Washington
Round-Up
July Washington Round-Up
Congress Moving on Managed Care Reform Legislation
With both the House and the Senate
Republican Health Care Quality Task Forces having completed
their work, both chambers have been working diligently to consider
managed care reform legislation before the August Recess. Due
to the mounting political and public pressure for managed care
reform, the House leadership decided to bring the bill straight
to the House floor for consideration, by-passing the normal
route through the committee review process.
On Friday, July 24, 1998, the House
passed H.R. 4250, the bill produced by the Republican House
Working Group on Health Care Quality, on a party-line vote,
216-210, with 12 Republicans voting against it and three Democrats
supporting the measure. Also, due to mounting pressure from
Democrats and Republican moderates, House Republican leaders
agreed to offer the Democrats version of managed care reform,
H.R. 3605. The bill was defeated on a 212-217 vote.
Both Republican
and Democratic bills offered some consumer protections, such
as a method to appeal
denials of coverage and a ban on "gag rules" that
would restrict communications between physicians and patients
regarding treatment options.
Both House and Senate versions would
include expanded access to tax-sheltered medical savings accounts,
which Democrats oppose.
The House Republican bill would
allow small businesses and associations to buy health insurance
more cheaply. The Senate Republican version does not include
this clause.
The Democratic bills in both the
Senate and House would provide more specific coverage mandates,
broader patient protections, broader access to specialty care,
the continuity of care when a patient's doctor leaves a health
plan, and would allow patient's who are injured or killed as
a result of an insurer's refusal to cover a particular treatment
or diagnostic procedure to sue the health plan for malpractice
and recover damages in state court.
The Congressional Budget Office
(CBO) has said that the Republican bill could reduce the average
medical insurance premium by 0.1 percent while the Democratic
plan would increase premiums by about 4 percent.
The Senate Republican leadership
hopes to bring their version of managed care reform legislation
to the Floor before they leave for Summer Recess on July 31st.
The President has stated that he
will veto managed care legislation if it is similar to the
House version.
OPTN Delay & OPO
Notification Amendments Included in the FY 1999 Appropriations
Bill
During the recent House Full Appropriations
Committee markup (approval) of the FY 1999 Labor, Health and
Human Services Appropriations bill, a legislative rider was
included that would delay implementation of the OPTN rules
until November 1, 1999.
This provision was first attached
to the legislation by Congressman Bob Livingston (R-LA), Chairman
of the House Appropriations Committee, and Chairman John Porter
(R-IL), Chairman of the House Appropriations Subcommittee on
Labor, Health and Human Services during Subcommittee approval
of the bill.
In addition, the
House Full Appropriations Committee also included an amendment
to delay the implementation
of a Medicare "Conditions of Participation" rule
addressing hospital notification of OPOs (scheduled to be implemented
on August 21, 1998). As you know, the Department of Health
and Human Services (HHS) and the Health Care Financing Administration
(HCFA) issued this rule in June. The purpose of the regulation
is to address organ donation and transplantation issues as
conditions of participation for hospitals to participate in
the Medicare and Medicaid programs. The final rule seeks to
increase organ donation by improving overall communications
between hospitals, organ procurement organizations and the
families of potential organ donors.
ASTP leadership,
the Public Policy Committee, and the Public Policy staff have
been working actively
with key decision-makers on Capitol Hill and within the Administration
to positively resolve these issues. Recent activities have
included "Action Alerts" to the entire ASTP membership
urging letters and telephone calls to Congressional leaders
and Members of the Appropriations Committees. ASTP also initiated
and coordinated a recent joint letter to Congress from ASTP,
the American Society of Transplant Surgeons and the Association
of Organ Procurement Organizations. The letter strongly urged
Congress to support the Medicare conditions of participation
policy to increase organ donation.
Prior to the August Congressional
recess, ASTP President John Neylan, MD, and President-Elect
John Lake, MD, came to Capitol Hill to discuss the OPTN and
OPO issues with the Department of Health and Human Services
and targeted Congressional leaders before they return home
for August recess. During meetings on Capitol Hill and within
the Department of Health and Human Services, ASTP has maintained
that if a delay of the OPTN rule does occur - that any such
time should be utilized constructively (with all of the appropriate
members of the community) so that the process may continue
to move forward.
The Senate Appropriations Committee
is expected to begin its consideration of the FY 1999 Labor,
Health and Human Services funding bill when Congress returns
to Washington in September.
Physician Congressman Greg Ganske
Resigns From Medicare Commission
Rep. Greg Ganske
(R-Iowa) resigned from the National Bipartisan Commission on
the Future of Medicare
on July 16. In a press statement, Rep. Ganske commented that
dissension in the Republican conference caused by his high-profile
role in pushing for "patients' rights" legislation
could hamper the Commission's work. The same day, Ganske had
appeared at a press conference with President Clinton and prominent
Democrats to urge the passage of H.R. 3605, the "Patients'
Bill of Rights."
Rep. Ganske's statements on his
resignation and on H.R. 3605 are available on the Web at http://www.house.gov/ganske/press.htm.
House FY 1999 NIH Funding Legislation
Set for Floor Consideration Next Week
The House is tentatively
scheduled to consider H.R. 4274, the FY 1999 Labor, Health & Human
Services, and Education Appropriations bill, which funds the
National Institutes of Health, next Wednesday or Thursday.
Last week, the House Appropriations Committee approved the
FY 1999 appropriation of $14.862 billion for the NIH, an increase
of 9.1 percent over the FY 1998 funding level. The appropriation
is $98.7 million more than President Clinton had requested.
However, the fate of the bill in its current form is uncertain.
Some House members are unhappy with the number of "legislative
riders" that are attached to the bill and may oppose the
bill in protest or attempt to amend the bill on the floor.
A "legislative rider" is a term used for a policy
provision that is attached to a spending bill. According to
House rules, spending bills are for appropriations matters
only and should not contain any policy changes, or "legislative
riders." H.R. 4274 contains a number of riders that would
eliminate several programs, most of which fall under the Department
of Education.
The committee also approved an appropriation
of $171.1 million for the Agency for Health Care Policy and
Research, the same amount the President had requested and a
16.8 percent increase over FY 1998. Health professions' education
received an appropriation of $303.8 million, or a 3.9 percent
increase over FY 1998.
