Pay/Go Rules Might Prevent Lawmakers From Blocking Proposed Medicaid Changes

Main Category: Medicare / Medicaid / SCHIP
Article Date: 02 Apr 2008 - 6:00 PDT

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Pay/go rules might hinder a measure (HR 5613), introduced by House Energy and Commerce Committee Chair John Dingell (D-Mich.), that would delay all or part of seven Medicaid regulations that would limit or eliminate federal reimbursements to states for certain Medicaid services, CQ Today reports (Wayne, CQ Today, 3/31).

The bill, introduced by Dingell in March, would postpone seven new Medicaid regulations for one year. The regulations, proposed by the Bush administration, would prohibit states from using federal Medicaid funds to help pay for physician training, place new limits on Medicaid payments to hospitals and nursing homes operated by state and local government, and limit coverage of rehabilitation services for people with disabilities, including those with mental illnesses (Kaiser Daily Health Policy Report, 3/17).

The Congressional Budget Office says the rules would save the federal government $19.6 billion over five years. Congress postponed four of the rules last year, but they are scheduled to take effect in May.

CBO in a preliminary analysis said Dingell's bill would cost $1.65 billion in fiscal years 2008 and 2009. According to CQ Today, the CBO score "could complicate the bill's advancement" because under pay-as-you-go rules Democrats enacted in 2007, lawmakers must couple proposals that will cost money with legislation that would reduce spending or raise funds of an equal amount. According to CQ Today, Democrats "have struggled since taking control of Congress to find spending offsets for many of their legislative priorities."

CQ Today reports that a Republican aide said Democrats might try to insert language from Dingell's bill into "must-pass legislation," such as a supplemental spending bill for the Afghanistan and Iraq wars, which would enable them to bypass pay/go rules. However, such a move "could upset conservative Democrats in the House who have been sticklers for the pay/go budget rules, and it could open the party to criticism from Republicans" (CQ Today, 3/31).

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