Healthcare lobby seeks last-minute bargains

Last-minute shoppers in the healthcare lobby will be busy this week.

Last-minute shoppers in the healthcare lobby will be busy this week.

While members and staff continue trying to work out a deal to block a 5 percent cut in Medicare’s payments to doctors, lobbyists for a variety of healthcare interests will make final pitches for pet projects of their own.

But as many holiday shoppers will learn in coming weeks, sometimes cupboards are bare. With time running short, some lobbyists doubt that the Medicare provisions they seek will make it through Congress this week.

K Street and Capitol Hill sources say lawmakers and staff, in consultation with the Bush administration, are weighing a lengthy list of possible add-ons to the Medicare physician-payments legislation.

It includes priorities for nursing homes, physical therapists, medical-device manufacturers, rural healthcare facilities, kidney-dialysis providers and even language designed to reverse an unfavorable federal court decision affecting a group of hospitals in Tennessee.

These legislative items carry a collective price tag approaching $20 billion and there appear to be few available offsets that do not spark strenuous objections from healthcare interests or the administration, such as the notion of carving out a few billion dollars from Medicare’s payments to health insurance companies.

The outgoing GOP majority’s apparent decision not to advance the remaining appropriations bills or an omnibus bill also deprives lawmakers of a massive vehicle to which they can attach costly riders such as the Medicare physician-payment fix.

Lobbyists also said leadership transitions in both chambers, not to mention the impending change in party control, are hampering the talks. House Ways and Means Committee Chairman Bill Thomas (R-Calif.) and Senate Majority Leader Bill Frist (R-Tenn.) did not run for reelection, and House Speaker Dennis Hastert (R-Ill.) will not be part of the GOP leadership team next year.

Most lawmakers have not been in Washington since before Thanksgiving and some may not return at all. Congressional aides also are dealing with logistical issues as office space changes hands in advance of the 110th Congress.

Extending several tax provisions, such as the research and experimentation tax credit, enjoys broad support in Congress, and lawmakers may be reluctant to jeopardize their prospects by attaching costly Medicare legislation to them.

The physician-payment issue remains the prime motivator for lame-duck legislating on healthcare. Without congressional action, doctors will see their fees reduced by 5 percent on Jan. 1.

Yearlong negotiations between the physicians’ lobby and lawmakers have not resulted in a deal. One proposal under consideration would freeze payments at this year’s rates and offset the cost by enacting a 10 percent cut in 2008, which would create a bigger problem that the incoming Democrats would have to address.

But doctors aren’t the only ones making last-ditch attempts to win desired legislation as the 109th Congress winds down.

Lobbyists for other healthcare interests have suspected for months that their efforts would continue all the way into the lame-duck session, regardless of the outcome of November’s elections.

The New Year will bring new limitations on physical, speech and occupational therapy for Medicare beneficiaries. Therapy caps would restrict beneficiaries to about $1,700 each year in physical and speech therapy and the same amount for occupational therapy.

In the Deficit Reduction Act (DRA) that passed this year, Congress required the administration to create a process that allows for exceptions to these restrictions. Although these provisions were a win for nursing homes, physical therapists and their allies, the policy expires at the end of this year. At a minimum, the therapy providers want Congress to extend the exceptions process; their ultimate goal is to eliminate the caps altogether.

Medical-device manufacturers are seeking relief from DRA provisions that will reduce Medicare’s payments for medical-imaging services.

Other industries are on defense, such as the health insurance sector, which is fighting to discourage lawmakers from viewing its Medicare funds as a source of dollars for other programs. Kidney-dialysis facilities and the makers of kidney medications also face a threat to their Medicare payments. Home-health providers, hospice providers and even hospitals must be on the lookout for their payments being trimmed to cover the cost of the doctor fix or other provisions.

Individual lawmakers have issues of special interest that they also hope to attach to a Medicare package.

Senate Finance Committee Chairman Chuck Grassley (R-Iowa) is a fervent supporter of payment bonuses for rural healthcare providers and an ardent backer of restricting the proliferation of specialty hospitals. Thomas has been a leading voice in Congress promoting the administration’s goal of requiring hospitals to publicly disclose the prices they charge for medical procedures.

Beyond Medicare, lawmakers are eyeing legislation on other healthcare programs.

Incoming House Speaker Nancy Pelosi (D-Calif.) is among those pushing for an extension of a program that lets people remain on Medicaid for a period of time after an increase in income would make them ineligible. Democrats, and a few Republican allies, also hope to shore up the State Children’s Health Insurance Program. The Ryan White CARE Act program for HIV/AIDS treatments expires Dec. 31 and a reauthorization has been held up by disputes about regional funding allocations. House Energy and Commerce Committee Chairman Joe Barton (R-Texas) shepherded legislation to reauthorize the National Institutes of Health through the House and continues to support final action on his bill.