House and Senate Negotiating Possible Medicaid Cuts in Budget Proposal
A letter signed by 44 Republican members of Congress urging House Budget Committee Chair Jim Nussle (R-Iowa) to restore $20 billion in Medicaid funds over five years to the chamber's budget "could give senators more leverage" in their negotiations with the House over a budget for fiscal year 2006, the AP/San Francisco Chronicle reports (Freking, AP/San Francisco Chronicle, 4/14).
The House FY 2006 budget resolution instructs the House Energy and Commerce Committee to find $20 billion in savings over five years, most of which is expected to come from Medicaid. The Senate budget plan originally included $15 billion in Medicaid cuts but senators approved an amendment to eliminate all Medicaid reductions (California Healthline, 4/14).
In their letter to Nussle, the Republican lawmakers said the Medicaid cuts would "negatively impact people who depend on the program and the providers who deliver health care to them" (AP/San Francisco Chronicle, 4/14). The letter states that the House should create a bipartisan commission, an idea already approved by the Senate, that would recommend changes to Medicaid (Pugh, Philadelphia Inquirer, 4/15).
Rep. Heather Wilson (R-N.M.), who initiated the letter, said, "The reality is the Senate had zero [proposed cuts], the House had $20 billion. This influences where a final number comes out and how it is connected to the formation of a commission."
House Minority Leader Nancy Pelosi (D-Calif.) said, "The question now is whether the Republican leadership and the Republican chairmen of the budget committees will honor the wishes of the majorities in both houses by reporting a conference report on the budget resolution with no cuts to Medicaid" (AP/San Francisco Chronicle, 4/14).
Senate Budget Committee Chair Judd Gregg (R-N.H.) told Nussle that the Senate would consider cuts of no more than $43 billion over five years to mandatory spending programs, such as Medicaid, agriculture and student loan subsidies, according to House and Senate aides. The House approved a budget with $69 billion in mandatory savings over five years, while mandatory cuts in the final Senate version totaled $17 billion over five years.
Gregg also told Nussle that the Senate would not approve a budget that included more than $12 billion in Medicaid cuts, according to a Republican Senate aide. According to CQ HealthBeat, "House GOP Leaders may not be so quick to reject the latest Senate offer." A House Republican leadership aide said, "We want to make sure we can come up with some reconciliation instructions that really do lead to a bill that we can pass" (CQ HealthBeat , 4/14).
In related news, Sen. John Spratt (D-S.C.), ranking member of the Senate Budget Committee, and Rep. John Dingell (D-Mich.) said they are "concerned that Congress does not have the information necessary to assess the Medicaid policies in the president's budget."
Spratt and Dingell added, "The lack of details provided thus far raises questions as to whether the overall Medicaid number was set as part of a larger deficit-reduction goal or was driven by explicit Medicaid policies."
Virginia Gov. Mark Warner (D), chair of the National Governors Association, on Thursday at a Kaiser Conversations on Health event at the Kaiser Family Foundation said that governors are "grinding through" discussions on Medicaid with HHS Secretary Mike Leavitt (Rovner, CongressDaily, 4/15).
Warner said the deal he is pursuing would include reductions in prescription drug spending, increases in Medicaid beneficiaries' cost-sharing, limits on asset transfers to achieve Medicaid eligibility and flexibility for states to adjust Medicaid benefits. Warner added that the governors favor improving the efficiency and quality of health care, encouraging people to fund their own long-term care and preventing employers from cutting their health insurance benefits. Warner raised concerns about the Bush administration's proposal to save $15 billion over 10 years by reducing Medicaid payments to pharmacists. He said, "We need to drill down on a [drug]-pricing approach that if there are going to be savings we take a little bit out of the hide of everyone."
Warner "sent mixed signals" on the possibility that the governors would submit a formal proposal to Congress this year, CQ HealthBeat reports. "This is an issue that can no longer be postponed," Warner said, adding, "What's happened in Tennessee is going to happen in every state in the country" (CQ HealthBeat , 4/14).