health action 2008

Bills in Brief

It took over a decade for health care reform to lose its Clinton-era-induced taboo status - but while health care policy is coming back in vogue, America will have to wait until 2009 before any major reforms become ripe for passage.

In the meantime, in 2007 Congress set out to pass a series of mini health care initiatives - which it may follow up on in 2008:

SCHIP. Congress head butted with Bush last year over expanding State Children's Health Insurance Program (SCHIP), which covers low income children who aren't low income enough to qualify for Medicaid. Congress, which wanted to double the scope of the act, lost. It considered a second go in '08, but now SCHIP has officially been punted to '09 (NYT). Meanwhile, the administration sent states a letter saying they had to tighten eligibility for SCHIP, only to have the GAO weigh in that the administration overstepped its legal boungs (GAO).

Medicaid. Similar to SCHIP, Medicaid helps states cover health care for the poorest kids, although the feds usually let states use Medicaid to cover kids above the poverty line. Last year, though, the feds started started crackin' the whip and giving our fewer waivers for expanded Medicaid coverage; this year Congress may act to push for more waivers to go through. The House also voted in April '08 to delay for a year a number of the administration's cost saving measures for Medicaid (AP).

e-Health care. Congress started working a couple years back to push through a bill that would get health records out of file cabinets and into more easily accessible data bases. Given its bipartisan support - and the fact that the rest of the industrialized world has gone over to e-filing - it could pass this year.

Charting treatments that work. Another no-brainer idea is to set up an independent office that tracks the effectiveness of treatments - hopefully guiding the medical field to use ones that work. Congress is fashioning some bills it hopes to pass this year, although it's unclear if the office's recommendations will be just that - recommendations - or if there will be incentives or requirements for them to be followed.

Bargaining for cheaper drugs. The House passed a bill last year requiring the administration to negotiate down Medicare drug prices; the Senate, however, tripped over its attempt to do the same. The Senate may take a second shot this year.

Refiguring doctors' fees for Medicare. Right now doctors' fees under Medicare depend on how fast the economy grows - not how much care they provide, how well they provide that care or how much their expenses are. There's talk in Congress on reconfiguring that formula. (MedPAC, Congress' advisor on Medicare, does a good job of spelling out the problem - and offers some solutions).

The president and Congress may also have to act this year after the "Medicare funding trigger" (which sets off when certain funding levels are breached) got pulled last year.

Meanwhile, through HR 6331, Congress opted for another short term fix - as it's done in the past - to keep Medicare fees from dropping 10%, as it was slated to do this summer. (WP)

Trimming Medicare. After crossing a budgetary line (where 45% of expenses are expected to be covered by general tax revenue), Medicare "triggered" a requirement that Congress look at - but not necessarily approve - ways to trim Medicare spending. The president has proposed making richer seniors pay more for drugs, which Congress doesn't look so hot on doing; lawmakers would rather cut back on funding for higher end "Medicare Advantage" programs. It's not clear, however, that anything will get done on Medicare this year. (WP)

Reimporting prescription drugs. As part of an FDA bill passed last year, senators tried to okay the importation of prescription drugs from Canada and a couple other rich countries - but an amendment that said any imported drug had to be blessed by the administration first, in effect killed any hopes of cheaper drugs coming over the boarder. (NYT) Congress may revive efforts this year.

Mental health parity. The House and Senate both passed bills requiring health insurers give mental health patients equal access to care (HR 1424 & S 558). Now a joint bill needs to be worked out. They got closer to a final deal the week of September 22 (WP), but whether they'll reach the finish line this year is an open question.

Regulating cigarettes. Congress could be on track to finish a bill letting the FDA regulate tobacco (WP).

Small business health plans. Once the Dems fought any effort to give small businesses leeway in providing health care coverage for employees - now a bipartisan group of senators are coming up with a small business health plan themselves, S 2795.

Other health bills still in the wings include: a bill barring discrimination based on what's in your DNA, HR 493 (just awaiting the president's signature); and a bill to keep drug companies from paying generics not to sell their drugs.

Updated Sept 28, 2008

Did we miss something, let some slant slip in, lose a link - or do you just have something to say? Drop a line below! In the spirit of open dialogue, cJ asks you keep it civil, keep it real and keep it focused on the message, not the messenger. See our policy page for more on what that all means.