|
|
|
Kaiser Daily Health Policy Report
Grassley, Graham Reintroduce Bill Giving Tax Credit, Deduction for Long Term Care
House Committees Debate Jurisdiction over Medicare Reform
In New England Journal, Iglehart Evaluates Chances of Medicare Prescription Drug Proposals
Increased Prescription Drug Prices Spark State Actions
Texas Lawmakers Approve Increased Spending; Medicaid Gets More Money
Idaho Lawmakers Vote to Eliminate Funding for CHIP Outreach Efforts
Los Angeles County Supervisors Approve Coverage for Some Home Health Workers
Companies Renew Efforts to Help Employees with Elder Care
Capitol Hill Watch
House Passes $1.94T Bush Budget 'Blueprint' Amid Democrats' Medicare Concerns
[Mar 29, 2001]
Republicans "pushed" a $1.94 trillion budget resolution for FY 2002 (H.Con.Res. 83) through the House on March 28, moving President Bush's "blueprint" for tax cuts and "curtailed" spending over the "first major congressional hurdle," while Democrats complained that the plan would "do nothing to buttress" Medicare, the AP/Philadelphia Inquirer reports. While the House passed the resolution on a "near party line" 222-205 vote, Republicans "hailed their victory as a triumph." The package would pave the way for Bush's 10-year, $1.6 trillion tax cut, provide $2.3 trillion in debt reduction over the next 10 years, use parts of the Social Security and Medicare surpluses to "overhaul both programs" and limit many programs to 4% growth next year. Democrats said that the measure would "squander" the projected $5.6 trillion surplus and "shortchange" efforts to strengthen Medicare and add a prescription drug benefit to the program (Fram, AP/Philadelphia Inquirer, 3/29). They also said that the budget would "impose cuts" in children's health care programs (Welch, USA Today, 3/29). Still, Republicans "finessed" some Democratic concerns by adding a $517 billion, 10-year "contingency fund" that lawmakers could "tap" to boost funding for government agencies or to add a prescription drug benefit to Medicare. The House yesterday also rejected, on a 243-183 vote, an alternative plan proposed by Democratic leaders that would have provided a smaller tax cut, additional debt reduction and "more money" for a Medicare prescription drug benefit (Hook, Los Angeles Times, 3/29). 'Stiffer Test' Ahead
The New York Times reports that the GOP budget will meet a "much stiffer test" in the evenly divided Senate next week (Rosenbaum, New York Times, 3/29). Republicans face "near-lockstep opposition" from Democrats, while some moderate Republicans have called Bush's tax cut package "too big" and his proposed spending restraints "too stingy" (AP/Philadelphia Inquirer, 3/29). Still, CongressDaily reports that Senate GOP leaders "appear to be gaining ground" in efforts to "reach out" to centrist Democrats. "They're just talking to everybody," Sen. Ben Nelson (D-Neb.) said, adding that he has sought assurances "that we'll pay down the debt, Social Security, and there'll be a prescription drug part of Medicare" (Earle et al., CongressDaily, 3/28). 'Unrealistic' Plan?
In an editorial, USA Today argues that while the GOP budget resolution "[s]ounds good," in "budgeting, as in war, the first casualty seems to be the truth." The editorial warns that "[u]nrealistic spending plans and runaway tax cuts are a recipe for a return to dipping into Social Security and Medicare funds and renewing deficits" (USA Today, 3/29). However, in an accompanying opinion piece, House Budget Committee Chair Jim Nussle (R-Iowa) argues that since taking over the majority in 1995, "Republicans not only balanced the budget, but we also locked away every penny of the Social Security and Medicare surpluses." He adds that the plan "holds [down] the overall growth of spending" and boosts funding for "important priorities," such as preserving Medicare and improving health care for Americans (Nussle, USA Today, 3/29).
