Congressional Outlook

With the prospect of war on the horizon, it is hard to be excited about watching what will unfold domestically in 2003. Nonetheless, a major part of our population will be focusing intently on Washington as President Bush attempts to address both domestic issues and international crises while initiating his own re-election campaign.

The President’s Jan. 28 State of the Union address was one of the more interesting that I have witnessed. It was full of surprises — initiatives for developing a hydrogen-powered car, assisting those suffering from addiction and providing medicines to AIDS victims in Africa — balanced with strong and determined words about the situation in Iraq. The President seemed to say that the United States would provide compassionate assistance to those in need around the world, but would also provide security by serving as an international “policeman” that will come down very hard on “outlaws.” I believe the contrasts and the delivery of the last two-thirds of the speech — where the President’s compassion and determination came through so clearly — made this a memorable address.

The major domestic issues that will be the subject of great debate this year were mentioned only briefly and were overpowered by the rest of the speech. The President was very vague about Medicare, and subsequent attempts by the press to clarify what the President has in mind regarding reform have not met with much success.

Prior to the State of the Union, there were rumors that the President would propose a major overhaul of Medicare, with the intent of moving beneficiaries from the existing fee-for-service plan into health maintenance organizations and preferred provider organizations administered by the managed care industry. The carrot for seniors to move into managed care would be the availability of a prescription drug benefit in those plans — and only in those plans. In his speech, the President clearly implied that the prescription drug benefit would not be available to those who stayed in the traditional Medicare plan. Yet, the White House dodged questions about this after the speech and said it would be a few weeks before it would send details to Congress.

Both Republicans and Democrats in Congress have been quick to argue that beneficiaries should receive prescription drug benefits whether or not they stay in the traditional plan. Sen. Chuck Grassley, R-Iowa, announced that this would be his position at a breakfast I attended the day the President delivered the speech. Since then, Sens. Olympia Snowe, R-Maine, George Voinovich, R-Ohio, Tom Daschle, D-S.D., and others have expressed their strong beliefs that seniors should not have to leave their existing plan to receive prescription drug benefits. Even Rep. Tom DeLay, R-Texas, the Majority Leader of the House of Representatives, has stated that seniors will not be faced with such a choice.

All of this leads to the questions of whether Medicare legislation will be passed this year and what it will look like. Answering either of these questions is very difficult. Although the Republican majority is stronger — with Sen. Bill Frist, R-Tenn., a medical doctor who is a strong proponent of sweeping Medicare reform, as Senate Majority Leader — passing Medicare legislation will be no easy task. The President is calling upon Congress to provide funds for a massive economic stimulus program, prescription drugs and Medicare reform, and to wage a war. Each one of these will consume hundreds of billions of dollars. The question is, Can the country can afford to do all three?

Further, if we go to war in the Middle East, the attention of everyone in the country will necessarily be focused on that war effort. This will make it very difficult for Congress to address the very thorny issues that Medicare reform raises.

Nonetheless, I would wager that we will see activity in the House of Representatives on prescription drugs and some Medicare reform by late spring or early summer. Rep. Bill Thomas, R-Calif., the Chairman of the House Ways and Means Committee, which has jurisdiction over Medicare legislation, is a forceful leader and will probably want to demonstrate that the House of Representatives has acted on the Medicare issue. I suspect the legislation he will pass will look something like the legislation for prescription drug and Medicare reform that he passed last year.

I do not believe reform will be nearly as sweeping as what it appears the White House had originally intended. It is very likely that Rep. Thomas will address the competitive bidding and average wholesale price issues in this legislation. In a meeting last month, Rep. Thomas said he still believed competitive bidding was very important. He also said he intended to address the average wholesale price for prescription drugs, although his staff had not finalized a solution to what he perceives as the problem with AWP.

However, passing Medicare legislation in the Senate will be very difficult. Republicans have only a two-vote majority, and the Democrats have parliamentary opportunities to prolong debate. There at least will be significant discussion, though, and perhaps a breakthrough that brings consensus.

All of this means that AAHomecare’s members and staff must continue their vigorous opposition to national competitive bidding. We already have begun to re-educate members of key AAHomecare committees about this issue. The Coalition for Access to Medical Services Equipment and Technology, which AAHomecare organized last year and continues to lead, has been called back together and will lobby both in Washington and at the grassroots level.

We will also have to make clear once again to policymakers that any reform of the AWP system must include provisions to reimburse home care providers for services performed as a part of furnishing respiratory medications or infusion therapies in the home setting. AAHomecare will need assistance from its members who provide these medications and therapies in educating the key players.

In addition to these issues, the inherent reasonableness regulation becomes final this month, and AAHomecare has filed comments pointing out the shortcomings of this regulation. Tom Scully, administrator of the Centers for Medicare and Medicaid Services, stated recently that the agency has no plans to exercise its IR authority at this time, and he hopes that it will be a tool of last resort. However, IR remains a dark cloud over the industry, and AAHomecare and our industry must be prepared to respond promptly if the DMERCs wade into this morass.

In the almost three years since I joined AAHomecare and the home care industry, there is one thing I have learned for certain: We can expect the government to take actions — or attempt to take actions — that will significantly impact the ability of our members to provide products and services for Medicare beneficiaries. This year will be no different. I am determined, however, that as we fight the fires — foreseeable and unforeseeable — we will also do everything we can to convince policymakers that home care is essential to solving the health care crisis facing this country. We simply cannot institutionalize the baby boom generation.

AAHomecare will do everything we can to advocate for expanding both the home health benefit and coverage of HME so that patients with chronic illnesses or disabilities can stay and be treated at home, where they want to be treated, and where it is most cost-effective. It is time for both Congress and the Administration to recognize that the country needs a robust home care industry, and that they should stop taking actions to destabilize it and make it more difficult to provide the services that will be so badly needed by Americans.

Tom Connaughton is president and chief executive officer of the American Association for Homecare in Alexandria, Va. To learn more, visit www.aahomecare.org.