MEDICARE ‘GIVEBACKS’: Clinton Escalates Fight with GOP
President Clinton yesterday "escalated" the battle over a Medicare 'giveback' measure, which would return $30 billion to Medicare providers and HMOs over five years, demanding that Congress allocate more funding for health programs for low-income Americans, disabled children and legal immigrants and less for private health plans, the New York Times reports. The fight over the legislation, part of a $240 billion, 10-year tax cut bill, jeopardizes the expected increase in payments to health care providers. "We are not rejecting all HMO payment increases. The president simply wants more accountability and a more equitable distribution of resources to beneficiaries and health care providers," Chris Jennings, White House health policy coordinator, said. While Clinton has called the provision "an unjustifiable spending increase for HMOs," most Republicans and some Democrats argue that the increased funding will help prevent "wholesale defections" of HMOs from the Medicare program. "The president sees imperfections in this bill for political reasons," Rep. Bill Thomas (R-Calif.) said, adding, "This measure is done. All the president has to do is sign it." Collin Peterson (D-Minn.) warned that if the president failed to pass the current version of the bill, "I'm not sure you'll get another bill. We'll be a long way into next year before we get more money out to hospitals, nursing homes and home health agencies." The health care industry "strongly supports" the Medicare legislation, and the possibility of delay has "alarmed hospitals," which say they need immediate financial aid. "There has been an assumption all year ... that Congress would fix the Balanced Budget Act. But if Congress goes into a lame duck session, there's no certainty," Thomas Scully, president of the Federation for American Hospitals, said.
Although 16% of Medicare recipients have enrolled in HMOs, the White House contends that private health plans would receive 34% of the funds provided by the Medicare bill. With his term drawing to a close, Clinton has tried to "force" Congress to "accept his priorities" on the legislation, insisting that lawmakers allow Medicaid coverage for pregnant women and children who are legal immigrants, permit working parents to purchase Medicaid coverage for children with disabilities and "make it easier" for children to enroll in Medicaid. The "dispute" over Medicare payments also "crystallizes" a long-standing feud between the administration and HMOs, which have "blocked" bipartisan patients' rights efforts. According to health plan officials, however, Clinton has "little comprehension of how health care markets work." They warn that his attempts to lock HMOs into Medicare with three-year contracts would drive them out of the program. "No responsible party ... would be locked into Medicare for three years, with no concept of how much they would be paid by the government in the second or third year," Diana Dennett, executive vice president of the American Association of Health Plans, said. Republicans have also urged Clinton to sign the Medicare legislation because the provision also would provide new benefits to recipients -- such as expanded coverage for mammograms, Pap smears and pelvic exams, wider coverage for colon cancer screening, funding for eye exams to detect glaucoma and less expensive outpatient hospital care (Pear, New York Times, 11/1).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.