Grassley, Graham Reintroduce Bill Giving Tax Credit, Deduction for Long Term Care
[Mar 29, 2001]
Sens. Charles Grassley (R-Iowa) and Bob Graham (D-Fla.) introduced a bill (S. 627) March 27 that would provide tax credits and deductions to help people buy long term care insurance or compensate for providing long term care to a family member, the Florida Times-Union reports. Grassley and Graham introduced a similar measure last year, but this year, with Grassley as head of the Senate Finance Committee, the bill has a better chance to pass, the Times-Union reports. Grassley said, "With millions of baby boomers set to retire in the future, it is crucial to find a way to better meet their long term care needs" (Friedland, Florida Times-Union, 3/28). Under the bill, people would be allowed to deduct up to $2,500 in annual long term care insurance premiums from their taxes. In addition, people who care for family members in their homes could take a tax credit of up to $3,000 (MacDonald, Hartford Courant, 3/28). About nine million people receive long term care, at a cost of $134 billion; more than half of that cost is paid by Medicaid and Medicare (Florida Times-Union, 3/28). The high cost of long term care insurance -- about $1,677 per person per year -- is one reason that fewer than 10% of the elderly and near-elderly have purchased it, according to William Scanlon, director of health care issues for the General Accounting Office (Hartford Courant, 3/28). According to a Grassley release, the AARP and the Health Insurance Association of America support the bill (Grassley release, 3/27). For an audio file of Grassley speaking at the press conference to release the bill, please visit http://www.senate.gov/~src/radio/grassley/longtermcare3-27.mp3.
Medicare
House Committees Debate Jurisdiction over Medicare Reform
[Mar 29, 2001]
Republicans on the House Ways and Means and Energy and Commerce committees this week held a "pivotal debate" over which committee would "get the lead role" in the upcoming Medicare reform and prescription drug benefit hearings, CongressDaily/A.M. reports. Ways and Means now has sole jurisdiction over Medicare Part A (which covers hospital, home health, skilled nursing facility and hospice care) but shares authority over Part B (which funds doctors' bills and other outpatient expenses) with the Energy and Commerce panel. During debate over President Bush's proposed budget on March 27 and 28, chairs of both committees each threatened to have their members vote against the budget resolution unless the jurisdiction question "was resolved to their satisfaction." According to a resolution passed by the Budget Committee last week, each committee must report by July 24 "changes in laws within its jurisdiction [on] Medicare reform and prescription drugs," using an amount no larger than $153 billion over 10 years. Energy and Commerce Committee members said that because their panel has no jurisdiction over the source of the $153 billion (the Part A surplus), it could be "shut out of having any way to pay" for its proposal. As a result, Energy and Commerce members asked the Rules Committee to amend the budget resolution to add "Medicare reform and prescription drugs" to a list of programs that can be funded using the "strategic reserve fund," which is made up of general revenue surpluses. However, Ways and Means members "cried foul," saying that allowing "Medicare reform" to be funded with general revenue surpluses "could give the Energy and Commerce Committee a way to poach" the Ways and Means panel's "exclusive turf of Medicare Part A." Ways and Means health subcommittee Chair Nancy Johnson (R-Conn.) said that as it stands, the budget resolution "gums up" the committees' jurisdictional lines, adding that it is "inappropriate" for the Energy and Commerce Committee to claim jurisdiction. House Speaker Dennis Hastert (R-Ill.) brokered a compromise, ordering that language allowing the use of general revenue for "Medicare reform" be pulled. CongressDaily/A.M. reports that this action "presumably leaves the Ways and Means Committee with its exclusive power over Part A -- but the Energy and Commerce panel a way to finance its Medicare bill" (Rovner, CongressDaily/A.M., 3/29). Johnson's Priorities
In an interview with CongressDaily, Johnson said that the "priority" of the Ways and Means health subcommittee is to pass a Medicare prescription drug bill, along with some Medicare reforms, such as improving preventive care and creating an independent board to negotiate with pharmaceutical benefit managers and govern Medicare+Choice. She said, "The bill we want to do puts in place modest management changes (to reflect) Medicare needs, including a few contracting changes. ... There's a lot more common ground with the Democrats this year." She added, "We're trying to be much more realistic and look carefully at the impact on seniors themselves. My concept of modernization is much broader" than the 1999 National Bipartisan Commission on the Future of Medicare, chaired by Sen. John Breaux (D-La.) and Rep. Bill Thomas (R-Calif.). However, she added, "We're not going to solve it all this year." For instance, she noted that various reforms, such as streamlining HCFA's administrative procedures, could "take longer to do." Johnson said she would like to include in the tax bill this year health insurance premium deductions, CHIP program expansion, increased access to Medicaid benefits for families with disabled children and health and long term care insurance tax credits (Fulton, CongressDaily, 3/28).
