Uphill Battles Await White House
Health Care Proposals in Congress
This Year
By Kate
Schuler, CQ Staff
President
Bush and congressional Republicans
will be highlighting their health
care agenda heading into midterm
elections this year, but most of
their initiatives are likely to be
recycled measures that Congress has
rejected in the past.
Following the White House's lead,
GOP lawmakers are expected to
promote market-oriented proposals
designed to rein in soaring
insurance costs for employers and
the federal government while
boosting the number of Americans
with some type of health coverage.
In his
State of the Union address next
week, Bush will be pushing tax
incentives for certain types of
heath insurance and more reporting
of quality data for health care
services - initiatives aimed at
giving patients a bigger stake in
choosing when to seek care and from
whom. Supporters call the approach
"consumer-directed health care."
Before
GOP leaders can dive into the
systemic changes they would like to
promote in the health care system,
they will have to deal with fallout
from a rocky start to the new
Medicare prescription drug benefit,
which took effect Jan. 1.
Widespread problems reported by
low-income seniors in getting drugs
they have previously received
through Medicaid, the joint
federal-state health insurance
program for the poor, have captured
media attention. Many states have
stepped in to pay for seniors' drugs
until Medicare gets the problem
sorted out and begins picking up the
cost through private health
insurance plans. Some moderate
Republicans and Democrats have
introduced legislation to require
the federal government to reimburse
states and to provide more
information to users.
"The
most pressing thing is the drug
benefit," said
Preston Hartman,
spokesman for moderate Republican
Sen. Olympia J. Snowe of
Maine.
"Extending the sign-up period is
something she really wants to do."
Snowe's bill (S 2168) is aimed at
giving seniors more time to sign up
for a plan without being penalized
with a late fee.
An
announcement Jan. 24 from Health and
Human Services Secretary Michael O.
Leavitt that the government would
cover any costs states cannot recoup
from health plans might blunt some
of pressure for congressional
action, but Democrats are likely to
keep up their calls for changes to
the program anyway.
Prescriptions
for Health Care
Among
the proposals Bush is expected to
outline next week is a plan to
expand tax breaks for individuals
purchasing health insurance. He may
also urge Congress to allow
taxpayers who buy their own coverage
to deduct their premium costs, since
premiums for employer-provided
health insurance are excluded from
taxable income.
Bush is
also expected to seek an expansion
of tax incentives for health savings
accounts (HSAs), which allow
consumers who purchase
high-deductible health plans to set
aside pre-tax dollars to cover their
routine health care costs. After
they spend a fairly significant
amount of their own money -
thousands of dollars for a family -
the insurance kicks in.
Republicans hope HSAs will prompt
patients to be more cost-conscious
consumers. Critics say such accounts
discourage cash-strapped individuals
from seeking care when they need it.
Getting
such legislation through Congress
this year could prove difficult.
There will be pressure on members to
rein in the deficit, and the cost of
new tax breaks could make lawmakers
skittish.
Congress has yet to clear tax cut
legislation (HR 4297, S 2020) that
the two chambers passed last year
under special reconciliation
protections that bar filibusters in
the Senate. With deficits climbing,
many lawmakers could be leery of
seeking yet more tax cuts.
In his
State of the Union address Jan. 31,
Bush also is expected to advocate
steps to give patients more
information about the quality of
health care providers and services
so they can make more informed
choices. Eventually, supporters
argue, this market-based approach
will lead to improved quality and
lower costs.
Joseph
Antos, health policy expert at the
American Enterprise Institute, said
better information about quality
would not yield immediate results
but could work over time. "I have
hopes we'll see savings down the
road," he said. "I have expectations
it will improve care."
Antos
added that granting access to such
data is something the administration
could do without going through
Congress.
Republicans in the House began to
put pressure on the American Medical
Association (AMA) last year to
report more data about what they do
and how patients fare. They sought
to tie an increase in Medicare
reimbursement rates for doctors to
good scores on various standards of
care. Known as
"pay-for-performance," the idea has
broad support among Republicans,
particularly in the House, but the
powerful doctors' lobby has opposed
moving hastily to such a system.
"We're
dedicated to efforts to improve
quality, but we want to make sure
it's done right . . . a phase-in
approach would be most appropriate,"
an AMA spokeswoman said.
Proposals
to accelerate the use of
computerized medical records also
will be on the agenda for both
Congress and the administration.
Senate
Majority Leader Bill Frist, R-Tenn.,
and Democrat Hillary Rodham Clinton
of New York formed an unusual
coalition last year to pass a bill
(S 1418) encouraging the
standardization and widespread use
of electronic medical records. In
the House, similar legislation (HR
4157) will be a priority for
Republicans Nancy L. Johnson of
Connecticut
and Nathan Deal of
Georgia.
The president last year said
electronic medical records for most
Americans should be available within
a decade.
"The
impact of technology in health care
goes beyond its role as a
cost-savings measure, though the
possibilities for reducing
inefficiencies and eliminating waste
are tremendous," said Sarah
Chamberlain Resnick, executive
director of the
Republican Main Street
Partnership, a coalition of moderate
Republicans.
By
reducing medical errors attributable
to illegible prescriptions and other
handwritten documents, and by
speeding communication among all
those treating a patient, electronic
records can also improve quality of
care and reduce the need for
treatment of injuries or illnesses
caused by medical errors, advocates
say.
On
another front, Snowe is pushing
legislation (S 406) to allow small
businesses that band together to
purchase health insurance to bypass
state coverage mandates.
The
House has passed such measures
numerous times - most recently in
August (HR 525) - but senators have
been reluctant to override state
requirements.
Michael
B. Enzi, R-Wyo., chairman of the
Senate Health, Education, Labor and
Pensions Committee, has introduced a
bill (S 1955) that might appease
some critics by requiring plans to
adhere to mandates that are
established in at least 45 states.
"Small
businesses have few - if any -
choices when it comes to purchasing
quality, affordable health
insurance," Snowe said Jan. 19.
But
even if the proposals are repackaged
to attract some additional support,
Bush's agenda is unlikely to gain
much traction in an election year.
"There
are other fish to fry. And Congress,
in an election year, will have a
hard time focusing on a set of
proposals that don't excite the
average voter," said Robert
Reischauer, the president of the
Urban Institute and a former
director of the Congressional Budget
Office.
"The
average American is not out on the
street pleading for health savings
accounts or consumer-directed plans.
They want the comfort of the
traditional health insurance
coverage," he said.
