Congress OKs Economic Stimulus Package; Obama To Sign Today

On Friday, the House and Senate approved a $787 billion economic stimulus package that includes a number of health care provisions, the Washington Post reports (Murray/Kane, Washington Post, 2/14).

The House passed the stimulus package by a 246-183 margin with no Republican support, and the Senate approved the package by a 60-38 margin with the support of three Republicans (Hitt/Weisman, Wall Street Journal, 2/14).

President Obama plans to sign the economic stimulus package into law on Tuesday in Denver (Feller, AP/Houston Chronicle, 2/17).

According to the Post, the enactment of the stimulus package would mark the "start of a new ideological era that places the federal government at the center of the nation's economic recovery" and provide a "down payment on much of President Obama's domestic agenda," such as health care reform (Washington Post, 2/14).

The enactment of the stimulus package also would result in a "big victory for Democratic priorities," such as health care reform, the New York Times reports (Herszenhorn, New York Times, 2/14).

Effect on Prospects for Health Care Reform

The Obama administration has said that the economic stimulus package would take steps toward health care reform, "perhaps softening the blow if Congress fails to comprehensively address the issue this year," the AP/Boston Herald reports.

Jenny Backus, a spokesperson for HHS, said that the health care provisions in the stimulus package represent the "beginning of the president's health reform vision." She added, "It's designed to get relief to people who need it most and to do everything we can to bring down the cost of health care and improve access and quality" (AP/Boston Herald, 2/14).

Meanwhile, "liberals are debating how to ensure that the stimulus outcome does not define the outer boundaries" of the Obama agenda on health care and other issues, "so that future legislation is not limited, as the stimulus was, by the demands of centrist senators," according to the Post.

Theda Skocpol, a political scientist at Harvard University, said, "We have to be out there explaining in the most elementary ways why something like universal health care is good for America."

According to Jacob Hacker, a political scientist at UC-Berkeley, Obama might have the ability to obtain more support from Republicans for health care reform legislation than he received for the economic stimulus package, as Republicans have expressed some support for his health care proposals (MacGillis, Washington Post, 2/17).

Effect for States, Cities

State officials likely will face issues with "managing competing pressures from communities, watchdog groups and federal regulators over how the money is allocated" from the economic stimulus package, the AP/Hartford Courant reports (Fouhy, AP/Hartford Courant, 2/16).

For example, some states have considered reductions in eligibility for Medicaid and other health care programs to address budget deficits, but "such cuts now could jeopardize any extra financing for Medicaid under the stimulus plan because the bill penalizes states that change their Medicaid eligibility to save money," according to the New York Times (Davey, New York Times, 2/16).

Meanwhile, although cities likely will "benefit once the money trickles down" from state governments, city officials "predict it will take longer for them to see funding" for health care and other programs, the AP/Miami Herald reports.

In response, the National League of Cities has launched a campaign to help city officials obtain funds from the stimulus package for such programs (Walters, AP/Miami Herald, 2/17).

Several newspapers recently examined health care provisions in the economic stimulus package. Summaries appear below.

COBRA/Medicaid

The stimulus package includes federal subsidies for health insurance premiums under COBRA and additional funds for state Medicaid programs, but House and Senate negotiators eliminated provisions included in earlier versions of the package that would have expanded the programs, the Los Angeles Times reports.

Under the stimulus package, states will receive $87 billion in additional federal Medicaid funds (Levey, Los Angeles Times, 2/17).

The stimulus package also includes $24.7 billion for federal subsidies to cover 65% of the cost of health insurance premiums under COBRA for as long as nine months for lower-income workers who have lost their jobs as a result of the current economic recession (Vitez, Philadelphia Inquirer, 2/17).

However, earlier versions of the stimulus package included provisions that would have allowed low-income workers who lost jobs that did not include health insurance to apply for Medicaid through 2010 and allowed recently unemployed workers ages 55 and older or those with at least 10 years of tenure at their jobs to continue to receive health insurance through COBRA until they find a new job that offers coverage or reach age 65, when they can enroll in Medicare (Los Angeles Times, 2/17).