Prescription Drugs
In New England Journal, Iglehart Evaluates Chances of Medicare Prescription Drug Proposals
[Mar 29, 2001]
While Congress works out a plan to restructure Medicare, the "chief question" it will face is what type of prescription drug benefit to attach to the program and how much money to allocate toward it, John Iglehart, editor of Health Affairs, writes in the fifth installment of the New England Journal of Medicine's Health Policy 2001 series. Iglehart writes that the "prospects for a Medicare drug benefit may soon improve, since virtually all members of Congress support it, the federal treasury is flush with revenues and President George W. Bush has said that enactment of such a measure is a priority of his new administration." However, to successfully enact a Medicare prescription drug benefit, Democrats and Republicans will need to come together and "resolve several fundamental disagreements." Iglehart writes that the Bush administration -- as well as "many Democrats" -- opposes instituting price controls on drugs, and the pharmaceutical industry is "prepared to wage war" to avoid them. He states that an "open-ended drug benefit would not be a viable approach either," since it "would place the entire financial burden on taxpayers and beneficiaries." Although federal agencies receive "substantial discounts" on pharmaceuticals, Iglehart writes that Congress cannot extend the federal supply schedule to Medicare purchases because drug prices for other insurers would then "undoubtedly rise substantially." Extending the federal prescription program to Medicare would also be "strongly oppose[d]" by drug firms, Iglehart adds. He concludes, "At this point, enactment of a Medicare drug benefit during Bush's first year in office seems unlikely, given both the new president's recently expressed determination to seek fundamental reform of the program, rather than only an expansion of drug coverage, and the sharply increased estimate of what broader drug coverage would cost" (Iglehart, New England Journal of Medicine, 3/29).
Increased Prescription Drug Prices Spark State Actions
[Mar 29, 2001]
With HCFA estimating that spending on prescription drugs will reach $366 billion and account for 14% of total medical costs by 2010, the Boston Globe reports that two sides are forming on the debate over drug costs: those who see costs as a "threat" to patients without drug coverage, as well as to Medicare and Medicaid, and those who argue that rising pharmaceutical costs simply indicate a shift in how health care is provided. Explaining the latter argument, Frank Lichtenberg, professor of finance and economics at Columbia University, said, "It's a mistake to just focus on the costs [of drugs]. We need to also focus on the benefits -- increased longevity, improved quality of life, and reductions in total medical expenditures." He added, "It might make sense to spend more on drugs if it reduces total medical spending" (Aoki, Boston Globe, 3/28). Nonetheless, many states are considering legislation to control prescription drug costs. As part of our on-going monitoring of state actions on prescription drugs, the following round-up provides information from four states. - Connecticut: The General Assembly's Insurance and Real Estate Committee voted 11-7 on March 27 in favor of a bill that would require insurers who refuse coverage of a non-formulary drug to pay for the medication for as much as 10 days while the denial is being appealed. The bill's opponents say it would "destroy" insurers' ability to control costs through the formulary system. Supporters, however, say the bill will prevent patients from becoming "destabilized" by being forced to "abruptly" change prescriptions if they switch health plans or if their insurer's formulary is changed (Levick, Hartford Courant, 3/28).
