Congress likely to tackle only modest healthcare measures before Nov. elections

After months of heated debates on hot-button healthcare issues, congressional leaders are looking to pass a few lower-profile health bills before the end of the 109th Congress.

The politics of healthcare issues typically do not lend themselves to election-year compromises and 2006 has not proved exceptional in this regard. President Bush vetoed the stem-cell-research bill and the GOP leadership in Congress endured the Democrats’ sustained assault on Medicare Part D without giving in to demands to amend the law.

But congressional aides and healthcare lobbyists have not given up hope that lawmakers will take final action on some smaller measures before heading home for the election.

The Senate Health, Education, Education, Labor and Pensions (HELP) Committee looks to have a busy few weeks ahead as Chairman Mike Enzi (R-Wyo.) and ranking Democrat Edward Kennedy (Mass.) are working together in the hopes of negotiating deals with their House counterparts on two relatively popular pieces of legislation.

The first is a reauthorization of the Ryan White CARE Act, which created a $2 billion-a-year program that provides medical assistance to HIV/AIDS patients.

The HELP Committee marked up its version of the bill in early August, but the panel’s report was not considered a finished product. The measure would change the geographic distribution of grants under the program, which would realign the winners and losers and has prompted objections from big-city lawmakers and cheers from representatives of rural and southern locales.

The House Energy and Commerce Committee may mark up the bill in September, with Enzi’s measure as a starting point, congressional and K Street sources said. If the House panel is able to move quickly, the bill’s Senate champions hope to avoid a time-consuming conference committee and move the modified bill through the floor under a unanimous consent agreement, then send it back for a final vote in the House.

Similarly, the Senate sponsors of a bill to promote the use of information technology in healthcare want to find a way to compromise with a substantially different, wider-reaching bill that passed the House shortly before the August recess.

The effort is being spurred by the Senate bill’s heavy-hitting sponsors, who include Majority Leader Bill Frist (R-Tenn.), Sen. Hillary Rodham Clinton (D-N.Y.), Enzi and Kennedy.

Significant sticking points would have to be overcome quickly if the sponsors were to get a bill to Bush before adjournment. For example, the House bill includes requirements that healthcare providers employ a revised set of computerized billing codes that the Senate bill leaves out. The Senate measure also would establish a program to offer grants for healthcare providers to purchase new technologies, an element of the bill that many House members find objectionable.

Despite the political hullabaloo surrounding the Medicare drug benefit this year, calls from Democrats and some vulnerable Republicans that changes be made to the program are likely to remain unheeded. But a major drive for another Medicare measure will ramp up in September.

The physician lobby is making an aggressive push for legislation to block a 5.1 percent payment cut that will take effect in January if Congress does not act. The American Medical Association (AMA) has been waging its campaign in Washington and in key districts and states all year, and the issue remains at the top of its agenda. During the week of Sept. 11, the AMA has organized a fly-in of doctors from across the country for office visits with lawmakers and staff.

The chief obstacle to preventing the cuts, as ever, is the hefty price tag. Although lawmakers almost universally agree that the payment formula that calls for the cuts is flawed, even holding payments at this year’s level for a single year would cost $1.1 billion, according to the Congressional Budget Office. Palatable offsets have so far eluded Congress. In addition, physicians have been skeptical of plans floated by some Republicans to tie their payment fix to a new program that would link fees to improvements in the quality of medical care.

As usual, the end of the legislative year is approaching and Congress has failed to pass the Labor-HHS-Education appropriations bill, the spending measure that seems the hardest to get through. In spite of optimistic predictions from senior GOP appropriators, the fiscal year appears all but certain to end Sept. 30 without the labor-HHS bill being passed. Congressional and lobbyist sources expect to see an omnibus appropriations bill moved after the elections, at best, and have not ruled out the possibility that Congress will simply adopt a continuing resolution that lasts until January.

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