MEDICARE GIVEBACKS: Ways and Means to Mark Up Bill Today

      With the House Ways and Means health subcommittee set to mark up a bill today that would boost payments to Medicare providers and HMOs, Chair Bill Thomas (R-Calif.) posted legislation on his Web site Monday that would cost between $26 billion and $30 billion over five years -- more than the $21 billion cap set by GOP leaders, CongressDaily/A.M. reports. The bill would increase Medicare reimbursements for bad debt acquired by hospitals, eliminate the expected reduction in skilled nursing facility payments and increase inpatient hospital payments by about half of the amount requested by rural hospitals. In addition, the legislation would provide $8 billion for managed care organizations participating in the Medicare+Choice program. The House Commerce Committee passed a similar bill last week that offered only $6 billion for HMOs. Meanwhile, the Senate Finance Committee will likely unveil its own BBA proposal today, with a closed member meeting set for Wednesday (CongressDaily/A.M., 10/3).

Of Cash and Spin Doctors
      The giveback legislation follows a "massive pressure" campaign by health care providers and payers -- including hospitals, HMOs and other health groups -- who have spent millions of dollars on advertising and grass-roots efforts to "convince Congress" to restore funding cut in the 1997 Balanced Budget Act, the Washington Post reports. Despite numerous government studies that suggest the health care industry has "overdramatiz[ed]" the effect of the reductions, Congress will likely pass a Medicare giveback bill before adjourning this year. "The cuts were overdone. The changes in '97 have significantly impacted some rural and mid-sized hospitals ... [but] my worry is that we will go too far, that we will be too nice to them," Rep. Tom Coburn (R-Okla.) said. According to an HHS Office of the Inspector General report last month, HMOs have "more than an adequate amount to care for Medicare" beneficiaries. One General Accounting Office study found that elderly Medicare patients in nursing homes have "not suffered a decrease in quality or access to care," and another GAO report "rebutted claims" by hospitals that low Medicare reimbursement rates had caused their "financial woes." Still, the health care industry campaign has "overwhelmed" members of Congress. "Every group has come at us with horror stories and after a while, I guess you tend to believe it," Rep. Mark Foley (R-Fla.) said, adding, "[But] I don't think they are hemorrhaging to the degree to which their ads suggest" (Vita, Washington Post, 10/3).