- Illinois: As part of a bill on tobacco settlement spending, the state House voted March 26 to appropriate $70 million for a program that subsidizes drug costs for low-income families and seniors. The bill's prospects in the Senate, however, are "uncertain." Gov. George Ryan (R) has proposed spending $105 million in tobacco settlement revenue on the program (Biesk, Chicago Tribune, 3/27).
- Louisiana: The Pharmaceutical Research and Manufacturers of America is "secretly behind" a print advertising campaign "slamming" a state proposal to require state authorization before doctors could prescribe "certain high-cost drugs" to Medicaid patients, the Baton Rouge Advocate reports. The full-page newspaper advertisement, published under the logo "Medicines Work for Louisiana," argued that the proposal would keep Medicaid patients from receiving "cost-effective medicines" and increase emergency room and hospital visits. The plan, which officials say could save the state $35 million annually, is expected to be considered during this legislative session and is supported by Gov. Mike Foster (R) (Shuler, Baton Rouge Advocate, 3/27).
- Massachusetts: Under the Prescription Advantage Program, a new state program scheduled to begin April 1, seniors and some disabled people may purchase prescription drug coverage on a sliding scale with a maximum premium of $82 per month. The state signed a $201 million contract on March 27 with pharmacy benefits manager Advanced PCS, which will operate the program. State health officials expect to have 14,000 people enrolled by April 1 (Powell, Boston Herald, 3/28).
Medicaid
Texas Lawmakers Approve Increased Spending; Medicaid Gets More Money
[Mar 29, 2001]
Despite warnings that rising health care costs could create a financial "crisis" in Texas and lead to "major tax increases," the state Senate Finance Committee approved a $111.7 billion, two-year state budget March 26, the Houston Chronicle reports. Compared to the $98.1 billion two-year budget lawmakers approved in 1999, the proposed budget is a "dramatic increase," the Chronicle reports. The reason for the increase is related to rising health care costs, as well as increases in inflation and in the state's population. The budget includes $1 billion in new spending to pay for the state's share of health insurance programs for state employees, retired teachers and state college and university employees. In addition, the budget includes $828 million in state tax dollars for Medicaid, with half that amount going to cover increased health costs (Ratcliffe, Houston Chronicle, 3/26). Also on March 26, the state House Appropriations Committee approved an emergency appropriations bill that, in part, would pay for a $595 million Medicaid shortfall in the current budget. To alleviate that shortfall, as well as those for other programs, state lawmakers approved a measure that would shift $718 million that the state had budgeted for 2000-2001 but never spent (Susswein, Austin American-Statesman, 3/28). Total budget overruns could reach as high as $700 million, the Austin American-Statesman reports (Susswein, Austin American-Statesman, 3/27). Deliberate Underestimations?
Some lawmakers have accused state Health Department officials of "deliberately low-balling" Medicaid cost estimates two years ago -- thus sparking the current budget shortfall -- "to save money for" then-Gov. George W. Bush's (R) proposed state tax cuts and to "help his presidential campaign," the American-Statesman reports. Health department officials underestimated the number of Medicaid beneficiaries by about 100,000 people and miscalculated the program's costs by $595 million. Some members of the House Appropriations Committee said that the Health Department made the error even though there were "several early warning signs that the numbers might have been off." For example, State Rep. Sylvester Turner (D) said that Medicaid enrollment was beginning to increase during the 1999 legislative session. For their part, agency officials say the increase was not visible until after the 2000-2001 budget had been approved (Austin American-Statesman, 3/28). More News
In other Texas Medicaid news: - A "processing glitch" has delayed payments from the state to care providers and social services treating children under the Medicaid Case Management program, the AP/Dallas Morning News reports. Health Department spokesperson Doug McBride said that about 50 providers had not been paid $50,000 in claims. A spokesperson for National Heritage Insurance Co., the state's main Medicaid contractor, said the company was working to correct the problem. The payment delay led some providers "to say they were on the brink of shutting down" (AP/Dallas Morning News, 3/28).
