BUDGET: HOUSE, SENATE PASS BILLS
The Senate and House approved yesterday "separate versionsThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
of landmark legislation intended to balance the federal budget in
five years, restore welfare benefits to some 300,000 legal
immigrants and impose significant savings to ensure the future
solvency of Medicare." Los Angeles Times reports that "[p]assage
of the companion spending bills marks a major bipartisan triumph
for President Clinton and the Republican leaders of Congress, who
agreed on a balanced budget as this year's top policy goal"
(Rosenblatt/Chen/Healy/Hook/Trodden, 6/26). According to the
Washington Post, the budget proposal would reduce the federal
deficit by $204 billion over the next five years, including $115
billion in Medicare cuts (Pianin/Yang, 6/26). House Budget
Committee Chair John Kasich (R-OH) said, "This is the first real
bill that will enact permanent changes into law that will result
in a balanced budget by 2002. The Berlin Wall of big government
has fallen. There will be tax cuts. It's no longer rhetoric.
It's reality" (Zagaroli, Detroit News, 6/26). The measures now
"face a new round of negotiations and compromise before final
passage" Post, 6/26).
CONSENSUS
Los Angeles Times reports that the House and Senate bills
"increase the range of health programs available under Medicare,
including HMOs run by doctors and hospitals." Under the bill,
insurers would be required to provide coverage for preventive
services such as Pap smears and cervical cancer screenings,
mammograms, prostate cancer tests and "payment for glucose test
strips for diabetics." Both of the measures also include $1.5
billion "to help low-income Medicare recipients pay their
premiums." The two measures also include a "significant" shift
in HMO payments "from high-cost areas, such as California,
Florida and New York to rural areas" (6/26).
THE DIFFERENCES
"Among the largest substantive differences between the two
bills are their treatment of Medicare beneficiaries," Congress
Daily/A.M. reports. The Senate proposal would impose a $5 co-
payment for home health benefits, raise the eligibility age for
beneficiaries from 65 to 67, and impose higher premiums for
beneficiaries with incomes greater than $50,000. The House bill,
however, "would provide beneficiaries with more in the way of new
preventive benefits, and many more consumer protections," such as
the elimination of "gag" clauses in physician contracts. House
leaders, however, struck a provision from the bill "that would
have left decisions about lengths of hospital stays for Medicaid
patients solely in the hands of doctors and patients" (6/26).
The House and Senate bills also differ on the number of Medicare
beneficiaries who can participate in a medical savings account
demonstration project. The House bill calls for 500,000
participants, while the Senate proposal would allow only 100,000
to participate (Los Angeles Times, 6/26).
CHILDREN'S HEALTH
"In a final show of cross-the-aisle cooperation before
passing the bill, the Senate voted to expand the health care
benefits already approved for children of low-income families to
include eye, ear and dental care," Post reports. The Senate bill
includes a total of $24 billion in additional funds to provide
coverage to low-income children, "including $8 billion from a
proposed increase in the cigarette tax." Post reports that the
House bill contained only $16 billion in funding for children's
health programs, "and now Senate leaders and the White House must
persuade the House to go along with the expanded spending." The
Senate measure "gives states a choice between a block grant or an
expansion of the Medicaid program," while the House bill creates
a block grant program "for states to spend as much as $16 billion
over five years" (6/26). New York Times reports that the Senate
"approved a far reaching amendment," sponsored by Sen. Pete
Domenici (R-NM) and Paul Wellstone (D-MN), that "says health
plans covering children must offer comparable coverage for mental
and physical illnesses if they provide any mental health benefits
at all" (Pear, 6/26).
IMMIGRATION
The Senate and House bills "represent a reprieve for many
low-income legal immigrants who faced a potential cutoff of
federal income support and medical benefits under last year's
welfare reform law," Los Angeles Times reports. Approximately
500,000 legal immigrants were slated to lose Social Security and
Medicaid coverage. However, under the proposals approved
yesterday, "about 300,000 of them would retain those benefits."
THE ABORTION FACTOR
A "potential stumbling block" to the conference committee
negotiations "is a provision inserted by Republicans that
abortion rights advocates say would permanently restrict
abortions by banning the use of federal funds for such
procedures" (Los Angeles Times, 6/26). Both the House and Senate
bill include a permanent ban on abortions, "allowing exceptions
only for rape, incest and life endangerment, in the new program
providing funds to states to help insure children through age 18.
Congress Daily/A.M. reports that the legislation "would represent
the first time Congress has written into permanent law provisions
of the "Hyde Amendment' carried in each year's Labor-HHS
appropriation." The ban would not apply to Medicaid or other
federal programs. However, the Senate version of the bill "also
would redefine the phrase 'medically necessary' so as not to
include abortion," which, abortion-rights advocates charge "would
have essentially the same effect as writing the Hyde amendment
into permanent law." Rep. Henry Waxman (D-CA) said, "They did it
in a sneaky, back-door way, but the full consequence is to say
that abortion is not medically necessary, so the states would no
longer have to provide this service" (6/26).