FY 1999 HEALTH SPENDING: Reaxs From Interested Parties
The omnibus $500 billion federal budget was passed by the Senate 65-29 yesterday and signed into law by President Clinton. Thirty-three Republicans and 32 Democrats voted "yes," 20 Republicans and nine Democrats voted "no" (Seelye, New York Times, 10/22). Here are some reactions from government officials, federal agencies, interest groups and activists on health care measures included in the budget.
Home Health Care
Rep. Bill Archer (R-TX), chair of the House Committee on Ways and Means, said that the "Medicare Home Health Care Interim Payment System Refinement Act of 1998 ... is necessary to deal with the situation created by the Administration's failure to implement the Medicare home health care prospective payment system on time." He said that the act, which increases reimbursements to home health care agencies and puts off a 15% rate cut for one year, was needed to fix a "current system [that] is simply unsatisfactory and causing real hardship for our nation's seniors and in the home health industry" (Archer release, 10/21). The American Association of Homes and Services for the Aging, a federation of long-term care and senior housing providers, applauded the $1.65 billion allocated to ease the burden of the Medicare home health care interim payment structure. AAHSA's Edgar Rivas said, "The extra money will help. ... However, the programs's basic structural problem remains: payments don't accurately reflect the additional costs for serving the most frail, medically-complex beneficiaries." He added, "We need to move as quickly as possible to a system based on the cost of providing the necessary care, instead of one that assumes every provider has been gaming the system in the past" (AAHSA release, 10/21).
Health Care Coverage
Health Insurance Association of America COO and president-designate Chip Kahn said that the omnibus bill "represent[s] one step forward and two steps back." He commends Congress for passing a bill that "will allow self-employed people to deduct the entire cost of buying their own health insurance" by 2003, but decries the passage of legislation requiring coverage for breast reconstruction following mastectomies and a measure allowing certain medical facilities to purchase private Medigap policies on behalf of their patients. Kahn argues that the breast reconstruction item, "while well-intended, is yet another example of congressional 'body part' legislation compelling health plans to devote scarce resources to one course of treatment, potentially at the expense of other worthy services." And he contends that the Medigap provision "is nothing short of a windfall" for eligible facilities, which "would receive $4 for every $1 paid toward the purchase of a Medigap premium" (HIAA release, 10/22). NPR's Julie Rovner reported that Sen. Al D'Amato (R-NY), sponsor of the breast reconstruction measure, "really didn't want to go home without anything to show for his big breast cancer initiatives, so they gave him this one little piece" ("All Things Considered," 10/21).
The Generic Pharmaceutical Industry Association celebrated the defeat of legislation that would have extended the patents for a select group of drugs including "Claritin and Eulexin (Schering-Plough), Relafen (SmithKline Beecham), Cardiogen 82 (Bristol-Myers Squibb), Dermatop (Hoechst Marion Roussel), Penetrex (Rhone-Poulenc-Rorer) and Nimotop (Bayer AG). GPIA President Dr. Alice Till said of the defeated legislation, "This special-interest proposal [was] not the fair and equitable process that the branded pharmaceutical industry has proclaimed it to be. ... This is a big win for consumers in the budget bill, and we also have saved millions of dollars more in wasteful federal Medicare and Medicaid spending. Patent extensions for brand-name drugs should not be done in backroom deals" (GPIA release, 10/22).
AIDS Action praised provisions in the budget that increased funding to prevent and treat HIV/AIDS, and Executive Director David Zingale said the spending bill paves the way for strong "FY 2000 funding levels that can launch a reinvigorated national prevention effort." The group lauded the allocation of $110 million to fight the epidemic in the African-American community, $261 million in additional funding through the Ryan White Care Act, $185.9 million more in AIDS research, an additional $225 million for the Housing Opportunities for People with AIDS Program (HOPWA), $297 million more for substance abuse prevention and treatment and a total $657.8 million in additional prevention funding. According to an AIDS Action release, the bill increases prevention funding by approximately 5% over 1997's increase. The group's main bone of contention with the omnibus bill was the language "barring federal funds to District of Columbia organizations that operate needle exchange programs, even if those programs are operated with local or private money" (AIDS Action release, 10/21). See the Kaiser Daily HIV/AIDS Report for more coverage of the federal budget. The online report is available at no cost at www.kff.org.
Dept. of Health and Human Services
Health and Human Services Secretary Donna Shalala said: "This is a history-making budget for [HHS]. Across the board, this budget meets or exceeds our priorities. It's the biggest investment in HHS in seven years, and will translate directly into better health and longer lives for millions of Americans." She lauded the $2 billion increase in NIH funding, a "strengthen[ed]" commitment to the Centers for Disease Control and Prevention and a $163 million increase in Medicare funding "to provide better service to beneficiaries, and fight waste, fraud and abuse" (HHS release, 10/22).