- State lawmakers are considering two bills that would tax the state's nursing homes to increase Medicaid reimbursements to those facilities. Although the "financing maneuver is unusual," the bills would allow the state to draw $2 in federal money for every dollar it collects from the nursing homes through the new tax. The process would give the state an additional $520 million, which could be used to hire more nurses and nursing aides and pay more competitive salaries. Through Medicaid, Texas contributes about 71% of the costs of caring for nursing home patients, reimbursing facility owners about $83.50 per resident per day. Under the bills, nursing homes would pay a $5 per resident per day "quality assurance fee" that is expected to raise enough money to allow the state to increase Medicaid reimbursements between $10 and $12 per resident per day. But nearly 200 of the state's 1,200 nursing facilities say they would not benefit from the bills because they do not house a "significant number" of Medicaid beneficiaries (Bahadur, Austin American-Statesman, 3/27).
- State House Appropriations Committee Chair Robert Junell (D) introduced a proposal last week that would transfer authority over the state's Medicaid program from the state Department of Health to the state Health and Human Services Commission. A "handful" of agencies administer various parts of the Medicaid program, the Dallas Morning News reports. Representatives from the Texas Hospital Association and the Texas Medical Association, as well as state lawmakers, "embraced" the idea, which could be attached to some of the other Medicaid-related bills the Legislature is considering. Health Department spokesperson McBride said the agency would "follow whatever the Legislature decides" (San Martin, Dallas Morning News, 3/20).
Children's Health
Idaho Lawmakers Vote to Eliminate Funding for CHIP Outreach Efforts
[Mar 29, 2001]
Funding for Idaho's CHIP outreach efforts would be reduced to zero under legislation passed March 28 by the Legislature's joint budget committee and the full Senate, the Spokane Spokesman-Review reports. Since 1999, the state has spent about $633,300 on outreach efforts, including advertisements, brochures, Spanish-language materials and coordinated efforts with schools. In addition, the Robert Wood Johnson Foundation is airing television advertisements promoting CHIP in the Boise market. Lawmakers voted to cut the funding to "save money," the Spokesman-Review reports. In addition, lawmakers said CHIP outreach efforts were contributing to a rise in the number of children identified as Medicaid-eligible and, thus increased Medicaid enrollment. Lawmakers said that increased Medicaid enrollment is "something they want stopped," the Spokesman-Review reports. State Sen. Stan Hawkins (R), who sponsored the bill, said that enrollment efforts had been "too successful" and that employers were dropping coverage and "encouraging [employees] to participate in CHIP." Rep. Don Pischner (R), suggested that rather than spend the money on outreach, it "might be better to spend [the] money on the program itself." Roger Sherman, program director for United Vision for Idaho, a citizen group, criticized lawmakers' action and their desire to reduce Medicaid enrollment, saying, "That outreach is the best thing [the program has] done in years. What it means is that people have access to programs that have been available to them for 12 or 15 years, but they didn't know it. Cutting it goes back to the policy of hiding the ball." The bill requires outreach efforts for the CHIP program and other state-run programs to meet "the minimum level allowed by federal law." However, according to Robert Reed, Medicaid branch chief for HCFA's Seattle office, federal law does not specifically set minimum levels. However, if Idaho does cut CHIP program outreach efforts, the state must submit an amended outreach plan to the federal government, which might not approve it, the Spokesman-Review reports. The measure now moves to the full House (Russell, Spokane Spokesman-Review, 3/29).
