Think Positive!

As a new Congress returns to Washington, we are presented with a new set of opportunities (and likely challenges) that emanate from a shift in control from the Republicans to the Democrats.

The move to a Democratic majority in both chambers means that the chairmen of all the committees in both the House and the Senate will change. In addition, the Democrats’ narrow majority in the Senate means that Republicans in that chamber will still be influential, and their support will be critical to the passage of any bill.

The Democratic leadership has pledged to address some large Medicare issues in 2007. They have said that they want to give the federal government the authority to negotiate directly with pharmaceutical manufacturers to obtain better drug prices under the new Medicare prescription drug benefit.

Congressional Democrats this year will also seek to offer health care coverage to more uninsured children, and possibly to more adults, as part of legislation reauthorizing the State Children’s Health Insurance Program. Many Democrats see this legislation as the only opportunity before the 2008 presidential election to inch closer to their goal of ensuring universal health care.

While Democrats wish to expand coverage, they also want to reduce the budget deficit. That’s the overall paradox Congress will be faced with this year.

What does the power shift mean for our industry? First, prospects for passage of modifications to competitive bidding (such as the Hobson-Tanner and Hatch-Conrad bills) are brighter. Second, reversing the Deficit Reduction Act’s provision requiring beneficiaries to assume ownership of oxygen equipment after 36 months is a real possibility, as is passage of the Home Oxygen Patient Protection Act.

At the same time, we will still be faced with the “image issue” that continues to plague our industry in Washington. Like it or not, our industry suffers from negative perceptions. The only way we can effectively combat that is to work with consumers and their representatives to amplify the message of the value that our industry brings to consumers’ lives. This must happen at both the local/grassroots level and the national level. In addition, providers need to cultivate relationships with their members of Congress to educate them about the items and services we provide so these policy-makers are informed about issues of importance to us.

With respect to our specific Medicare issues, we have excellent policy arguments to pursue legislative modifications (or even repeal?) of competitive bidding. The impact on consumers and small business will likely be dramatic.

In addition, the forced ownership of oxygen will likely drive up the costs of competitive bidding. The current requirement that providers transfer ownership of oxygen equipment to beneficiaries greatly complicates competitive bidding by increasing the provider’s costs from losing equipment and, therefore, the prices the provider can bid.

Medicare may end up paying more for home oxygen due to the significant increased costs to providers that result from the loss of equipment. As a result, Congress should repeal the provision that requires beneficiaries to assume ownership of oxygen equipment and, instead, allow them the choice of whether they wish to assume ownership.

In 2006, bills were introduced in both the House and Senate that would remove the restrictive “in the home” language in the Medicare statute. (CMS has interpreted the phrase to mean that coverage for DME is limited to a beneficiary’s need for the item in the home.) The bills enjoyed support from more Democrats than Republicans. If these bills were passed into law, Medicare beneficiaries would undoubtedly have increased access to the level of equipment that suits their medical needs and lifestyles.

Clearly, 2007 presents numerous opportunities. But these things don’t happen without widespread and real involvement by providers across the country. Join your state/regional and national associations to get plugged in and obtain talking points on these issues. The future is ours, for home care truly is the cost-effective, consumer-preferred way to receive health care.

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].