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Reconciliation Worries Health Care Lobbyists

So far, lobbyists have received just scraps of unofficial information about Senate Finance Committee proposals to cut health care spending as part of a larger reconciliation package. But industry lobbyists have become sufficiently worried about what could be lurking to spur an on-the-ground campaign against such cuts.

In interviews, several health care lobbyists said hospitals, nursing homes, home health providers and drug companies, among others, could face Medicare and Medicaid cuts as part of the Finance panel’s cost-saving efforts.

GOP lobbyist T.J. Petrizzo, who represents several health care clients, said: “We had clients on the phone [Monday] night with certain Senators, so as they go in and out of these meetings, they will be informed.”

Petrizzo added that Senators were working into Tuesday evening discussing proposals.

“Everybody was flipping out,” said one longtime health care lobbyist who would not speak for attribution. Without the actual documentation, though, “people had to work off their worst nightmare scenarios.”

However, lobbying insiders said the health care industry has been wary of pushing too hard for now, for fear of putting their groups on the outs with the powerful Senate Finance Chairman Chuck Grassley (R-Iowa) and, in some cases, so as not to divulge their sources on the Senate staff who passed them information about cuts being considered.

Various industry groups have been trying to get something on paper and also are trying to size up what their counterparts are doing.

One GOP lobbyist who represents hospitals said, “It’s hard to lobby when you don’t actually see the language,” but remaining on defense is a necessity. “The rules of reconciliation are so tight that it’s almost impossible to get things out of there, so the first fight is going to be in committee. We have to make noise.”

Karen Ignagni, president and CEO of America’s Health Insurance Plans, said that even discussions of possible cuts from Medicare’s upcoming prescription drug program send the wrong message. That has been the message she took to Capitol Hill.

“We’re not even in the second anniversary of the passage of [the Medicare drug bill], so for Congress to even begin to discuss cuts … it really goes to the heart of whether Congress — and the government — is a reliable business partner,” she said. “It would be an about-face.”

Pharmaceutical Research and Manufacturers of America spokesman Ken Johnson said in a statement: “We are still reviewing reconciliation proposals being considered to determine their impact on patient care.”

While many lobbyists are playing defense for their clients, John Jonas, who heads Patton Boggs’ health practice, is hoping lawmakers will include a provision that would require new expenditures.

Kidney Care Partners, a coalition of health workers and patient groups, wants Medicare to institute an annual inflation adjustment for dialysis care under the system. Jonas said his coalition has suggested ways to pay for it by accepting cuts in other dialysis programs. “We’re realistic that this is a very tight budget,” he said.

But as pet projects sweeten the bitter pot of spending reductions, Members and competing industries are getting fed up that their own pet projects could suffer because Members will need to add more cuts to offset any increases. And the more spending additions that get made, the more money that needs to get cut.

Adding new pots of spending may be a votegetter, but several health lobbyists said that some Members have become fed up with having to find additional cuts to offset the spending.

“Reconciliation is always crazier in the health care world, because it’s the tendency of the committee staff to keep such a close hold,” said one longtime health care lobbyist.

Still, some lobbyists say all the hyperventilating is unnecessary. Peggy Tighe, formerly with the American Medical Association, represents health care clients at the firm Strategic Health Care. On Monday morning, she received a panicked call from a client worried about a potential cut. Her message to the client: “We’ve got to first look at the language and breathe.”