Senate Passes 2009 Budget Ignoring Bush Medicare,
Medicaid Cuts; Moves to Restore Docs Pay Cut
Paints bleak picture for next president, who will
face tough decisions, such as on cutting benefit programs to prepare for
the retirement of the baby-boomers
June 5, 2008 The Senate yesterday approved a new
budget for the 2009 fiscal year that ignores the cuts to Medicare and
Medicaid that were proposed in the budget proposed by President George
Bush. Senators on Finance Committee also moved closer yesterday to
agreement on legislation that will stop the 10.6 percent cut in Medicare
play for physicians now set to become effective on July 1. The final
details focus on funding and the possible increased pay in future years.
The Senate on Wednesday voted 48-45 to approve a
$3.1 trillion fiscal year 2009 budget resolution (S
Con Res 70), which includes large increases in funds for
domestic programs and excludes reductions in funds for Medicare and
Medicaid proposed by President Bush, the
AP/Philadelphia Inquirer
reports.
The resolution would increase funds for domestic
federal agencies by almost 5%, or $24 billion (Taylor, AP/Philadelphia
Inquirer, 6/5). The resolution includes $1.013 trillion in discretionary
spending (Sanchez, CongressDaily, 6/4).
The resolution would provide about $21 billion more
in discretionary spending than Bush requested. According to the
New York Times,
Bush has threatened to veto appropriations bills that exceed his
request, and Democrats might "try to avoid an election-year fight with
the White House by holding back major appropriations bills until his
successor takes office" (Pear, New York Times, 6/5).
According to the AP/Inquirer, the resolution
"leaves to the next president the task of sorting out a host of fiscal
problems" and "leaves wrenching Medicare and other federal benefit
decisions to future policymakers."
The resolution "paints a bleak picture for the
next president, who will face tough decisions, such as on cutting
benefit programs to prepare for the retirement of the baby-boom
generation," the AP/Inquirer reports (AP/Philadelphia Inquirer, 6/5).
Senate Budget
Committee Chair Kent Conrad (D-N.D.) said, "We have passed a
fiscally responsible budget, and that is a major accomplishment." He
added that the resolution would "expand health coverage for kids" (New
York Times, 6/5). White House
Office of
Management and Budget Director Jim Nussle criticized the
resolution as a "missed opportunity" to address long-term financial
problems in entitlement programs such as Medicare and Medicaid. He
added, "They deferred on the decision on entitlements, but they didn't
on taxes" (Clarke [1], CQ Today, 6/4).
Prospects
The House likely will approve the resolution on
Thursday (Montgomery,
Washington Post,
6/5).
House
Appropriations subcommittees likely will begin to mark up the
12 appropriations bills next week, "even though it appears unlikely that
Congress will send those bill to Bush," according to CQ Today (Clarke
[2], CQ Today, 6/4).
Rep. James Walsh (R-N.Y.), ranking member of the
House Appropriations
Labor, HHS,
Education and Related Agencies Subcommittee, said that the
subcommittee will not mark up the Labor-HHS-Education appropriations
bill for a few weeks (Clarke [1], CQ Today, 6/4).
The Senate will begin to mark up appropriations
bills as early as June 16 (Clarke [2], CQ Today, 6/4).
Supplemental War Appropriations Bill
In related news, opposition from the
Blue Dog Coalition
has delayed action on a $250 billion supplemental war appropriations
bill (HR
2642) that includes a one-year moratorium on seven new
Medicaid regulations proposed by the Bush administration, Roll Call
reports (Dennis, Roll Call, 6/5). The regulations would save Medicaid an
estimated $13 billion over five years (AP/USA
Today, 6/4).
The coalition opposes the legislation because of a
lack of offsets for some of the funds that the bill would provide. On
Wednesday, members of the coalition asked House Speaker Nancy Pelosi (D-Calif.)
and Senate Majority Leader Harry Reid (D-Nev.) to include offsets for
those funds. According to CQ Today, House leaders are "mulling"
proposals to address the concerns of the coalition, whose members have
threatened to vote against the bill (Clarke [3], CQ Today, 6/4).
Nussle on Wednesday reiterated that Bush would veto
the legislation in the event that the bill includes domestic spending
(Sanchez, CongressDaily, 6/5).
