Annals of Long Term Care

109TH CONGRESS CONVENES

Lawmakers convened January 4th for the start of the new Congress. Members were sworn in, and party leaders filled vacant committee seats. The 109th Congress has nine new senators, 40 new House members, and one new delegate. Four more physicians were elected in November, bringing the total number of doctors on Capitol Hill to 11. Joining their colleagues in the House and Senate are: Rep. Charles Boustany, MD (R-LA), a thoracic surgeon; Rep. Tom Price, MD (R-GA), an orthopaedic surgeon; Rep. John J.H. “Joe” Schwarz, MD (R-MI), an otolaryngologist; and Senator Tom Coburn, MD (R-OK), a family physician.

The Republican leadership chose new chairmen for several committees with jurisdiction over issues important to the long-term care community. In the Senate, Michael Enzi (R-WY) now heads the Health, Education, Labor and Pensions Committee, succeeding Judd Gregg (R-NH), who stepped down to chair the Budget Committee. Enzi’s priorities include improving access to health care, workforce issues, patient safety legislation, and accelerating the use of health information technology. Democrat Edward Kennedy (D-MA) remains as Ranking Member. The Senate Appropriations Committee is chaired by Thad Cochran (R-MS), who replaced Ted Stevens (R-AK).

In the House, Republicans selected Rep. Jerry Lewis (R-CA) to chair the powerful Appropriations Committee. Lewis beat out Reps. Ralph Regula (R-OH) and Hal Rogers (R-KY) for the post. A longtime veteran of the Appropriations panel, Lewis is beginning his 14th term in the House. He replaces Rep. Bill Young (R-FL), who had to step down due to term limits. The Appropriations Committees in the House and Senate have jurisdiction over funding for the National Institutes of Health (NIH), including the National Institute on Aging, the Agency for Healthcare Research and Quality, and Title VII health professions programs, including geriatrics training programs.

The Republican leadership removed Rep. Chris Smith (R-NJ) as chair of the Veterans Affairs Committee, a move that drew strong protests from veterans groups. He is succeeded by Rep. Steve Buyer (R-IN).

No changes were made in the leadership of the committees with jurisdiction over the Medicare and Medicaid programs.

Medical liability reform and potential reductions in entitlement programs will dominate debate on Capitol Hill this year. Tight limits on the rate of growth for discretionary spending on the NIH and aging programs in fiscal year (FY) 2006 will be considered as well in an effort to rein in a record federal deficit. The release of President Bush’s budget in early February will trigger congressional discussion and action in these areas.

MEDICAL LIABILITY

President Bush has made passage of tort reform legislation by the GOP-controlled Congress a priority for his second term. In his first major speech of the new year, delivered in Madison County, IL, Bush decried the proliferation of “junk” lawsuits, which “drive up insurance costs for all doctors, even for those who have never been sued; even for those who have never had a claim against them.” He called on Congress to deliver “a meaningful, real medical liability bill to my desk so I can sign it in the year 2005.”

Last year, legislation to cap noneconomic damages passed the House but stalled in the Senate.

Senate Democrats, though weakened by the loss of four seats in the November elections, intend to continue to fight the President’s liability proposal. Edward Kennedy (D-MA) called the President’s medical malpractice plan “nothing but a shameful shield for drug companies and HMOs who hurt people through negligence.”

MEDICAID

Another battle is brewing over potential cuts in federal Medicaid support to the states as a way of reducing the budget deficit. In December, Senate Democrats wrote to the President outlining their opposition to Medicaid reforms that cap federal spending or undermine the program’s coverage entitlement. The National Governors Association (NGA) also has mounted a bipartisan lobbying effort to fend off new federal limits on Medicaid. In a letter to the President, NGA Chair, Mark Warner (D-VA), and Vice-Chair, Mike Huckabee (R-AR), said, “We agree that maintaining the status quo in Medicaid is not acceptable. However, it is equally unacceptable in any deficit reduction strategy to simply shift federal costs to states.” The NGA noted that its most recent survey of states shows Medicaid now averages 22% of state budgets, a commitment that “has caused a strain on funding for other crucial state responsibilities.”

Likewise, provider groups have signaled their concerns as well. AGS joined 25 other organizations in urging the President not to propose any reductions or caps on Medicaid spending in his FY 2006 budget. “With many states in fiscal crisis, Medicaid reductions at the federal level would drastically unravel an already frail health care safety net,” the organizations warned in a December 16th letter.

Other groups signing on to the letter include the American Medical Association, the American Hospital Association, the American College of Physicians, and the American Academy of Family Physicians.

MEDICARE

Medicare is also seen as a likely target for budget reductions in FY 2006. Finding savings in the program will not be easy, however. Physicians and other providers paid under the fee schedule already face cuts of 5% annually each year from 2006 through 2012 under current law, unless Congress acts. Physician groups, including AGS, will be at the forefront of efforts to fight these reductions as well as to seek a permanent fix to the formula on which the update is based. Complicating reform of the sustainable growth rate (SGR) formula, however, is the high cost of corrective action, estimated at between $90 billion and $115 billion.

Lawmakers are looking closely at recommendations by MedPAC and others to tie physicians’ reimbursement to their performance, but provider groups, including AGS, warn that additional funding, rather than a budget-neutral redistribution of funds among physicians, will be crucial to the success of such an initiative. In a December letter to MedPAC commissioners, AGS and over 45 other organizations representing physicians argued that any pay-for-performance initiatives recommended by the commission to Congress should not be budget-neutral within the physician reimbursement system and should not be subject to volume controls such as the SGR formula. Rather, the letter said, “Comprehensive efforts to improve the quality of patient care should be accompanied by reliable, positive updates in physicians’ Medicare reimbursement rates.”