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Weighing the Health Care Impact of Hill Budget Blueprints

By John Reichard, CQ HealthBeat

March 14, 2008 -- Amendments to the fiscal 2009 spending blueprint may not mean much given President Bush's threat to veto spending bills that exceed amounts he wants to spend on federal health programs. In fact, the lawmakers themselves who develop the spending bills aren't beholden to budget resolutions. But the amendments—ranging from a $2.1 billion increase for the National Institutes of Health to provisions that would give $375 million more to the Food and Drug Administration—point to possible congressional priorities.

And some of those priorities could actually become law if lawmakers decide to delay final action on fiscal 2009 spending until after Bush leaves the White House.

The budget measures approved by the House on Thursday and the Senate early Friday (S Con Res 70 and H Con Res 312) leave open the possibility of a budget deal in which Medicare changes are approved in the Senate by a simple majority. The House measure includes instructions that could be used for Medicare legislation and the Senate measure does not; but if the respective chambers agree on a final budget blueprint after they return the week of March 31 from their spring recess, it could include the House-approved instructions. That language allows legislation to move in the Senate with protection against a filibuster if the measure reduces the federal deficit.

Senators offered dozens of amendments, many related to health care, to modify the budget plan approved last week by the Senate Budget Committee.

Republican attempts to get Democrats to focus on restraining Medicare spending growth fell short in action on the Senate floor. An amendment by Sen. John Ensign, R-Nev., to shift more of the cost of the Medicare prescription drug benefit to affluent seniors won just two Democratic votes, those of Sen. Thomas R. Carper of Delaware and Sen. Claire McCaskill of Missouri. Eight Republicans joined 46 Democrats and two Independents in defeating it, 56 to 42. Individuals with incomes above $82,000 and couples with incomes above $164,000 would have been required to pay higher monthly premiums for the Medicare Part D benefit.

Meanwhile, lawmakers appear to be gearing up to increase Medicare spending compared to current law by offering legislation to block a projected 10.6 percent cut in Medicare payments to physicians required under current law. Sen. Debbie Stabenow, a Michigan Democrat, announced Thursday that she is introducing a bill that would block any cuts in payments to doctors for 18 months.

Stabenow's bill would stop the six months of cuts in 2008 that begin in July and replace them with a 0.5 percent increase, then in 2009 replace the cuts with a 1.8 percent increase. Bonus payments of 1.5 percent for reporting data on quality of care would be extended through 2009.

An amendment to the Senate budget measure added by Democrat Jeff Bingaman of New Mexico is designed to increase the number of Americans eligible for the comprehensive Medicare drug benefit for low-income beneficiaries. Sen. Olympia J. Snowe, R-Maine, who said she joined Bingaman in proposing the amendment, issued a statement Friday saying the Senate also approved an amendment calling for a vote this spring on legislation (S 2687) to curb marketing abuses in the Medicare Advantage program.

Senate Republicans took a stab at countering, at least to some degree, efforts by Democrats to block regulations developed by the Bush administration to trim Medicaid outlays compared to levels called for under current law. The regulations in part address tactics used by states to increase federal Medicaid spending that many analysts regard as inappropriate.

Iowa Republican Charles E. Grassley suggested on the Senate floor Thursday that while the regulations may in some instances go too far, they address "real problems" with inappropriate spending. Blocking the regulations entirely would cost taxpayers $19.7 billion over five years, he said. Grassley said the Senate Finance Committee should develop legislative changes to replace the regulations, not simply cancel them. Rather than push for an amendment to that effect, however, he joined in a successful effort by Republican Sen. Wayne Allard of Colorado to win approval of an amendment to ensure that the Health and Human Services secretary has authority to prevent fraud and reduce inappropriate spending in the Medicaid and State Children's Health Insurance Program (SCHIP).

Senate Finance Committee Chairman Max Baucus, D-Mont., meanwhile, won approval of a "Sense of the Senate" amendment that administrative regulations should not undermine Medicaid's health coverage guarantees or shift Medicaid cost burdens to the states. And in the House, Rep. John D. Dingell, D-Mich., the chairman of the Energy and Commerce Committee, and Rep. Tim Murphy, R-Pa., announced legislation on Thursday that would place a one-year moratorium on the administration's Medicaid regulations.

Other amendments adopted by the Senate dealt with a wide range of issues.

An amendment by North Dakota Democrat Byron L. Dorgan would shift funding to allow for an increase of $1 billion in the budget for the Indian Health Service.

An amendment offered by Sen. Edward M. Kennedy would increase by $71 million the resources available to the Food and Drug Administration for food and drug safety purposes. Kennedy noted in a news release Thursday that the Budget Committee's budget bill provides for an increase of $304 million; his measure would bring the total to $375 million, the increase recommended by an FDA scientific advisory group that says the agency is so underfunded that the nation verges on a public health catastrophe as a result.

An amendment by California Democrat Barbara Boxer would allow for legislation to cover more pregnant women in SCHIP. States have the option of providing such coverage under SCHIP, and in some cases do so.

Another amendment, sponsored by Sen. Richard M. Burr, R-N.C., would match President Bush's spending request for the Biomedical Advanced Research and Development Authority, backers said. BARDA, which is part of the Department of Health and Human Services, develops drugs, vaccines, therapeutics and diagnostics used in public health emergencies, including nuclear, biological, and other terrorist attacks.

The provision would raise the amount for overall health programs by $148 million. Backers of the provision said they want to target those funds to BARDA; when coupled with the $102 million included in the fiscal 2008 omnibus spending measure (PL 110-161), the increase would bring the agency's total budget to $250 million.

An amendment by Sen. Christopher J. Dodd, D-Conn., would boost funding for autism research, education, and early detection by $197 million at the National Institutes of Health, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration. Another Dodd amendment would increase spending under the Maternal and Child Health Block Grant by $184 million.

Up to $160 million would be spent on a three-year extension of a pilot program for background checks on caregivers hired by long-term care facilities under an amendment by Sen. Herb Kohl, D-Wis.

An amendment by Sens. Hillary Rodham Clinton, D-N.Y., and John W. Warner, R-Va., would increase funding by $53 million for respite care for family caregivers for the frail elderly and disabled.

Another amendment by Dorgan would increase organ donations by funding programs authorized by a law popularly known as the Organ Donation and Recovery Improvement Act of 2004.

Amendments by Sens. John E. Sununu, R-N.H., and John Kerry, D-Mass., would promote the use of electronic prescribing of prescription drugs.

And an amendment by Sen. John Vitter, R-La., expresses the sense of the Senate that legislation should be brought to the floor legalizing the importation of certain prescription drugs as a way to counter high prices in the United States for the products.

Matt Korade contributed to this story.

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