Senate Finance
Committee Republicans Outline Plans To Delay Medicare Physician Payment
Cut
Senate Finance
Committee Republicans, led by ranking member Chuck Grassley
(R-Iowa), on Wednesday released an outline of legislation that would
halt a 10.6% reduction in Medicare physician fees scheduled to go into
effect July 1, among other provisions, CQ Today reports. The bill will
compete with legislation
outlined
by committee Chair Max Baucus (D-Mont.), which also focuses on halting
the payment reduction.
The bills share some similarities, including
creating electronic prescribing requirements, adding quality reporting
programs and payment increases for physicians in underserved areas. In
addition, both outlines do not contain provisions that Democrats and
Republicans have disagreed on, including financial assistance for
beneficiaries enrolled in the Medicare drug benefit. Both bills also
would halt the payment reduction for 18 months.
However, Grassley's measure would provide
physicians with a 1.1% increase next year, compared with a 0.5% increase
proposed by Baucus. According to CQ Today, "While the difference seems
small, it could mean hundreds of millions of dollars in reimbursements
for physicians" (Armstrong [1], CQ Today, 6/4).
Baucus said he plans to introduce his bill on
Friday or Monday, while Grassley said he would introduce the competing
bill shortly thereafter (Edney, CongressDaily, 6/4).
'Tactical Maneuver'?
Grassley's crafting of a similar bill "could
represent a tactical maneuver ... to give moderate Republicans and those
facing tough election battles a GOP-written version of the bill they can
support," CQ Today reports (Armstrong [2], CQ Today, 6/4).
Either bill would need 60 votes in the Senate to
invoke cloture (Armstrong [1], CQ Today, 6/4). According to
CongressDaily, attaining 60 votes could be difficult for Democrats.
However, Baucus on Wednesday "returned ... to talk about compromise
after he abandoned bipartisan negotiations two weeks ago," CongressDaily
reports (CongressDaily, 6/4).
"We'll come together," Baucus said, adding, "It
makes much more sense for us to be together" (Armstrong [1], CQ Today,
6/4).
Funding 'Split'
According to CongressDaily, "Democrats and
Republicans mainly are split over how to fund the entire package."
Democrats want to make cuts to Medicare Advantage
plans, while Republicans are only willing to cut indirect medical
education payments in MA (CongressDaily, 6/4).
Conservative Republicans and the White House say
that private sector competition will ultimately reduce costs, but
Democrats disagree, according to CQ Today. Sen. Kent Conrad (D-N.D.)
said, "There have got to be savings out of Medicare Advantage. That is a
runaway train."
The bills are estimated to cost between $12 billion
and $18 billion (Armstrong [2], CQ Today, 6/4). However, neither outline
contains details about funding. The Bush administration opposes any cuts
to MA and has threatened to veto legislation that includes them.
Conrad said, "Frankly, the big problem is the White
House" (Armstrong [1], CQ Today, 6/4).
According to CQ Today, last December, Democrats,
led by Baucus, were faced with a similar issue. At that time, they
advocated for a two-year halt on payment reductions, "paid for with deep
cuts" to MA. Instead, a "more modest package" that halted physician
payment reductions for six months eventually emerged.
According to CQ Today, Conrad, Baucus and other
legislators have refused to discuss the possibility of a similar result.
However, lobbyists and other congressional observers say the current
debate could again result in a short-term solution, giving "lawmakers
nine months' or a year's worth of time to reconvene and try again under
a new administration" (Armstrong [2], CQ Today, 6/4).
E-Prescribing Garners More Support
In related news, support for e-prescribing in
Medicare is "gaining momentum in Congress" as both Baucus and Grassley
included similar provisions in their outlines, the Wall Street Journal
reports.
According to the Journal, both plans "would take a
carrot-and-stick approach" that would give physicians additional
Medicare payments for adopting e-prescribing, then penalize physicians
in subsequent years for failing to change over to the technology.
E-prescribing efforts also have received backing by a broad lobbying
coalition.
An aide to Baucus said that the lawmaker "believes
the Medicare program should be a leader in implementing widespread use
of e-prescribing in doctors' offices all across the country." Grassley
said that "e-prescribing makes a lot of sense wherever it's possible"
(Wilde Mathews/Radnofsky, Wall Street Journal, 6/5).
