16).
Children's Health
With Budget Increase, Florida County to Enroll Children on Waiting List for Healthy Kids
[Mar 16, 2001]
The Juvenile Welfare Board in Florida's Pinellas County has agreed to allocate $213,000 to Healthy Kids, the state's CHIP program, eliminating a waiting list of nearly 1,900 children, the St. Petersburg Times reports. Healthy Kids, a quasi-governmental initiative, covers more than 168,000 Florida children, nearly 6,000 of whom reside in Pinellas County. Parents contribute monthly premiums of $15 per child and copays of $3 to $5 per office visit, the Times reports. Thirty-five of the state's 67 counties contribute a varying "local match" to the program. However, "few [other counties] have to pay the 20% match shouldered by Pinellas," and still other counties do not have a local match requirement at all (Krueger, St. Petersburg Times, 3/9). Pinellas had been the only county of the 35 required to provide a local match that had not come up with the complete amount. While the state had continued to cover the 5,903 Pinellas County children already enrolled in the Healthy Kids program, children who had sought enrollment since July 1 were placed on a waiting list (Kaiser Daily Health Policy Report, 1/8). Although the board in the past had provided matching funds to launch Healthy Kids, it has "several objections to the financing of the program" and emphasized that it was "not taking on the role of permanent financier." Board Executive Director James Mills said the board "still has long term objections to taking on the burden but decided it should help the children who needed care," the Times reports. Some board members said the local Healthy Kids organization did not "aggressively" seek funding sources other than the board, but Elizabeth Rugg, executive director of Suncoast Health Council, the local fiscal agent for Healthy Kids, said the program "has worked hard to raise money, but it's a tough sell" (Krueger, St. Petersburg Times, 3/9).
Medicaid
For First Time in Two Years, TennCare Enrollees Given Option to Switch Health Plans
[Mar 16, 2001]
Tennessee will mail "ballots" to TennCare enrollees during the first week of April, allowing them to switch health plans "for the first time in more than two years." Currently eight private MCOs handle benefits and processing claims for TennCare enrollees, but state officials announced last month that, beginning July 1, the program will expand to include 10 health plans. In addition, BlueCross BlueShield of Tennessee will operate TennCare Select, a "special" statewide plan for children with disabilities and those in state custody. BlueCross will also continue to operate its regular TennCare plan, although the HMO will cut enrollment from 600,000 to no more than 300,000 members, the Nashville Tennessean reports. According to the Tennessean, BlueCross, Access MedPLUS, John Deere Health and PHP will serve east Tennessee, while Access MedPLUS, Xantus and a California-based health plan, Universal Care, will serve central Tennessee. Access MedPLUS, OmniCare, TLC and Better Health Plans, another MCO, will serve western Tennessee (Snyder, Nashville Tennessean, 3/16).
Texas Senate Committee Drops Efforts to Simplify Medicaid in Budget Recommendations
[Mar 16, 2001]
In making its recommendations for the $14 billion state Health and Human Services budget, the Texas Senate Finance Committee did not allocate any funding to "simplify the Medicaid application process," the AP/Ft. Worth Star-Telegram reports. While "top" lawmakers had earlier called the $400 million simplification efforts a "priority," higher-than-expected Medicaid enrollment figures and prescription drug costs have created a $602 million shortfall for the program over the past two years, prompting legislators to cut the enrollment measures in order to save money. Proposals to simplify Medicaid included reducing the "large" amount of paperwork, providing continuous coverage for 12 months and "eliminating" face-to-face interviews to determine eligibility. Supporters said the proposals would "help sign up most" of the 600,000 children in Texas that are eligible for Medicaid but not enrolled. Updated revenue estimates and cost cutting could produce a "budget bump" when the House and Senate negotiate a final budget package, which would allow lawmakers to include the provisions (Mabin, AP/Ft. Worth Star-Telegram, 3/13).