Comparative-Effectiveness Research

The stimulus package includes $1.1 billion in funds for comparative-effectiveness research, and enactment of the package would mark the first time that the federal government has spent "substantial amounts" for such research, the New York Times reports.

Under the stimulus package, HHS would receive the funds immediately and allocate them over several years. The provision also would establish a council of as many as 15 federal employees to coordinate such research and advise Obama on use of the funds. Supporters hope that the results of such research "will eventually save money by discouraging the use of costly, ineffective treatments," the Times reports.

However, pharmaceutical and medical device companies have raised concerns that the "findings will be used by insurers or the government to deny coverage for more expensive treatments and, thus, to ration care," and some Republicans have "complained that the legislation would allow the federal government to intrude in a person's health care by enforcing clinical guidelines and treatment protocols," according to the Times (Pear, New York Times, 2/16).

Health Care IT

The stimulus package includes $19 billion for health information technology as part of an effort to make all U.S. health records electronic by 2014, McClatchy/Kansas City Star reports (Douglas, McClatchy/Kansas City Star, 2/13).

According to the Washington Post, the effort to switch to electronic health records has "lagged for several reasons," such as "concerns over lack of universal protocols for collecting data, as well as rules that establish how, with whom and under what circumstances the data can be shared."

Many health care providers have raised concerns about "liability if private information gets into the wrong hands," the Post reports (Huslin, Washington Post, 2/16).

NIH

Sen. Arlen Specter (R-Pa.), one of only three Senate Republicans to vote for the stimulus package, agreed to support the package in large part because of additional funds for NIH included in the legislation, the Times reports.

Under the stimulus package, the NIH budget would increase by 34%, from $29 billion to $39 billion.

Specter, the "most ardent champion on Capitol Hill" for NIH, used "backroom" procedures to add funds for the agency in the stimulus package, the Times reports (Harris, New York Times, 2/14).

Broadcast Coverage

ABC's "This Week" on Sunday featured a roundtable discussion on the economic stimulus package with Sens. Chuck Schumer (D-N.Y) and Lindsey Graham (R-S.C.) and Reps. Maxine Waters (D-Calif.) and Peter King (R-N.Y.) (Stephanopoulos, "This Week," ABC, 2/15).
NBC's "Meet The Press" on Sunday included an interview with David Axelrod, a senior adviser to Obama, in which he discussed health care and other provisions in the stimulus package, as well as a roundtable discussion with Ron Brownstein of National Journal; Washington Post columnist Eugene Robinson; Roger Simon of The Politico; and Kimberly Strassel of the Wall Street Journal on health care and other provisions in the package (Gregory, "Meet The Press, NBC, 2/15).
NBC's "Nightly News" on Monday examined the potential effects of the health care provisions in the stimulus package on the U.S. health care system (Bazell, "Nightly News," NBC, 2/16).
NPR's "All Things Considered" on Monday reported on concerns raised by Republicans about funds for comparative-effectiveness research included in the stimulus package. The segment includes comments from Gail Wilensky, a health care economist; David Nexon of the Advanced Medical Technology Association; Rep. John Shadegg (R-Ariz.); conservative radio host Rush Limbaugh; and Robert Blendon, a professor and health care policy expert at the Harvard School of Public Health (Rovner, "All Things Considered," NPR, 2/16).
NPR's "Day to Day" on Monday examined how funds provided in the stimulus package to expand adoption of EHRs could improve patient care and reduce costs. The segment includes comments from Michael Randolph, a primary care physician at Union Memorial Hospital in Baltimore; Peter Basch of MedStar Health; and Mark Levitt, chair of the Certification Commission for Healthcare Information Technology (Levitt, "Day To Day," NPR, 2/16).
WAMU's "Diane Rehm Show" on Tuesday included a discussion on the stimulus package with Jared Bernstein, chief economist and economic policy adviser for Vice President Biden; Alice Rivlin, a senior fellow at the Brookings Institution; Jonathan Weisman of the Wall Street Journal; and Rea Hederman, a senior policy analyst at the Heritage Foundation (Rehm, "Diane Rehm Show," WAMU, 2/17).

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