Senate Republicans, Democrats Seek Changes To Health Care, Other Provisions In Economic Stimulus Package

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Health Insurance / Medical Insurance;  Public Health
Article Date: 03 Feb 2009 - 6:00 PDT

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The almost $900 billion economic stimulus package the Senate will begin to debate this week "faces a treacherous path," as both Republicans and Democrats seek to change some provisions related to health care and other areas, the San Francisco Chronicle reports (Coile, San Francisco Chronicle, 2/2). According to the New York Times, although the House version of the stimulus package passed last week without support from any Republicans, "some Senate Republicans clearly want to find a way to support the bill, and President Obama wants a strong bipartisan vote to show his ability to build consensus" (Herszenhorn, New York Times, 1/31).

Senate Minority Leader Mitch McConnell (R-Ky.) on Sunday said that the stimulus package might fail without changes to certain provisions in the legislation (Daniel, AP/Philadelphia Inquirer, 2/2). Among other proposed revisions, some Senate Republicans have recommended changes under which states would receive the $87 billion in additional funds for Medicaid included in the stimulus package in the form of loans (Cohn et al., CongressDaily, 2/2). In addition, Senate Finance Committee ranking member Chuck Grassley (R-Iowa) seeks to change the formula in the stimulus package used to distribute the funds to ensure that rural states receive a fair share (Kane, Washington Post, 2/2).

Some Senate Democrats also seek changes to the stimulus package. Sen. Ben Nelson (D-Neb.) said, "I don't even know how many Democrats will vote" for the stimulus package "as it stands today" (Hurt, New York Post, 1/31). Nelson called provisions in the stimulus package that would provide $1.1 billion for comparative effectiveness research and $75 million for anti-smoking programs "questionable, marginally supportive and stimulative for jobs." He added those provisions "ought to be part of something else, not part of a jobs stimulus bill" (San Francisco Chronicle, 2/2).

Obama To Meet With Democrats on Stimulus Package
President Obama plans to meet with congressional Democrats on Monday to reiterate the need for passage of the economic stimulus package, Reuters/Boston Globe reports (Colvin/Eckert, Reuters/Boston Globe, 2/2). In his weekly radio address, Obama said that his administration and Congress are "moving forward with a sense of urgency" to pass the stimulus package, which he said would place a "down payment on America's future by investing" in health care and other areas. Obama added that he will "continue working with both parties so that the strongest possible bill" is passed (Rhee, "Political Intelligence," Boston Globe, 1/31).

Many Republican Governors Call for Passage of Stimulus Package
Many Republican governors, faced with large state budget deficits and increased costs for programs such as Medicaid, have called for passage of the economic stimulus package despite opposition from some congressional Republicans, the AP/Globe reports. According to the AP/Globe, although Republican governors are not "entirely enthusiastic about the plan," they "are counting on the spending to help keep their states afloat." Minnesota Gov. Tim Pawlenty (R) said, "States have to balance their budgets. So if we're going to go down this path, we are entitled to ask for our share of the money" (Fouhy, AP/Boston Globe, 2/1).

Analyses of Stimulus Package
Several newspapers recently published analyses of the economic stimulus package. Summaries appear below.

• AP/Orlando Sentinel: The stimulus package would provide "tens of billions of dollars to causes that have little to do with jolting the country out of recession," such as $870 million to fight pandemic flu and $400 million to help prevent the spread of HIV and other sexually transmitted infections, the AP/ Sentinel reports (Taylor, AP/Orlando Sentinel, 1/31).
  
  
• Chicago Tribune: "If the stimulus plan succeeds, it's likely to mean a larger, more activist government for years to come," but the "idea of government as an active player in national life could be discredited anew" in the event that the package fails, the Tribune reports (Hook et al., Chicago Tribune, 2/1).
  
  
• New York Times: An economic stimulus package designed "to stanch the killing of jobs is now transforming into a series of long-term commitments," such as health insurance for recently unemployed workers, that "are sure to add enormously to the national debt," the Times reports. The Times continues, "But the question that the Senate will begin debating Monday is whether grand ambitions are getting in the way of pulling the country out of a nose dive" (Sanger, New York Times, 2/1).
  