HHS Approves Minnesota's Request for Expanded In-School Services for Medicaid-Eligible Students with Special Needs
[Mar 16, 2001]
HHS Secretary Tommy Thompson this week approved two changes in Minnesota's Medicaid program that would "make it easier" for children with physical or developmental disabilities to receive medical and rehabilitative services while in school. Minnesota had requested a waiver to change two parts of its Medicaid program. One part of the waiver expands Medicaid coverage of Individual Education Plan services (as designated under the Individuals with Disability Act) to children through Medicaid's Early and Periodic Screening, Diagnostic and Treatment benefit. The second part allows Medicaid to cover personal care services that school districts provide for children with Individual Education Plans or Individualized Family Service Plans. Families can choose a provider to perform such services and are not restricted to choosing a provider employed by the school district. Thompson said, "I am pleased to approve changes that will get services to children where they need them -- at school" (HHS release, 3/13).
Medicare
Providers Call HCFA, Medicare Regulations Burdensome at Ways and Means Health Subcommittee Hearing
[Mar 16, 2001]
Paperwork and the "burdens" of complying with HCFA regulations have "overwhelmed" some care providers, representatives of provider groups told the House Ways and Means health subcommittee yesterday in the subcommittee's second hearing on Medicare reform, CongressDaily/A.M. reports. Democrats on the subcommittee "reminded" providers that the "burdens are comparable, if not lighter, than those placed on them by private insurers," CongressDaily/A.M. reports. However, Gary Mecklenburg of the American Hospital Association said that claims processing under Medicare "is worse" than it is in the private sector, and Susan Wilson of the National Association for Home Care added, "In the private sector, we definitely have our problems. But we can seek resolution with them in terms of care ... This is not so with HCFA." American Medical Association President-elect Richard Corlin testified that processing claims is burdensome in both Medicare and private health plans but still asked congressional members to support the recently introduced Medicare Education and Regulatory Fairness Act (HR 868), which would "give providers more recourse to battle with the agency." Corlin said, "Passage of this legislation, independent of any HCFA reform efforts, would send a clear message to HCFA and its contractors that Congress wants them to focus on educating physicians and providers about how to bill correctly, rather than to conduct heavy-handed audits of already submitted claims" (Fulton/Rovner, CongressDaily/A.M., 3/16). To view a Healthcast of this hearing, go to http://www.kaisernetwork.org/health_cast/ .
Providers
Hospitals Expand Emergency Rooms As Patient Visits Rise
[Mar 16, 2001]
Despite concerns from insurers over costs, a "growing number" of Americans use hospital emergency rooms for "everyday medical treatment," the Philadelphia Inquirer reports. While care at emergency rooms is "expensive and fragmented," patients are utilizing emergency rooms because primary care physicians are "scheduled ... to the hilt" and "overwhelmed" with patients. However, while visits to emergency rooms rose 7% between 1997 and 1999 over the past few years, it is "too early" to predict a long term trend. The Inquirer reports that a "backlash" against managed care, as well as medical TV shows that raise "anxiety levels" and improve the public's image of ER doctors, may have contributed to the increase in emergency room use. Even though some primary care physicians "go out of their way" to accommodate sick patients, some "won't wait even a few hours." Therefore, experts say emergency rooms are changing from a "last recourse" to a place for "24-hour access care" for "all sorts" of problems. To treat the increasing number of patients without "traditional emergencies" such as gunshot wounds or car accidents, many hospitals have expanded their emergency rooms by offering "fast track" care by hiring additional physicians' assistants and nurse practioners. Michael Carius, president-elect of the American College of Emergency Physicians, said, "You can either try to change demand, or you can try to meet demand." While emergency rooms have not seen an increase in uninsured patients, there has been a "jump" in chronically ill patients seeking care. The Inquirer reports this is due in part to medical progress, as people are living longer. In addition, doctors are "prone" to refer "hard to diagnose" cases to the emergency room. Efficient Care, All Day, Every Day
Some doctors think it is cheaper to "centralize" after hours care at the emergency room, rather than keeping primary care offices open nights and weekends. Uwe Reinhardt, a Princeton University health economist, said, "Using the emergency room for routine procedures is actually quite efficient." Emergency rooms also offer care at "any time," so patients do not need to miss work. In addition, hospital administrators are beginning to view emergency rooms as a point of contact with patients, as 40% to 60% of inpatients come through the emergency room. Ted Christopher, director of emergency medicine at Thomas Jefferson University Hospital, said, "It's kind of like a field of dreams. If you build it, they will come. I think hospitals have realized the ER is the gateway to the hospital" (Burling, Philadelphia Inquirer, 3/16).
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