Coverage & Access
Los Angeles County Supervisors Approve Coverage for Some Home Health Workers
[Mar 29, 2001]
Ending "months of debate," the Los Angeles County, Calif., Board of Supervisors on March 27 voted to provide "basic health care coverage" to roughly 6,000 home health workers, the Los Angeles Times reports. Under the plan, set to take effect next January, home aides who work at least 112 hours per month, or 28 hours per week, will receive coverage. Still, the Times reports that the plan "covers only a fraction of the more than 30,000 in-home health aides who officials say are uninsured because most do not work enough hours to meet the threshold." Two supervisors abstained from voting on the measure, saying "they did not agree with granting coverage to workers who logged so few hours while other county employees have to meet a higher threshold" (Los Angeles Times, 3/28). San Mateo Workers Press for Raise
Meanwhile, about 50 home health workers "packed" a meeting of the San Mateo County, Calif., Board of Supervisors March 27 seeking a $4 hourly wage increase, the San Francisco Chronicle reports. Currently, the 1,900 "mostly part-time workers" who care for 2,400 elderly, disabled and low-income residents throughout the county receive $7.50 an hour and no vacation benefits, according to Myriam Escamilla of Service Employees International Union Local 715. County supervisors said they are "sympathetic" to the workers' request but say "their hands are tied until the state comes out with its revised budget in May." The push in San Mateo for better wages and benefits follows a Bay Area trend; in 1999, roughly 3,000 Santa Clara County home health workers became the first in the state "to obtain health care benefits under a labor contract with their county," and workers in Contra Costa County received a pay increase later that year. Workers in Santa Clara, Contra Costa and Alameda counties and in San Francisco now make more that those in San Mateo. The Chronicle reports that this disparity has led more San Mateo workers to commute to neighboring counties for work (Pence, San Francisco Chronicle, 3/28).
Health Care Marketplace
Companies Renew Efforts to Help Employees with Elder Care
[Mar 29, 2001]
After a "decade of trying, but largely failing," to help employees who care for elderly relatives, some companies have made "another push" with new, "ambitious" benefits programs, the Wall Street Journal reports. Ford Motor Co., for example, began in January offering the firm's 150,000 employees across North America free house calls by geriatric care managers to determine the health of elderly family members and develop plans for their care. AT&T Corp. plans to "rol[l] out" four "one-stop shops" to help coordinate care and services for employees' elderly relatives, while Fannie Mae recently hired a full-time elder care case manager to help employees at the agency's Washington, D.C., headquarters. The Journal reports that the moves mark the "latest response" to a national trend, as more than 14 million U.S. employees care for elderly family members. According to a 1997 study for MetLife Inc., employees who care for elderly relatives cost employers as much as $29 billion a year in lost productivity because of time spent away from work. The National Council on the Aging also found that 25% of employees caring for elderly family members who lived an hour or more from the office "missed at least one day of work each month," and 15% "took unpaid leave." In addition, a second MetLife study found that caring for elderly relatives usually requires at least eight hours a week over eight years, and the problem will likely "mushroom" with the increasing number of middle-aged workers and longer-living parents. "We're in the business of making cars, and if an employee is stressed out about his sick mother, that car isn't going to be made as well," Greg Mack, Ford's health program manager, said. 'Unsuccessful' Past
Still, the new benefits programs follow a decade of "largely unsuccessful efforts" to help employees who "double as caregivers." In the late 1980s, many companies established "resource-and-referral" programs, usually toll-free telephone numbers that offered counseling and information about local elder care services. However, few employees used them, "even though arranging elderly care can be a complex and time-consuming process." The problem, according to the Journal -- "[f]ew people plan ahead for elder care and when a crisis hits, they don't think of the workplace as a resource." Skip Schlenk, director of the AT&T Family Care Development Fund, said, "No one goes to the water cooler and says, 'I'm exhausted! Mother kept me up all night,' like you do when you have a baby teething'" (Greene, Wall Street Journal, 3/29).
Looking for a Daily Report on a specific date? Click here for instructions on how to find it.
...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... .....
|
|
|
|
