"2003: The Year Ahead in Health on the Hill" 1/28/2003
Kaisernetwork.org and Congressional Quarterly's Mary Agnes Carey and Rebecca Adams provide a glimpse of the issue debates that will shape health policy in 2003.
Interviews with Lawmakers
Republican and Democratic leaders at the center of coming health policy debates talk with Congressional Quarterly reporters.
The Issues
Congressional Quarterly's Mary Agnes Carey and Rebecca Adams provide a detailed look the health policy issues expected to be prominent in 2003: Medicare prescription drugs and provider funding, rising health insurance premiums, Medicaid and state budgets, AIDS funding, medical malpractice, the uninsured, stem cells/cloning, and abortion. View a similar review of the major issues of 2002 here.
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Chair, Senate Committee on Finance
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Ranking Minority Member, House Energy and Commerce Health Subcommittee
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Chair, Senate Health, Education, Labor and Pensions (HELP) Committee
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Ranking Minority Member, House Ways and Means Health Subcommittee
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Democrats, Republicans and President Bush have said they want to move early in the 108th on Medicare prescription drug legislation, but it is unclear how they will resolve substantial differences over how much to spend on a benefit, whether the private sector or the government should play the dominant role in designing and administering the benefit, and whether to link a drug benefit to broader changes to Medicare. While House GOP leaders successfully passed their Medicare drug plan in the 107th Congress, the Senate was unable to reach consensus on the issue. In addition to Medicare drugs, lawmakers must turn their attention to another related matter -- whether or not to boost payments to physicians, hospitals, and other Medicare providers, who have complained that the program has cut their payments too deeply. Some doctors, in particular, are threatening to leave Medicare unless a scheduled 4.4% cut for this year is reversed.
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Health insurance premiums are widely expected to increase at double digit rates for employers once again next year, with workers being asked to pay more towards their monthly premiums, as well as higher deductibles and co-payments for office visits, hospital care and prescriptions. Due to these increases and the struggling economy, fewer employers may offer health coverage to their workers, leading to increases in the number of uninsured Americans. Also, some employers have already begun to scale back retiree health coverage or eliminate it for future retirees. As health care costs continue to climb, employers and employees are likely to turn to Congress for help.
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Financially strapped state governments have asked President Bush and Congress to give them some budgetary relief as Medicaid costs rise and revenues drop. Among their requests, state governors have asked the federal government to cover a larger share of Medicaid costs. And, with prescription drug expenses rising and states covering the medication costs for low-income seniors, governors are seeking to increase the discounts that drug companies must provide to state Medicaid programs. Many also want to raise co-payments for drugs and services provided to Medicaid beneficiaries. Democrats in Congress have put forward a fiscal relief proposal for the states, but the Bush Administration did not include a state relief initiative in its economic stimulus initiative. Congress did little to answer state fiscal concerns in the 107th Congress, and it's unclear if they will do so in the 108th.
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The Global Fund to Fight AIDS, Tuberculosis and Malaria has said it needs an additional $2 billion in funds for this year, $4.6 billion for 2004 and as much as $20 billlion for 2007 to combat the AIDS epidemic in developing countries. In the U.S., the State Department has asked Congress to increase funding to fight HIV/AIDS around the world and incoming Senate Majority Leader Bill Frist, R-Tenn., has sponsored legislation to accomplish that goal. In the 107th Congress, differences over how much money to spend, as well as the scope of the bill, proved to be insurmountable. In the 108th Congress, the measure must compete with many other expensive policy initiatives, such as funding a Medicare prescription drug benefit and an economic stimulus package, as well as a possible war with Iraq and homeland security. Congress is likely to face continuing pressure to fund domestic HIV/AIDS needs as well. Faced with rising drug costs and declining state revenues, many state AIDS Drug Assistance Programs are cutting costs by limiting benefits and restricting enrollment through waiting lists or reduced income eligibility thresholds, with AIDS advocates turning to the federal government for help.
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Republicans say that medical malpractice awards have spiraled out of control, leading to big increases in malpractice insurance premiums and driving some doctors and emergency clinics out of business. The House last fall passed sweeping limits on malpractice liability, but their attempts to rein in such lawsuits failed in the Senate, where Democrats have argued that caps could diminish quality of care. Republicans are certain to try again in 2003. The issue gained national notice in January 2003 when more than two dozen surgeons in West Virginia began 30-day leaves of absence to protest the costs of malpractice insurance, and a number of states are considering legislation to impose caps on legal damages. Recently President Bush issued a call for specific changes to the medical malpractice system.
View President Bush's Press Conference on Medical Liability Reform
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Concerns about the rising number of Americans without health insurance are moving back into the national spotlight. After significantly dropping in 1999, the number of Americans who lack health insurance is rising. More than 41 million people, one in seven Americans, are uninsured. Proposals to help the uninsured population include GOP plans to provide tax credits to subsidize private insurance and Democratic proposals to expand public health insurance programs and employer-based coverage. President Bush is likely to call for tax credits to help the uninsured in his budget, which will be delivered to Congress February 3.
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Claims of human cloning are reviving debate over congressional proposals to ban the practice. Two competing bills to ban human cloning are likely to face action early in the 108th Congress. President Bush's preference is a measure by Rep. Dave Weldon, R-Fla., and Sen. Sam Brownback, R-Kan., that would ban cloning completely. Supporters of a complete cloning ban say that embryonic-stem- cell research creates a human by inserting DNA material into an unfertilized egg. The other measure, supported by a bipartisan coalition including Sen. Dianne Feinstein, D-Calif., and Rep. James Greenwood, R-Pa., would make reproductive cloning a felony but would let researchers continue to work on embryonic stem cells, which some say holds the promise of curing a variety of diseases such as Parkinson's and Alzheimer's. In July 2001, the House of Representatives approved, 265-162, the cloning ban by Weldon. However, the bill stalled in the Senate.
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The 30-year anniversary on January 22 of the landmark U.S. Supreme
Court decision Roe v. Wade legalizing abortion will revive debates over
whether to limit the availability of abortion.
With Republicans in control, abortion opponents want to push for bills that
the Republican-controlled House has passed but have died in the
Senate. Those measures include a bill making it a crime to evade parental
notification laws by taking a minor across state lines for an abortion and a
bill making it a federal crime to hurt a fetus during an attack on a
pregnant woman. Advocates of changes to abortion laws also want to assure
hospitals and other health care providers that they can refuse to perform
abortions without penalty.
Supporters of upholding current abortion law say that they may lose one
fight on a late-term procedure abortion rights opponents refer to as
partial-birth abortion. The House voted in July to outlaw the procedure but
the legislation was not considered
in the Senate. The bill is likely to surface again in the 108th Congress.
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