Health Bills Face Uphill Battle

Budget Woes Mean Reform Is Unlikely

Posted February 6, 2004 at 5:36pm

The tight budget constraints facing Congress have virtually eliminated any chance both Democrats and Republicans had this year to address public concerns about skyrocketing health care costs and the rising number of uninsured Americans.

And because Republicans are in charge of both the House and Senate, they acknowledge that their inability to pass any new significant health care legislation this year will make it more difficult for them to counteract Democrats’ traditional advantage with voters on the all-important election-year issue.

“This is a year where it is impossible to low-ball expectations,” said Senate GOP Conference Chairman Rick Santorum (Pa.).

Nevertheless, Santorum noted that Republicans would likely try to move some small and inexpensive health care proposals. “We’re going to have ideas, and we’re going to move them,” he said.

In order to stay on top of the message game, Senate Majority Leader Bill Frist (R-Tenn.) has asked Senate Health, Education, Labor and Pensions Chairman Judd Gregg (R-N.H.) to lead a health care task force charged with identifying the most pressing issues and coming up with policy objectives to address them.

“It’s more along the lines of getting our act together,” said Senate Finance Chairman Chuck Grassley (R-Iowa), who said Gregg would explore health care proposals that could move through either of their panels. “You have to have agreement between Republicans before you can start work on bipartisan legislation.”

Still, Grassley acknowledged that Gregg could find himself empty handed at the end of the year when Congress has done little to address either the uninsured or health care costs.

“I think it’s going to get a lot of attention, but I don’t think it has the possibility to become law,” Grassley said of the various proposals floating in Congress.

Gregg, however, appeared clear-eyed about his task at a Jan. 28 HELP hearing.

“No matter how much some may want it, there is no single, silver-bullet solution,” said Gregg, who challenged the notion that the problem of the uninsured, who he said are usually without insurance for only a few months, needs to be addressed with sweeping legislation.

Democrats are similarly pessimistic about the possibility of making any major changes to health care law this year.

“Democrats would like very significant health care legislation passed,” said Finance ranking member Max Baucus (D-Mont.).

Still, he expressed serious doubts about whether his party would have any success. “I expect there’ll be some legislation passed this year, but I think it’ll be minimal,” he said.

Still, many Democrats, such as Sen. Edward Kennedy (Mass.), are looking to push far-reaching proposals, including a universal health care bill and a full-scale rewrite of the recently enacted Medicare prescription drug bill.

To pay for many of his proposals, Kennedy has long advocated a rollback of Bush’s $1.3 trillion tax cuts — which is highly unlikely to happen.

Senate Republicans are largely hoping that their success in getting the limited prescription drug benefit under Medicare passed last year will be enough to counteract Democrats on the presidential campaign trail who are increasingly invoking the health care issue.

“Republicans are going to be able to talk, if they want to, about prescription drugs,” said Sen. Trent Lott (R-Miss.) of the upcoming presidential and Congressional elections.

Still, Lott noted that he, like many other Republicans, does not want to try to do more than the $400 billion Medicare prescription drug plan, which barely passed the House because of strong conservative opposition to expanding what they see as an already expensive federal entitlement program.

“I don’t think it’s necessary for us to do anything on health care,” said Lott. “We did something last year and we did it badly. … Maybe we need to fix some of the problems in that bill, such as exploding costs” to the federal government.

Though the Congressional Budget Office has largely stuck by their $400 billion estimate for the cost of the Medicare plan, the White House’s Office of Management and Budget recently dropped the bombshell that the potential costs could reach $534 billion — a further drain on the federal Treasury and an unwelcome addition to the already soaring deficit.

It’s not so much that all Republicans want to rest on their laurels after having passed the Medicare law. Many Republicans contend that there is just no money even for some of the modest health care proposals — such as tax credits for individuals and families to buy health insurance — floated by President Bush in his State of Union address last month.

That doesn’t mean that people won’t be trying, however.

According to Grassley, the most likely health care proposal to move this year is a Bush plan to allow people who use health savings accounts to deduct 100 percent of their catastrophic health care premiums.

Santorum agreed: “It’s really the most important thing we can do. It’s a small piece, but it’s going to help with health care costs.”

Grassley also held out the possibility that legislation to allow the reimportation of cheaper prescription drugs from Canada and other countries could make it through Congress this year.

“In regards to the reimportation deal, you don’t run into a lot of budget problems,” said Grassley of the relatively low cost of implementing the change that was stricken at the last minute from the Medicare law.

Sen. Olympia Snowe (R-Maine) is actively strategizing how to get the reimportation legislation back on the Senate’s agenda.

Because the House passed a version of the bill last year, Snowe hopes to find a way in which the Senate could simply pass identical legislation that would go directly to President Bush’s desk.

Still, Snowe acknowledged that in order to get the measure passed, Congress would likely have to design a separate bill dealing with the administration’s concerns about the safety of drugs that would come into the United States from other countries.

Either way, the legislation faces substantial opposition.

“I’d filibuster that,” Santorum said of Snowe’s plan.

Sen. John Breaux (D-La.) also expressed opposition to the reimportation legislation, saying that once seniors begin to receive Medicare’s help with their drug costs, the issue of cheaper drugs from Canada and Mexico “will fall to the wayside.”

In the meantime, Snowe has teamed up with Sen. Ron Wyden (D-Ore.) to push for a rollback of language in the Medicare law that prohibits the government from negotiating lower drug prices for Medicare beneficiaries.

Under a bill introduced last week, Snowe and Wyden would repeal the explicit prohibition on such negotiations and order a study on whether current negotiating powers of the Veterans Affairs and Defense departments help the government get lower prices for drugs than private plans do.

The legislation also would address reimportation by punishing pharmaceutical companies that restrict foreign wholesalers or pharmacists from selling their lower-cost drugs in the United States. If companies used what Snowe and Wyden said were underhanded tactics, they would lose their current dollar-for-dollar tax deduction for advertising.

Still, Snowe acknowledged that getting the proposal passed as a stand-alone bill would likely be a heavy lift. She’s hoping that Senate Republicans will bring up some other health care-related measure to which she and Wyden can attach their measure.

Still, there is substantial resistance to any changes to the Medicare law before it fully takes effect in 2006.

“We shouldn’t change it until we have it implemented,” Breaux said.

But Breaux’s negativity on changing the Medicare bill does not extend to new proposals to deal with the uninsured.

Breaux said last week that he and Sen. George Voinovich (R-Ohio) are in the beginning stages of crafting legislation to permit individuals, facilitated by state agencies, to pool their resources and buy insurance at lower costs.

Bush, along with many in Congress, has already called for allowing small businesses to join together to negotiate lower insurance prices for their employees. It’s unclear how either proposal will fare in Congress this year.