MEDICARE: Clinton May Veto Bill Favoring HMOs

      White House officials yesterday announced that Clinton would veto a Republican proposal to return $26 billion to $28 billion in Medicare funding to health plans and providers, unless Congress overhauls the package to shift funding from HMOs to hospitals, the AP/Baltimore Sun reports. In a letter to Republican leaders, HHS Secretary Donna Shalala and White House budget director Jack Lew wrote, "Should these untargeted, excessive and unaccountable HMO payment increases crowd out critical beneficiary and health provider policies, we would recommend that the president veto your legislation." House Speaker Dennis Hastert (R-Ill.) responded that Clinton had "clearly tried to inject politics into what should be a non-partisan debate" (AP/Baltimore Sun,10/18). The Medicare bill aims to restore cuts Congress made in 1997 to balance the budget, and funnels billions back to hospitals, HMOs, home health care agencies and other providers (Pear, New York Times, 10/18). House Ways and Means health subcommittee Chair Rep. Bill Thomas (R-Calif.) said, "I am baffled that the White House would threaten to veto this much- needed legislation." But the White House "contended" that under the Republicans' giveback bill, HMOs would receive more than one- third of the Medicare funding, despite the fact that only 16% of Medicare recipients are enrolled in managed care plans. Thomas estimated that approximately 25% of the measure would go towards HMOs (AP/Baltimore Sun, 10/18). The New York Times reports that Congress hopes to "reverse the exodus" of managed care plans from Medicare by increasing payments to those plans, but Clinton "contends" that HMOs are "already overpaid by Medicare." In addition to requesting that funds be shifted away from HMOs and towards hospitals and other providers, the Clinton administration "demanded that Congress require HMOs to stay in the Medicare program and preserve existing benefits for three years." Chris Jennings, White House health policy coordinator, said, "We want an assurance that, if [HMOs] receive more money, they will continue to provide coverage and benefits." However, Thomas warns that a "veto of the Medicare relief bill would deny millions of seniors critical access to the health care they need," and although hospitals would be the "chief beneficiaries" of a presidential veto, the American Hospital Association said a veto could "imperil billions of dollars in relief for health care providers and patients they serve" (New York Times, 10/18).

Clinton Urges Congress to Finish Budget
      As Congress nears adjournment, the White House yesterday "pressured" Congress to "return to Washington and finish work on the budget for fiscal 2001," and "signaled" that it would not sign any more continuing resolutions, or "weeklong temporary spending bills." White House Chief of Staff John Podesta said, "They pass a weeklong CR, they take a five-day weekend vacation, and then they come back and work for a day or two. And that's not getting the job done." Although Republicans had hoped to have completed work on 10 of 13 annual spending bills by today, "neither the House nor Senate will take its first vote of the week before tonight," the Washington Times reports. However, John Feehery, spokesperson for House Speaker Dennis Hastert (R-Ill.), said that "there is nothing to worry about, negotiations are under way and progress is being made" (Godfrey, Washington Times, 10/18).