MEDICARE ‘GIVEBACKS’: House Passes $11.5B in Restorations
The Medicare Balanced Budget Refinement Act of 1999, the "only Medicare legislation with a chance to pass Congress this year," cleared the House with flying colors Friday on a vote of 388-25. The $11.5 billion "giveback" measure will restore across five years some of the funding for hospitals, nursing homes and home health care companies slashed by the 1997 Balanced Budget Act (Love, AP/Philadelphia Inquirer, 11/6). Bill sponsor Rep. Bill Thomas (R-CA) said, "It's a refinement bill, not a reform bill. We still need to address prescription drugs. But this very narrow, very shallow canoe that cannot support that initiative today." The Wall Street Journal notes that the Medicare measure does not go as far as either Republicans or Democrats had hoped: President Clinton and Democrats pushed hard this year for a prescription drug benefit, while many Republicans "wanted a top-to-bottom restructuring to make the senior health insurance program less bureaucratic" (Murray, 11/8). The measure, $1.8 billion more than the $9.7 billion relief package approved last month by the Senate Finance Committee, would restore about 5% of the $200 billion in reimbursement cuts to hospitals, home health and nursing homes in 1997. Leaders from the House and Senate will meet this week to "hammer out a compromise." CongressDaily/AM reports that Senate leaders are "reluctant to bring the bill to the floor, because some senators may try to add amendments that would significantly expand" the program. If House, Senate and Clinton administration negotiators are able to reach a compromise early this week, the measure will likely be attached to another bill scheduled to move at the end of this Congress, such as the tax extenders bill (11/8).
Specifics for Facilities
Most of the money in the House bill would be restored to teaching hospitals, rural hospitals and disproportionate share facilities that "care for [a] large number of uninsured patients." Home health and nursing home patients will also see relief through a boost in Medicare fees. An incentive provision for Medicare HMOs would provide larger payments and cash bonuses if they agree to insure patients in underserved areas (AP/Philadelphia Inquirer, 11/6). Under the measure, 62% of the nation's teaching hospitals would stand to gain, while the remaining 38% would lose out. California would stand to gain nearly $130 million while New York teaching hospitals would lose up to $103 million over the next five years (Holland, Albany Times Union, 11/6).
Specifics for Patients
As for individual Medicare beneficiaries, USA Today notes that patients treated at clinics or practices owned by hospitals currently "can pay two or three times more for their care than those who go to independent doctors or clinics. But buried in [the bill] is a tidbit for consumers:" a $776 cap on out-of-pocket expenses for Medicare outpatient care, "the same as patients would pay if admitted to the hospital." Bill co-author Rep. Pete Stark (D-CA) said the cap is "still not enough. Beneficiaries should obviously pay less than if they had to spend a day in the hospital. It's a step in the right direction" (Appleby, 11/8). Other restorations:
- The $1,500 cap on speech and physical therapy combined would be raised to $1,500 for each type of therapy;
- Medicare payments for pap smears would go up "to ensure access to the latest technology";
- Medicare enrollees who lose HMO coverage when their plan withdraws would have greater flexibility to enroll in alternatives, such as a nearby plan or Medigap insurance. (AP/Philadelphia Inquirer, 11/6).
More Insider Comments
House Commerce Committee Chair Thomas Bliley (R-VA) said, "Two years ago we made some very important changes that are keeping a vital program alive. But some of the changes we made went a little too far." Thomas Scully, president of the Federation of American Health Systems, said, "It's a very good bill. Is it massive assistance? No. But at the margins, it will probably be very helpful" (Hosler, Baltimore Sun, 11/6). After Friday's vote, Rep. Tom Coburn (R-OK) said, "Congress has saved rural health care" (Myers, Tulsa World, 11/6).
Kudos for the House
Following Friday's vote, some organizations applauded the House effort to restore Medicare funding. They include:
- American Association of Homes and Services for the Aging: President Len Fishman thanked the House and said, "The efforts of AAHSA and its members in ensuring that our elected leaders in the House understood the unintended consequences of the Balanced Budget Act on nursing home care are reflected in this legislation. The Senate version of this bill does include additional payments for rehabilitation therapies, which would improve the legislation passed today by the House" (AAHSA release, 11/5).
- The National Association of Community Health Centers, Inc: Thanking the House, President and CEO Tom Van Coverden said, "the leadership shown by the House of Representatives ... will help ensure that millions of working Americans across this country will have access to the affordable health care services of their community health center" (NACHC release, 11/5).
- Health Insurance Association of America: President Chip Kahn said, "HIAA applauds the House of Representatives for passing ... the Medicare Balanced Budget Refinement Act of 1999, that will improve Medicare and help expand seniors' private health plan options by restoring some funding to the Medicare+Choice program. HIAA is also pleased that the House of Representatives did not include any prescription drug mandates on Medicare+Choice or Medigap plans which would increase costs and make coverage less affordable for seniors" (HIAA release, 11/5).