  
• Washington Post: The likely passage of the stimulus package indicates the need for a federal budget that "defuses the spending time bomb for health and retirement programs," and Obama and congressional Democrats have "high ambitions to chart such a course," the Post reports (Montgomery, Washington Post, 2/2).

Editorials

• Christian Science Monitor: A plan included in the stimulus bill to link health records to a "nationwide health network that aims to improve patient care and reduce rising costs" is "ambitious," but "at what cost to privacy in this most personal part of life?" a Monitor editorial states. While electronic health records offer many patient care benefits, surveys show that even U.S. residents who favor EHRs "worry about misuse -- a worry that has held up past 'e-health' legislation," according to the Monitor. Although the bill "spreads accountability to more types of health organizations" and includes other privacy provisions, the editorial states that "its imperfections are not minor." The editorial continues that the bill "does not resolve, for example, the debate among privacy advocates over patient consent in the use of records," nor does it contain an "'opt-out' provision for people who don't want to participate in an e-network." It adds that the "House held no hearings on electronic medical records," and "the Senate held one last week -- even as the bill was being marked up elsewhere." The Monitor concludes that "[w]ith no resolution of patient consent, with no opt-out clause, and with questions over savings and time frame, this legislation is too important for a rush job" (Christian Science Monitor, 2/2).
  
  
• New York Times: The "goal" of the $20 billion included in the stimulus package for EHRs, "to improve the quality and lower the costs of care," is "sound" as an idea, "but it also raises important questions about how to ensure the privacy of patients," according to a Times editorial. It continues, "Fortunately, the legislation would impose sensible privacy protections." It would "strengthen the privacy requirements and apply them more directly to 'business associates' of the providers ... that have access to sensitive data but are not readily held accountable for any misuse," according to the editorial. In addition, the legislation would "go a long way toward preventing" abuses, according to the Times. It adds that although insurers and "some disease management groups are complaining that the new requirements would impose administrative burdens that could actually impede the use of electronic records and interfere with coordination of care," it "should be possible through implementing regulations to fine-tune the privacy requirements so that they do not disrupt patient care." The editorial concludes, "Congress must make every effort to ensure that patients' privacy is protected" (New York Times, 2/1).

Opinion Piece
"If America is going to solve this economic crisis, I believe we need to embrace a bolder vision for America's future," Rep. Patrick Kennedy (D-R.I.) writes in a Providence Journal opinion piece. He adds, "Having long been an advocate for health information technology, I am pleased that" the House's economic stimulus bill (HR 1) "includes $20 billion to computerize health records, cut costs and reduce medical errors." Kennedy writes that the health IT provision is one of "a number of important investments in our national fabric that would bear economic results in both the short and long term" (Kennedy, Providence Journal, 2/1).

Broadcast Coverage
American Public Media's "Marketplace Money" on Friday examined the cost of COBRA provisions in the stimulus package. The segment includes comments from Kansas Insurance Commissioner Sandy Praeger (Herships, "Marketplace Money," American Public Media, 1/30).

American Public Media's "Marketplace Morning Report" on Monday discussed the prospects for the stimulus package in the Senate (Marshall Genzer, "Marketplace Morning Report," American Public Media, 2/2). "Marketplace Morning Report" on Monday also featured a segment on the Stimulus Watch tool offered by the Committee for a Responsible Federal Budget. The segment includes comments from group President Maya MacGineas (Karson, "Marketplace Morning Report," American Public Media, 2/2).

CNN's "Newsroom" on Friday featured a report on the $75 million included in the stimulus package for smoking cessation programs (Griffin, "Newsroom," CNN, 1/30).

NPR's "All Things Considered" on Sunday examined the $5.8 billion for disease prevention and wellness programs included in the stimulus package. The program includes comments from Jeff Levi of Trust for America's Health; John Seater, an economist at North Carolina State University; and health economist Louise Russell of Rutgers University (Aubrey, "All Things Considered," NPR, 2/1).

NPR's "Morning Edition" on Monday examined Medicaid provisions in the stimulus package. The segment includes comments from Robin Rudowitz, a principal policy analyst for the Kaiser Commission on Medicaid and the Uninsured; Nassua Health Care CEO Arthur Gianelli; and Sen. Jon Kyl (R-Ariz.) (Rovner, "Morning Edition," NPR, 2/2).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

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