MEDICARE ‘GIVEBACKS’: Congress, Clinton Remain Deadlocked

Congress met in a "rare" weekend session in their continued negotiations with President Clinton over delayed budget legislation, including a $240 billion tax bill, which contains a provision that would restore about $30 billion in Medicare funds to providers and HMOs (Morgan, Washington Post, 10/30). Last Thursday, the House passed the measure 273-174, and while the Senate continues to debate the bill, Clinton has vowed to veto the tax legislation, arguing that the Medicare provision provides "too much" funding to HMOs "at the expense" of hospitals, nursing homes and other providers (Morgan/Pianin, Washington Post, 10/29). While Clinton called the provision a "massive giveaway to HMOs," House Speaker Dennis Hastert (R-Ill.) argued that the administration has "squeezed the money out of the HMO side of Medicare so that a lot of them can't reach rural areas (Neikirk, Chicago Tribune, 10/28). Senate Majority Leader Trent Lott (R-Miss.) and GOP leaders also warned that if Clinton vetoes the bill, they will delay restoring the Medicare funds until next year. According to House Ways and Means Committee ranking member Charles Rangel (D-N.Y.), such a delay would have a "serious impact" on "financially strapped" hospitals in urban and rural areas. Republicans added that Clinton may have "second thoughts" about rejecting the tax package, which includes many provisions that "enjoy broad support" from both parties. "[Clinton] seemed defensive, and I think he's having veto-threat remorse," Hastert spokesperson John Feehery said (Washington Post, 10/29). Clinton, however, urged lawmakers to "put aside partisan demands," adding, "I am not trying to provoke a confrontation here. They'll get some of what they want; we'll get some of what we want" (Abrams, AP/Nando Times, 10/29). Rumors circulated Sunday that GOP leaders may attach the Medicare "giveback" provision to a separate Labor-HHS appropriations bill, although Republicans denied the charge (Fulton et al., CongressDaily/A.M., 10/30).

Lott also said that budget negotiations may continue until Election Day. On ABC's "This Week" Sunday, he warned that Congress would remain in session until Nov. 7 "if that's what it takes" (Washington Post, 10/30). Lott said that Clinton has demanded that Republicans "cave to what his demands are," but added, "There are some ideas being exchanged. There is a mood -- that it is time to bring this to a conclusion." In the House, Hastert also vowed to continue the budget negotiations, calling Clinton's threatened veto "politically motivated." He said, "I think the president is being threatened by House Democrats. I see them losing this thing (the political campaign to regain control of the House). They are panicking, trying to find a fight, trying to find an October surprise." Hastert also doubted that Congress would pass another bill if Clinton vetoed the tax legislation. In a letter to Clinton Friday, the speaker blamed House Minority Leader Dick Gephart (D-Mo.) for the budget impasse. "It is difficult to negotiate with House Democrats when their leader puts on war paint and wields a spear ... this shouldn't be a battle," he wrote, referring to a Democratic meeting last week where Gephart dressed as a character from the film "Braveheart" (Chicago Tribune, 10/28). According to Clinton, however, the "right wing of the Republican caucus" has hindered negotiations (AP/Baltimore Sun, 10/29). "[T]he Republican leadership closed its door to compromise ... literally," Clinton said, accusing the House GOP of passing the tax bill "on a partisan vote" (Houston Chronicle, 10/28). According to the AP/Sun, the "verbal dueling" underscored both parties' efforts to use the budget battle to attract votes with "trust between the two sides ... fraying" (AP/Baltimore Sun, 10/29).

While both presidential candidates have "vilifie[d]" HMOs as cost-controlling "ghouls," the editors of the Washington Post argue that HMOs, while "not perfect," hold down health care costs and contain insurance premiums, leading to fewer uninsured Americans. The editors note, however, that Texas Gov. George W. Bush (R) still attacks Vice President Al Gore's prescription drug plan as a "government-controlled HMO" and Gore casts HMOs as "villains" that "twist public policy around to help their profits at the expense of your health." Meanwhile, the editors point out, the White House has accused HMOs of "sucking up too much Medicare money," converting health plans into "just another industry with its hand out," and Democrats paint HMOs as a "powerful industry squeezing the weak." Noting that health care remains "easy territory for demagogues," the editors conclude that, with a myriad of cost issues facing the health care system today, "Indiscriminate HMO-bashing rhetoric will only make solutions harder" (Washington Post, 10/28).