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Deeper Passions Likely to Color 2006 Health Care Tableau

FEBRUARY 7, 2006 -- One of the rituals that begins the annual process of health policy making is the slate of congressional staff previews in which aides sketch out the lay of the year's health care landscape for an attentive public and press.

As in past years, the health care tableau emerging for 2006 from these previews features a wide variety of issues. But one difference this year may be deeper passion over health care, as Republicans make an even stronger imprint on the traditionally Democratic issue.

Hill staffers at a Tuesday briefing at the annual National Health Policy Conference in Washington, D.C., presented an agenda featuring a mix of routine near-term issues and more long-range goals, the latter illustrating the fundamental battle shaping up over the future of health care.

Issues in the foreground included cheaper health care for small businesses, reauthorization of legislation governing the National Institutes of Health and the Ryan White Act, legislation to spur health information technology, and proposed bans on health care discrimination based on genetic makeup.

But in the background was a sense of growing tension over continuing Republican efforts to reshape the dominant systems of health care that are prized by Democrats, ranging from Medicare to Medicaid to employer-based health care.

The Year's Issues

  • Cheaper health care for small employers is a near-term priority for the Senate Health, Education, Labor and Pensions Committee, said Steve Northrup, the committee's majority staff director. Chairman Michael B. Enzi of Wyoming and Sen. Ben Nelson, D-Neb., are working on a bill that would reduce costs by letting small employers buy health care that would be exempt from what Northrup said are costly benefit mandates.

  • GOP leaders for several years have championed legislation promoting "association health plans," which also would provide small businesses access to plans exempt from mandates. But Northrup said employers shouldn't have to be members of a trade association to get that kind of regulatory relief.

  • Reauthorizations of the Bioterrorism Act of 2002 and the Ryan White Care Act should be important in Congress, Northrup said. He said Ryan White reauthorization is a priority for President Bush as well, and added that his Senate committee will also work with the House Energy and Commerce Committee on the legislation.

    According to Chuck Clapton, chief counsel for health for the House Energy and Commerce Committee, a top priority this year for the panel's chairman, Joe L. Barton, R-Texas, is reauthorization of the National Institutes of Health (NIH), the organization of which, he said, has been shaped over the decades by a series of public health crises.

    But Clapton said there has been no systematic attempt to examine whether NIH is organized in a way that delivers the greatest return on the large public investment in the agency—something Barton believes is badly needed.

  • Medicaid's Section 1115 waiver process—which grants states freedom from certain Medicaid requirements—is likely to get a "fresh look" by the Senate Finance Committee, predicted Mark Hayes, the panel's GOP health policy director. That provision has been used to allow a number of changes to traditional Medicaid, but Hayes said it needs greater scrutiny to determine whether the programs it creates meet the requirement of being budget-neutral.

    The review will seek to determine which lessons can be learned from 1115 programs. Hayes said the examination will aim to turn 1115 back into a "demonstration program." States have used it widely to make major reforms as they sought greater flexibility in Medicaid. With passage of the Deficit Omnibus Budget Reconciliation Act, that flexibility may be achieved in other ways.

    States also will be facing funding shortfalls next year in the State Children's Health Insurance Programs. Hayes said the committee will seek legislation addressing those shortfalls.

  • Gene testing and health IT will be the subject of bicameral efforts, Northrup said. The Senate HELP Committee will work with House lawmakers on passage of legislation to prevent employers and insurers from discriminating based on their genetic makeup. Society will never be able to take advantage of the gains in genetic testing if people fear that the results will be used to deny them coverage, he said.

    Northrup said Enzi and his committee also aim to work with the House to pass legislation approved by the Senate to foster adoption of health care information technology. Senate legislation "will goose that process along," Northrup said. With final congressional passage rather than more health technology proposals, "instead of killing trees we'll be saving lives," he said.

  • Medicare and HSAs evoked strong sentiments at Tuesday's session.

    A House Democratic aide who asked not to be identified said that the Bush administration's proposed tax breaks to promote health savings accounts (HSAs) were "close to immoral."

    Hayes said Democrats and others who depict Part D of the Medicare program as an attempt to break the Medicare system are "rather insulting."

    The Democratic aide said the Bush HSA plan would cost $156 billion over 10 years She argued that the money would cover more of the uninsured if spent through public insurance programs.

    Northrup said that HSAs would appeal to the healthy and wealthy but countered that they also provide the uninsured with an affordable way to get coverage. Hayes said the Bush plan would cover 8 million uninsured Americans.

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