New Senate Faces Same Issues, Staffers Say
Senate Democrats, poised to assume control of the chamber after Sen. James Jeffords' (I-Vt.) departure last week from the Republican Party, will likely tackle a number of health issues this year, but they will still have to iron out differences with GOP lawmakers to "get things done," several top congressional staffers and a member of the Bush administration said. Discussing the prospects for health legislation during the next 100 days at a briefing sponsored by the Alliance for Health Reform yesterday, Dean Rosen, staff director of the Senate Health, Education, Labor and Pensions Subcommittee on Public Health, said, "The changeover means that Democrats will have more control over the agenda" -- including issues such as a patients' rights bill, a prescription drug benefit under Medicare and measures to help the uninsured -- but Republicans "will still have a very important role" on health issues. According to Elizabeth Fowler, chief counsel on health and entitlement for the Democratic staff of the Senate Finance Committee, Jeffords' decision to leave the Republican Party has left the future of health legislation in the Senate "up in the air." She added, however, that Sens. Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa) -- the incoming and outgoing Finance Committee chairs, respectively -- would continue efforts to pass a Medicare prescription drug benefit and legislation to help the uninsured, despite the shift in the Senate. Mark McClellan, a consultant to the White House Council of Economic Advisers, added that Senate Minority Leader Tom Daschle (D-S.D.), who is expected to become majority leader, plans to move ahead with "core policy priorities," including patients' rights legislation and a prescription drug benefit, that Republicans "were hoping to get to soon anyway." Bridgett Taylor, chief health adviser to House Energy and Commerce Committee Democrats, said that because "Democrats are still in bondage" in the House, both parties must "reach out and work in a bipartisan fashion" to pass health legislation this year.
The panelists addressed the future of a number of specific health issues at the briefing, including:
- Patients' rights: Although he is "not sure what to expect" in the Senate, Rosen said that he hoped lawmakers would pass patients' rights legislation this year, rather that using the issue as a "vehicle for posturing." Taylor agreed, adding that this year will determine "who wants to get this bill done and who doesn't." McClellan, citing employer liability and questions about legal remedies as the last major stumbling blocks, said that he hopes lawmakers will "roll up [their] sleeves" and hammer out a bill. In the House, John McManus, staff director of the Ways and Means Subcommittee on Health, said that lawmakers have expressed frustration" over stalled legislation, adding, "We ought to get this done as soon as possible." Rosen said that the Senate will likely debate a bill (S 283) sponsored by Sens. John McCain (R-Ariz.), Edward Kennedy (D-Mass.) and John Edwards (D-N.C.) in the next few months.
- Medicare reform: McManus, pointing out a number of "significant and complex" issues, said that "prospects are good" for Medicare reform this year, calling the $300 billion that lawmakers have earmarked for a prescription drug benefit "more than enough," despite projections to the contrary issued by the Congressional Budget Office. In addition, McClellan said that the Bush administration "look[ed] forward to working with Republicans and Democrats to achieve" legislation to strengthen Medicare. Rosen, however, said that Medicare has some "fundamental flaws" and hinted that lawmakers "may not get there" on reform this year.
- Uninsured: McClellan said that the Bush administration supports a "multi-part strategy" to help the uninsured, including tax credits and an "innovative approach" to Medicaid and CHIP. McManus added that House lawmakers hope to establish medical saving accounts and a purchasing pool to help lower premiums for recipients of tax credits. Fowler called the administration's efforts a "good sign," but warned that the budget does not include funding for tax credits. In addition, Taylor said that tax credits may prove inadequate; she expressed support for expanding Medicaid and CHIP. Rosen predicted that legislation to help the uninsured would "probably have a marriage" of tax credits and expanded public programs.
- Medical errors: Rosen said that legislation to reduce errors had a "better than 50-50 chance" of passing in the Senate.
- Nursing shortage: Calling the issue "critical," Rosen said that the Senate would address the problem this year, as well as shortages of pharmacists and rural providers.
- Medicare "givebacks": Fowler said that she does not expect lawmakers to pass legislation this year giving additional Medicare reimbursements to providers or insurers; last year, Congress restored $35 billion over five years for cutbacks that resulted from the 1997 Balanced Budget Act.
- Health Insurance Portability and Accountability Act: Rosen said that while lawmakers may consider legislation to delay implementation of HIPAA rules, he said that such a bill likely would not pass (Josh Kotzman, California Healthline, 5/31).
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