Government

National health priorities shift as Democrats take control of Congress

Medicare drug price negotiations and stem cell research take center stage, while Medicaid cuts and HSAs are pushed to the wings.

By David Glendinning — Posted Nov. 27, 2006

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When the Democrats take control of Congress in 2007 for the first time in about a dozen years, they will inherit a big list of health care issues important to physicians. But some observers already are saying that the political climate and budget problems could hinder significant action during the next two years.

With nearly a decade of Medicare pay cuts to physicians on deck, reform of the reimbursement system is a top priority for the American Medical Association and other physician groups. How pressing this issue will be to Democratic leaders, however, is less clear, lobbyists and policy experts say.

In recent years, Republican lawmakers have taken the lead on reversing reductions in doctor pay and promoting long-term plans for reform. While some Democrats have authored proposals and supported GOP plans for change, they largely have not been in the driver's seat.

The prospect of legislation reversing Medicare cuts is dimmer under Democratic leadership because the party has focused more on other health care issues, said Tom Scully, an attorney with Alston & Bird and a former Centers for Medicare & Medicaid Services administrator. Any pay reform bill that advances through Congress will face pressure from lawmakers hoping to add on these other health priorities -- competition that could slow down or kill the legislation.

"Medicare bills don't pass easily. They're freight trains, and once you start moving one, you can't just keep it as a doctor bill," Scully said.

The only health care goals in the Democrats' election year plan -- A New Direction For America -- are authorizing the government to negotiate lower drug prices for the Medicare prescription drug program, ending "wasteful giveaways" to drug companies and HMOs under Medicare, and advancing stem cell research.

When Democratic leaders held postelection media events to outline their plans for the next session, they did not mention reforming Medicare physician payment. The direct negotiation drug initiative will be the first health issue championed by incoming House Speaker Nancy Pelosi (D, Calif.), who vowed to bring up legislation within 100 hours of taking power.

The AMA, nevertheless, remains hopeful that it can call on broad bipartisan support to fix the reimbursement problem, said AMA Board of Trustees Chair Cecil B. Wilson, MD.

"The agenda will always be crowded, and the question is: 'What are the priorities?' " he said. "If the problem is serious enough, Congress always finds a way to do it. You haven't solved your problem if you fix other parts of the Medicare system and you do not fix the payment issue."

Republicans, who still will constitute a sizeable minority in both houses, will continue to push their reform plans and help drive the debate. But several key players who have dominated the issue in the past, such as House Ways and Means Committee Chair Bill Thomas (R, Calif.) and health subcommittee Chair Nancy Johnson (R, Conn.), will not return to Congress next year. Johnson, who was defeated by her Democratic opponent, had authored one of the few long-term Medicare payment overhauls that received good marks from physicians. Thomas is retiring.

The expansion of health savings accounts, favored by the AMA, is expected to take a back seat next year. Democrats consider these products, which feature high-deductible coverage, tantamount to "disproportionate, regressive tax benefits for the wealthy," said Ron Pollack, executive director of the consumer group Families USA.

Setting the stage for 2008

Some priorities of the new Democratic leadership match physician goals. Allowing federal officials to bargain directly with drug firms to lower Medicare drug costs, for instance, is strongly supported by the AMA. Congress also might listen to requests by many doctors to commit more funding to the Centers for Disease Control and Prevention and the National Institutes of Health, said Robert Blendon, ScD, a professor of health policy and political analysis at the Harvard School of Public Health.

In addition, several legislative activities resisted by physicians are likely off the table at least for the next two years due to Democratic opposition. Medicaid cuts that threaten to limit beneficiaries' eligibility, reduce benefits and hike cost-sharing levels, for example, likely would be dead on arrival in the new Congress, said Families USA's Pollack.

But even such top Democratic priorities as the Medicare drug negotiation bill continue to be strongly opposed by the White House. President Bush already has vetoed a stem cell research bill and likely would do the same to a bill trying to change the Medicare drug benefit, said Joseph Antos, PhD, a health care scholar at the American Enterprise Institute, a conservative think tank.

