House Approves Budget Bill To Cut Medicaid, Other Programs

The House on Friday voted 217-215 to approve a five-year budget plan (HR 4241) that would save the government nearly $50 billion, including about $12 billion in cuts to Medicaid over five years, the AP/Las Vegas Sun reports (Taylor, AP/Las Vegas Sun, 11/17). Republican leaders last week removed the bill from the floor because of a lack of support, but on Friday they won moderates' votes by "fram[ing] the debate over the bill as a moment of truth in the battle against stubborn budget deficits," the Washington Post reports.

In the final vote, 14 House Republicans and all House Democrats opposed the bill. Lawmakers approved several changes to the Medicaid cuts before passing the final bill, the Post reports. The renegotiated bill does not include a provision that would have raised copayments from $3 to $5 for Medicaid beneficiaries with annual incomes below the poverty level, but the bill would permit copayments to rise with inflation.

Lawmakers also approved a provision that would deny Medicaid long-term care coverage for people with home equity of $750,000 or higher, up from an earlier limit of $500,000 (Weisman/Murray, Washington Post, 11/18). Another change lawmakers approved would slightly increase Medicaid transformation grants to fast-growing states (Dennis, CQ Today, 11/18).

The bill still would allow states to impose new costs on Medicaid beneficiaries and to scale back coverage. In addition, the bill would reduce payments to pharmacies, encourage pharmacies to sell generic drugs and place limits on the transfer of assets by some people to qualify for Medicaid (AP/Las Vegas Sun, 11/18).

Rep. Sherwood Boehlert (R-N.Y.) said, "Moderates feel we have been heard, we have been listened to."

Rep. Gene Taylor (D-Miss.), said, "This is the cruelest lie of all, that the only way you can help people who have lost everything is by hurting somebody else" (CQ Today, 11/18).

The AP/Sun reports that "House leaders now face arduous talks with the Senate, which passed a much more modest plan earlier this month" (AP/Las Vegas Sun, 11/17).

In related news, the House on Thursday voted 224-209 to reject the fiscal year 2006 Department of Labor-HHS appropriations bill (HR 3010). All House Democrats and 22 Republicans voted against the bill (Hulse, New York Times, 11/18).

The Labor-HHS bill is the largest annual appropriations bill. The bill would have increased NIH funding by 1%, or $253 million (CQ HealthBeat, 11/17).

Lawmakers said the bill was defeated by a "wide-ranging coalition of conservatives, who do not vote for social services spending under any circumstances; moderate Republicans upset about cuts in rural health care access; and Republicans in general, who did not receive earmarks under a bill-wide ban negotiated with the Senate," CongressDaily reports (Cohn, CongressDaily, 11/17).

House Ways and Means Committee Chair Bill Thomas (R-Calif.) said he voted against the bill because of a provision that would ban the government from paying for erectile dysfunction drugs beginning in 2006. Thomas said the government has already signed contracts with Medicare drug plans to cover ED drugs next year, and that the provision could open the government to lawsuits.

Rep. Jo Ann Emerson (R-Mo.) said she voted against the bill because it "whacked the heck out of rural health care."

The bill would have cut health programs in rural and underserved areas by more than $200 million.

Emerson said several other Republican members voted against the bill because of rural health care (Swindell, CQ Today, 11/17).

Following the bill's "surprise" defeat, "Republicans were considering options that include sending the bill back to conference, where conferees could attempt to craft a bill that would muster a majority; attaching it to another piece of appropriations legislation or passing a continuing resolution that would fund programs at the lower end of last year's or this year's levels," CongressDaily reports (Heil, CongressDaily, 11/18).

NPR's "Morning Edition" on Friday reported on House passage of the budget. The segment includes comments from Reps. Marion Berry (D-Ark.), Robert Menendez (D-N.J.), Budget Committee Chair Jim Nussle (R-Iowa) and Adam Putnam (R-Fla.) (Seabrook, "Morning Edition," NPR, 11/18). The complete segment is available online in RealPlayer.