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Health Care Lobbies Battle to Shape Stimulus Provisions

By John Reichard, CQ HealthBeat Editor

JANUARY 22, 2009 -- Hospital, insurer, employer, and other lobbyists scrambled Thursday to shape and reshape health care provisions in the House economic stimulus package, urging lawmakers to keep certain provisions, dump others and add still others.

Their efforts came as key House panels approved or verged on approval of the package, leaving lobbyists to increasingly pin their hopes for change on the Senate. Both the House Ways and Means and Energy and Commerce Committees were marking up their provisions of the stimulus package Thursday while on Wednesday the House Appropriations Committee approved its version of the bill.

The provisions approved by the appropriations panel included $3.75 billion for Department of Defense medical facilities, $2 billion more for the National Institutes of Health, another $1.5 billion for renovating university medical labs receiving NIH grant money, $1.5 billion to renovate, expand, or create new community health centers, $1.1 billion for studies comparing the effectiveness of medical treatments, $1 billion for veterans' medical facilities, $900 million for research relating to a pandemic flu vaccine and defenses against chemical and biological weapons, $600 million to train primary care doctors to practice in rural areas or inner cities and $462 million for construction and renovations at the campuses of the Centers for Disease Control and Prevention.

Insurers joined employers in urging that various provisions to strengthen medical privacy protections be dropped. While saying it supports privacy safeguards, the insurance lobby America's Health Insurance Plans (AHIP) said in a letter to House Speaker Nancy Pelosi, D-Calif., that regulations required under the privacy provisions would "restrict information that could be exchanged for health promotion, disease management, and care coordination programs."

Language authorizing state attorneys general to enforce federal privacy standards "will create a '50 state' approach to federal regulatory enforcement that is neither uniform, clear nor cost-effective," AHIP President Karen Ignagni said in the Jan. 21 letter.

"Broadly worded" requirements for notifying consumers and the Health and Human Services Department in cases where medical privacy is breached "could unnecessarily alarm individuals before harm has been established. And new requirements for tracking and disclosing electronic information--even for treatment, payment, or health care operations--likely would discourage rather than encourage use of electronic health records, Ignagni said.

The National Business Group on Health (NBGH), which represents many of the nation's biggest corporations, urged the removal of certain provisions to help laid-off workers keep their health coverage by expanding certain rights under the Consolidated Omnibus Reconciliation Act (COBRA).

NBGH earlier expressed support for language that would help the newly jobless pay the steep premiums associated with coverage maintained under COBRA. But NBGH President Helen Darling emphasized in a letter Thursday to House Ways and Means Committee leaders that her members support temporary subsidies.

The stimulus package would "extend COBRA indefinitely to former employees 55 and older and those with 10 years or more tenure in their jobs until they find a new job or until they are Medicare eligible," Darling noted. The actual cost of COBRA "can be as high as 133 percent to 150 percent of the average per-employee plan costs," Darling wrote. "These costs would significantly increase if people could keep COBRA longer as they approach Medicare eligibility and their health care costs generally increase due to higher medical costs and higher rates of chronic conditions," she said.

If former employees chose to keep their current coverage for extended periods under COBRA, "then employer plans have to keep track of them, collect premiums and process COBRA payments for many years until their long ago employees either relinquish their coverage or it expires." COBRA's "administrative burden for former employees would become permanent . . . at the expense of current employees and their employers."

In a telephone press briefing Thursday American Hospital Association executives urged lawmakers to add language to the stimulus to make it easier to borrow by strengthening a mortgage insurance program at the federal Department of Housing and Urban Development. "Millions as opposed to billions" would be added to the stimulus to finance the changes, including a grant program to help facilities qualify for the program, said AHA lobbyist Michael Rock.

In the briefing, AHA President Richard Umbdenstock called attention to a new survey by the association detailing the impact of the credit crisis on hospitals. Almost half the hospitals responding to the survey said it was "significantly harder" to obtain financing through tax-exempt bonds or philanthropy, and about one-third said it was significantly harder to gain access to capital through equity or venture capital funds, taxable bonds, or banks and financial services companies. Nearly half of hospitals said they were postponing capital projects. Of these, about two-thirds said the postponements affected inpatient services and almost half cited on impact on emergency or urgent care services.

AHA also urged Congress to keep provisions temporarily increasing the federal share of payments for Medicaid and funding investments in health information technology, as well as changing a Medicare inpatient payment regulation eliminating part of the payments received by teaching hospitals for capital costs. The change would place a one-year moratorium on the three-year phase-out of the payments.

The House stimulus package also makes "technical corrections" to previous legislation meant to provide regulatory relief to long-term care hospitals.

Similarly, the National Hospice and Palliative Care Organization is urging lawmakers to keep a House provision that would block regulatory language cutting payments to hospice programs. The provision places a one-year moratorium on the regulation to ensure that hospices receive the same reimbursement rate for wages.

Meanwhile, the AIDS Institute is urging lawmakers to keep language they said would provide an additional $355 million for domestic programs to prevent AIDS, viral hepatitis, and sexually transmitted diseases. Preventing disease "will dramatically reduce future health care costs," said Carl Schmid, the institute's director of federal affairs.

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