Health centers close out 2006 with a lot of unanswered questions; questions such as the fate of health center funding and reauthorization. And now more importantly, what will the year 2007 bring? Undoubtedly a lot of change will take place with a new Congress ready to take over and a major shift of power is already underway. Against this teeming backdrop, political contenders will soon line up on the political stage for the 2008 presidential election. The changing of the political guard will likely trigger a fresh look at old problems, among them America’s health care crisis. Already Sen. Ron Wyden (D-OR) that will guarantee health insurance for all U.S. residents, saying, “The last time America tried to fix health care was in 1993 and 1994 — since then, employer-based coverage has been melting away like a Popsicle in the sun.”
As Congress wrapped up its final legislation for the 109th Congress, we figured we’d give a short recap of what happened on the priority issues for Health Centers.
Reauthorization: We’re still scratching our heads over this one: how does a bill with powerful bipartisan support and momentum in both the House and Senate fail to pass? Last spring and the ensuing summer, it was all going swimmingly. The “Health Centers Renewal Act (H .R. 5201), introduced by Rep. Michael Bilirakis (R-FL) and Rep. Gene Green (D-TX) gained almost 300 co-sponsors in the House. In the Senate, Orrin Hatch (R-UT) and Edward Kennedy (D-MA) introduced the companion bill (S. 3771) with over 60 cosponsors. In the end, politics and funding questions converge, and a two-year authorization of health centers was blocked first by Sen. Tom Coburn (R-OK) who put a hold on the legislation on the Senate floor, but also by House negotiators who indicated that even a 6% funding increase for year 2 in the bill may be too much for them to pass. This impasse led the Senate to call it a day without clearing the bill in any form, so it’s back to the drawing board for 2007.
Appropriations: After resounding and near-unanimous support for health center expansion from the President’s Budget (+$181 million), the House Appropriations Committee (+$206 million) and the Senate Appropriations Committee (+$145 million), political finger-pointing stalled the process as the 109th Congress drew to a close, and that delay has now imperiled any chance of increased health center funding for 2007. Fearing a politically contentious floor fight before the elections, Republican leaders in both Houses decided back in the summer that the FY2007 Labor-HHS bill was “too hot to handle” before the elections, and conventional wisdom held throughout the fall that Congress would return after November 7th to clean up the year’s unfinished spending decisions. However, with control of both Houses of Congress switching hands after the elections, and with harsh fights within the Republican party over government spending and “earmarks,” the Republican leadership adjourned early on December 9th without action on 9 of the 11 appropriations bills, essentially leaving domestic spending on auto-pilot and leaving the “financial mess” (in the words of incoming Majority Leader Harry Reid (D-NV)) in the laps of the incoming Democratic majority. Not to be outdone, on the Monday after Congress adjourned for the year, soon-to-be Democratic Appropriations Chairmen Sen. Robert Byrd (D-WV) and Rep. David Obey (D-WI) announced their plan for disposing of FY2007 appropriations: rather than go back and renegotiate every bill, Obey and Byrd announced they would fund programs through a year-long “joint resolution,” keeping last year’s funding going for all programs, eliminating earmarks, and including a few “limited adjustments” for high-priority items. Needless to say, NACHC will be pushing for health centers to be one of those “limited adjustments” when Congress returns.
Medicaid: In one of its first acts of 2006, Congress approved a $38.8 billion, five-year budget reconciliation bill that lawmakers had been unable to complete the previous December. The measure (the Deficit Reduction Act, or DRA) cleared the way for spending cuts to Medicare ($6.5 billion) and Medicaid ($4.1 billion), and set in motion a host of Medicaid policy changes: State flexibility to redesign the program, and changes in cost-sharing, case management services, and citizenship eligibility requirements, all of which impact health centers. But the law was not all doom and gloom. Among other things, it specifically called for protecting the viability of health centers to continue caring for Medicaid beneficiaries by protecting the current Health Center PPS (Deal Amendment). The law also included a Partnership for Medicaid initiative making available $50 million to health centers and other safety providers for the establishment of collaborative health networks to reduce non-emergent ER visits. Also, the law appropriated a much needed $2 billion to help health centers and other providers with uncompensated care costs related to Hurricanes Katrina and Rita.
Meanwhile, after nearly 18 months and an estimated $5.8 million, the Federal Medicaid Commission – appointed by HHS Secretary Michael O. Leavitt and including NACHC’s own John Rugge, MD, CEO of Hudson Headwaters Health Network in New York – closes shop later this month with the release of its final report on long-term reforms to Medicaid. One proposed reform, strongly supported by NACHC and the Partnership for Medicaid, is that federal law and regulations “encourage states to place all categories of Medicaid beneficiaries in a coordinated system of care premised on a medical home for each beneficiary.” This is a good thing.
SCHIP: Just hours before the Congress adjourned for the year, lawmakers passed legislation that temporarily staves off shortfalls set to hit SCHIP in 2007. However, the fix is only partial and will require early congressional action next year to ensure that beneficiaries are not later dropped from SCHIP rolls. In a sign of things to come, lawmakers are already at odds over how SCHIP should evolve, with some lawmakers favoring expansions to the program (for example, providing coverage to higher income children or parents), while others warn that those expansions defy the purpose of the program and threaten to bust the federal budget.
Medicare Part D: With almost an entire year behind the newly created Part D drug benefit, the Medicare prescription drug plan is still a hot topic. The drug benefit came in under the projected budget, costing $30 billion as opposed to the projected $43 billion. President Bush attributed the savings to consumers and market competition. However other cost analyses suggest that the difference was the result of lower-than-expected enrollment and a smaller increase in drug prices than anticipated. CMS and the Social Security Administration were busy monitoring the program and providing a wealth of technical assistance to seniors and health care advocates to ensure that seniors participating in the program avoided any significant disruptions in their care. The drug program began its annual ‘open enrollment’ period November 15th, 2006, which allowed Medicare beneficiaries without drug coverage to choose a plan, while those already enrolled in Part D plans could decide whether to stay or choose a new plan. A number changes in the Part D benefit prompted CMS to reach out to NACHC, health centers and countless others for help with getting out its messages about enrollment in the Low-Income Subsidy (“Extra Help”), changes regarding ‘grace periods,’ and potential changes by drug plans including higher premiums and co-payments and changes in drug formularies. NACHC moved forward with its efforts to get CMS to recognize difficulties that some health center pharmacies experienced with Part D plan contracting. As a result, both the Health Resources and Services Administration (HRSA) and CMS have committed to helping health centers with this problem and NACHC will continue to work with all health centers on this important issue.
Health Centers Added to FEHBP Coverage ( H.R. 4980/S. 3813). If passed, the legislation, introduced by Reps. Charles Bass (R-NH) and Danny Davis (D-IL) in the House and Sens. Gordon Smith (R-OR) and Jeff Bingaman (D-NM) in the Senate, would have helped health centers substantially reduce the cost of providing health insurance to their employees, by adding health center employees to the statutory list of those covered under the Federal Employees Health Benefit Program (FEHBP). Many health centers have called asking about the status of the bill. The bottom line is that it will have to be reintroduced in the new Congress. Please contact Susan Jenkins at NACHC for further information.
Health Information Technology: There were many bills introduced this Congress but the discussions boiled down to two pieces of legislation. The Senate passed S. 1418 in November 2005 and the House passed H.R. 4157 in September of this year. Unfortunately the two chambers were unable to come to an agreement before adjourning for the year. Don’t expect this issue to go away in the 110th Congress, though. Many members are placing health information technology high on the list of items they would like to work on in the new Congress. NACHC will keep you updated on any legislation in the new Congress.