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Baucus Touts 'Medicare Preservation Commission'—Minus the Steroids

By Jane Norman, CQ HealthBeat Associate Editor

August 5, 2009 -- Count in the Senate Finance Committee negotiators when it comes to support of an independent body enforcing Medicare policy — but just don't call it "MedPAC on steroids."

Finance Committee Chairman Max Baucus, D-Mont., said on Wednesday that the group of six bipartisan senators attempting to shape the committee version of a health overhaul agree that they like the idea of beefing up the current Medicare Payment Advisory Commission (MedPAC).

Baucus, whose remarks came after a morning meeting of the group of six senators, said the Finance version would be called the Medicare Preservation Commission.

"That's basically the old MedPAC on steroids," said Baucus. "We don't like the name MedPAC on steroids because it has too many unnecessary implications, so we named it the Medicare Preservation Commission."

Baucus also suggested there might be more group meetings even after the Senate adjourns on Friday for its summer recess, though it wasn't clear if he meant in Washington or possibly locations outside the Beltway.

"We're going to be definitely working over the recess. In fact, we've got some ideas where we might meet over the recess. And some of that is going to be pretty exciting," he said, without elaborating.

An enormous amount of media attention already has settled on the six senators conducting the health talks because overhaul legislation approved by another Senate committee and three committees in the House has come on party-line votes.

If they were to go on the road in the members' home states, it could be quite a far-flung adventure. The "gang of six" is made up of Democrats Baucus of Montana, Kent Conrad of North Dakota, and Jeff Bingaman of New Mexico, and Republicans Charles E. Grassley of Iowa, Olympia J. Snowe of Maine and Michael B. Enzi of Wyoming.

Finance Committee aides also confirmed late Wednesday that the "group of six" will meet with President Obama on Thursday in what's bound to be a high-profile event. The time or location of the meeting is not clear.

MedPAC was established under the 1997 Balanced Budget Act to advise lawmakers on issues surrounding Medicare, the biggest driver in the health care system because it spends so much money and sets fee schedules. MedPAC's meetings and recommendations are closely watched, and it employs staff members who conduct detailed reports and research. But the commission has no ability to order changes in the system.

President Obama has proposed such a MedPAC-like panel with much greater powers, dubbing it the Independent Medicare Advisory Commission (IMAC). Some House members have picked up on the idea though others don't care to give up the clout they have to affect Medicare rates and policies.

Sen. John D. Rockefeller IV, D-W.Va., has introduced legislation (S 1110) that would expand the powers of MedPAC to make it into an executive agency resembling the Federal Reserve. Rockefeller's argument is that members of Congress don't have the political will to resist lobbyists for special health interests who plead for a break on Medicare decisions that don't go in their favor. Rockefeller would rename MedPAC the Medicare Payment and Access Commission.

While not providing a lot of specifics on how Finance negotiators would like to see the commission structured, Baucus said the senators "spent a lot of time dotting the "i"s and crossing the "t"s" on their proposal.

"The goal clearly is twofold: to let an independent organization make professional judgements about Medicare payments and Medicare procedures," said Baucus.

"The second is appropriate congressional involvement. It's kind of a balancing act we have to undertake here."

Baucus said the commission must have "sufficient authority to make decisions, in order to get their job done," and bend the cost curve of Medicare spending.

That's also so that the proposal would get a "positive score from CBO," he said. The Congressional Budget Office (CBO) has said that the president's version of an independent commission would save just $2 billion over a 10-year period, though Office of Management and Budget Director Peter Orszag has sharply criticized that analysis.

Baucus said that lawmakers "want to make sure there's enough congressional involvement so Congress can play a role here, but not so much of a congressional role that it renders the independent organization's recommendations irrelevant or at least not very valuable because Congress could overturn them too easily."

The commission would make recommendations and unless Congress voted to halt them, "the recommendations automatically go into effect," he said.

He added: "So we're trying to spend time striking that right balance and we did. I think we came up with a pretty good resolution."
The negotiators also examined the question of Medicaid expansion, which is worrying states who say budgets hit by the economic downturn can't handle more spending on the program for low-income people. Baucus said each state covers different populations differently, which makes national policy difficult to set.

"A lot of states are strapped and we're very sensitive to that, don't want to put unnecessary burdens on state budgets," he said. But lawmakers do want 95 percent of Americans to be covered by insurance, he said. Baucus said he plans to meet with state governors although a date or time has not yet been set.

The Senate negotiators plan to return to work Thursday. By week's end, when the Senate adjourns for the summer recess, they will be "further than we are today," Baucus said.

Conrad said the Medicare commission, Medicaid expansion and affordability are three large issues left, and Thursday senators will focus on affordability.

He also said that discussions on how abortion should be treated in the overhaul bill continue and committee members are reaching out to both sides involved in the debate. "There are ongoing discussions with pro-life and pro-choice groups, getting their input," said Conrad. "So we're not prepared to reach a conclusion, but there are active discussions underway and with all sides to try to get something together that will be acceptable."

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