WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.
“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health-care reform. And it is long overdue.”
“Having run vigorously against a 'do-nothing' Congress, Democrats … now have to show that they are the do-something Congress,” said Dr. Norman J. Ornstein, a resident scholar at the American Enterprise Institute, a conservative think tank in Washington.
There is also a sense that America's employers are ready to support health care reform, said Sen. Ron Wyden (D-Ore.). “In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.
Democrats' first focus has been and still is on covering the uninsured, said Sen. Wyden.
“You cannot fix American health care unless you get everybody covered,” he said. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”
“What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs that we have and who yet aren't enrolled,” said a Democratic congressional staffer speaking at the briefing.
About 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP). However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage. States have been increasing their outreach efforts, but they have been stymied by shortfalls in federal matching funds for SCHIP. This year, 14 states are expected to run out of federal funds by May.
As Congress considers the reauthorization of SCHIPthis year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement. (SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.)
When it comes to decreasing physician pay under the sustainable growth rate formula, both Democrats and Republicans have expressed interest in finding a solution. However, no one has come up with a remedy that fits into the current budget outlook.
“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” the Republican congressional staffer said.
Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.
Democrats speaking at the conference said they hope to make refinements to the Medicare Part D drug benefit, such as improvements in the low-income subsidies and a reassessment of the higher payments that Medicare Advantage plans currently receive. Several proposals have already been introduced to allow the government to negotiate drug prices.
Republicans are expected to oppose significant changes to the program. “From our perspective this program has been wildly successful beyond any estimation that we could have made back in 2003 when we passed the Medicare Modernization Act. [In light of this], why are we talking about making fundamental changes to this program?” said the Republican congressional staffer.
While action on these and other health care issues seem likely this year, there is a short window of opportunity to complete them before election politics come into play, said Dr. Ornstein.
“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along. That doesn't mean you have to finish everything, but … you better be pretty close to field goal range at the end of that 8 months,” he said. That seems likely to hold true now this year given that at least 26 members of Congress have announced or are considering announcing a run for the White House, he said.