Archive for the ‘Politics’ Category
Medicare, which by 1988 could absorb 10 percent of the federal budget, will be the broadest arena for debate, touching virtually every aspect of health care from money to medical ethics. Increased beneficiary cost sharing may not emerge in this politically risky presidential election year, but many other options to reduce federal spending are certain to be targets for possible action. Included in the growing list are mandatory assignment for physicians and reductions in Medicare payment rates for hospitals. Without question, the mood will be one of restriction, of tightening down.
Congress did not reach a consensus on major, long-term issues last year and may continue its postponement of reducing the federal deficit, predicted to top $200 billion a year into the indefinite future, or making structural changes in spending and tax laws to assure the solvency of Medicare’s Hospital Insurance (HI) trust fund. These could well become the legacy of the 99th Congress in 1985, as some legislators already have predicted.
This “congressional impotence,” as House Ways and Means Committee chairman Rep. Dan Rostenkowski (D-IL) called it, was not without its price to hospitals. AHA-supported provisions to improve the area wage index under prospective pricing were put on hold, as were continuation of a delay in the single reimbursement limit for skilled nursing facilities and hospital representation on peer review organization (PRO) governing bodies. And along with such holdovers was legislation in the House that would have exempted nonprofit hospitals from restrictions on the use of tax-exempt bonds.
Also put aside was a Senate bill (S. 951) to provide health insurance for the unemployed at a federal cost of $1.8 billion, including an amendment by Senator Lloyd Bentsen (D-TX)–strongly backed by the AHA, the Federation of American Hospitals (FAH), the Association of American Medical Colleges (AAMC), and National Association of Public Hospitals–that would have required states to spend 10 percent of program funds on grants to hospitals serving large numbers of the uninsured who are unable to pay for care. The House had attached similar provisions to its more generous $4 billion version of the bill (H.R. 3521), also lost in the haste to adjourn, that would have provided $233 million over three years to such hospitals.
Those issues will arise anew. And continued, perhaps more rancorous, debate will center on the politically charged issue of increased Medicare beneficiary cost sharing. In addition, recommendations of HHS’s Advisory Council on Social Security, which labored exclusively throughout 1983 on Medicare’s money problems, will raise the specter of capping the amount of tax-free employer-paid health insurance premiums (an option endorsed by the AHA); phasing-in an increase in Medicare eligibility age to 67, starting January 1, 1985; and requiring mandatory physician assignment, among other proposals. Early clues to the Reagan Administration’s initiatives, many to be based on council recommendations, are expected in the President’s health budget, which will be announced early in the year, probably not long after Congress convenes on January 23. But, for political safety, increased beneficiary cost sharing is not likely to be among them.