Democrats and Health Care

With a new Congress comes new opportunities for our industry to move our policy agenda forward on Capitol Hill.

The Democrats control a majority in both chambers for the first time since the 103rd Congress in 1993-1995. Democrat Nancy Pelosi became the first woman to serve as Speaker of the House. With a decided 233-202 majority, the Democrats have dramatically changed the political dynamics in the House of Representatives.

With these numbers, House Democrats are capable of moving their agenda forward, as evidenced by their first week back in session in early January. During the first 100 days of the new 110th Congress, the Democrats delivered on campaign promises when the House easily passed several key bills.

The Democrats’ bill (H.R. 4) requiring the federal government to negotiate directly with pharmaceutical manufacturers for drugs provided under the Medicare Part D drug benefit passed by a vote of 255-170. The measure would change the benefit to require the Secretary of Health and Human Services to negotiate prescription drug prices that beneficiaries receive under the benefit directly with pharmaceutical manufacturers. It would also bar the government from setting up a formulary or restricting access to drugs as a way of leveraging lower prices.

The original Medicare drug benefit law, passed as part of the 2003 Medicare Modernization Act, bars the federal government from being involved in negotiations by the private health insurance plans that run the programs.

Prospects for passage of this prescription drug bill are far less certain in the Senate, where Democrats enjoy only a 51-49 majority. Even if the Senate were to pass the measure, President Bush has pledged to veto it.

Washington insiders see the House passage of this prescription drug bill as just the first front in the Democrats’ battle with the health care industry. A likely next target on the list is the insurance companies, which will be faced with demands for cuts in their Medicare subsidies under the Medicare Advantage program.

As part of the 2003 Medicare drug benefit legislation, the Republican Congress sought to infuse more private-sector involvement into the program by dramatically increasing federal payments to private insurance plans operating in Medicare Advantage. In that part of Medicare, private insurers provide beneficiaries a package of medical benefits as an alternative to the traditional Medicare Parts A and B programs.

Democrats say the payment increases for insurers in the Medicare Advantage program — projected to be worth as much as $46 billion over the decade beginning in 2004 — are a waste of taxpayer money, and they view Medicare Advantage as an attempt by Republicans to privatize the traditional program. This year, some Democrats want to reduce payments to the private plans, and budgetary concerns are heightening the pressure on the payments to insurers.

The State Children’s Health Insurance Program, a federal block grant, will soon need to be reauthorized, and many Democrats would like to expand it. Congress is also likely to boost Medicare payments to doctors. At a time when Democrats are aiming to be fiscally responsible, such spending would likely have to be offset, particularly under the new “pay as you go” rules Congress recently approved.

So what does all this mean for HME? It means there are many new leaders and other members we must meet, cultivate relationships with and educate. It means we must frame our issues in a way that is appealing to the Democratic majority and the moderate Republicans in the Senate who will be key to passage of any measure. It means we must truly get consumers involved in communicating our agenda to members of Congress.

Our priorities are limited — no further cuts to Medicare payments for home oxygen therapy and repeal of competitive bidding or, at least, legislative modifications to rationalize the government’s implementation of the bidding program. Within the context of the various congressional priorities, we must ensure that House and Senate leaders understand our issues and are ready to work with us to achieve these priorities.

A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 440/329-6226 or by e-mail at [email protected].