All of this adds up to a new Democratic Congress that likely will use what leverage it has to define its agenda for the 2008 presidential elections rather than achieve actual changes in law in the near term, Dr. Blendon said. Any exception would have to be a widely supported measure, such as pandemic flu preparedness legislation, he said.

Tight budgets also will present a challenge, with proposals such as long-term Medicare payment reform potentially running into the hundreds of billions of dollars. Congress is expected to reauthorize the State Children's Health Insurance Program before its 10-year run expires in 2007, but lawmakers will have a tough time finding the money to expand it and boost other programs the way the Democrats want, Dr. Antos said.

"Unfortunately, the money is going to sharply limit what Democrats can do this year and would have sharply limited what Republicans could have done next year had they been in charge of the Congress," he said.

Iraq, scandals and Katrina

The issue of uninsured Americans and health care access also might be relegated to the back burner in the 110th Congress because constituents have more pressing concerns on their minds. Although an overwhelming majority of Americans want a bipartisan solution to improving health care access, that's not what decided votes in the 2006 election, according to pollsters and other observers.

"Health care had very little to do with it," said Whit Ayres, a Republican pollster with Ayres McHenry & Associates in Alexandria, Va. "This was an election about Iraq and scandals and Katrina."

Said John Rother, AARP's director for policy and strategy: "This is not an election that's really about a big mandate for big health care ideas."

On most polls, health care trailed the war in Iraq and the economy in importance to voters.

Americans as a whole, nevertheless, remain concerned about health care access. Roughly 80% of adults in early November said they wanted Congress and the state legislatures to do more to extend access to coverage, according to a nationwide poll by Ayres McHenry & Associates and the Glover Park Group, working for America's Health Insurance Plans.

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ADDITIONAL INFORMATION

Voters send doctors to Congress

Eight physicians were re-elected and one, Steve Kagen, MD, was newly elected to the House. No doctors were newly elected to the Senate; one physician-incumbent was not up for re-election and the other retired.

State (Party) Specialty
Charles W. Boustany Jr., MD Louisiana (R) Cardiovascular surgery
Michael Burgess, MD Texas (R) Obstetrics-gynecology
Phil Gingrey, MD Georgia (R) Obstetrics-gynecology
Steve Kagen, MD Wisconsin (D) Internal medicine
Jim McDermott, MD Washington (D) Psychiatry
Ron Paul, MD Texas (R) Obstetrics-gynecology
Tom Price, MD Georgia (R) Orthopedic surgery
Vic Snyder, MD Arkansas (D) Family medicine
David Weldon, MD Florida (R) Internal medicine

Source: American Medical Association Political Action Committee

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Lame duck hopes

Much of the attention in Washington, D.C., after the November elections was focused on the political landscape for 2007 and beyond. But Congress needs to finish up its work for the 109th Congress before moving on.

Lawmakers returned to Capitol Hill the week of Nov. 13 for a weeklong session and planned to recess again for the Thanksgiving holiday. With little hope of approving all of the remaining spending bills to fund the government for the 2007 fiscal year, both houses planned to pass a continuing resolution that would maintain funding at 2006 levels through the first week in December. When they return, they will have a chance to wrap up unfinished business.

That means the final weeks of 2006 are the last chance for Congress to stave off a 5% Medicare physician pay cut before it kicks in Jan. 1, 2007. But what some once saw as a likely action is an unknown now that Democrats will take control of the House and Senate next year.

Congressional aides and lobbyists said the chaos and distraction that a shift in power brings to Capitol Hill could mean that lawmakers will consider only "must-pass" items, such as spending bills, in the year's final weeks. A temporary physician pay fix might not make the cut. Supporters could try to attach language to a spending bill or another continuing resolution, but competition for inclusion on the "last train out of town" will be tight.

For doctors, the Medicare fix is a must-pass measure, said AMA Board of Trustees Chair Cecil B. Wilson, MD. Lawmakers might revisit the issue in 2007 and pass a retroactive pay change if they don't act before year's end. But by the time that happens, Dr. Wilson said, some doctors already may have decided to leave Medicare or cut off access to new patients because of declining reimbursement.

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