Senate To Vote On Economic Stimulus Package Today

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Health Insurance / Medical Insurance;  Public Health;  IT / Internet / E-mail
Article Date: 11 Feb 2009 - 5:00 PDT

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The Senate on Monday voted 61-36 to end debate on the $838 billion economic stimulus package, which includes tens of billions of dollars for health care and other programs, McClatchy/Arizona Daily Star reports (Lightman, McClatchy/Arizona Daily Star, 2/10). Three Republicans -- Sens. Arlen Specter (Pa.), Olympia Snowe (Maine) and Susan Collins (Maine) -- voted to close debate on the bill, providing Senate Democrats with the 60 votes needed to avoid a filibuster (Kane, Washington Post, 2/10). The vote cleared the way for the Senate to vote on the package on Tuesday (Pierce, Roll Call, 2/9).

Some Senate Republicans complained that their ideas were overlooked in formulating the package. Senate Finance Committee ranking member Chuck Grassley (R-Iowa) said that he and other Republicans have been unable to offer amendments, including one that would place restrictions on the increase in federal aid to states for rising Medicaid costs (Herszenhorn, New York Times, 2/10).

If the legislation is approved, the Senate and House are expected to reconcile differences between the versions by Thursday and present each chamber with a final bill that will be briefly debated and voted on (McClatchy/Arizona Daily Star, 2/10). Senate Majority Leader Harry Reid (D-Nev.) said, "There is no reason we can't do this by the end of the week," adding that if necessary he is willing to hold the Senate in session into the upcoming Presidents' Day recess (Espo, AP/Kansas City Star, 2/9).

Differences in Senate, House Packages
House and Senate lawmakers are gearing up for a "difficult endgame," as reconciling the differences between their competing versions of the economic stimulus package "won't be easy," CQ Today reports (Rubin, CQ Today, 2/9). The differences include:

• COBRA provisions: The Senate version includes $5 billion less than the House bill for federal COBRA subsidies. The Senate version also would provide a 50% subsidy for 12 months compared with 65% for nine months in the House version;
  
  
• Health information technology: Overall health IT spending is at about $19 billion in the Senate bill, compared with $20 billion in the House bill (Armstrong, CQ Today, 2/9). The Senate bill also grants $3 billion in discretionary funds for the HHS Health IT coordination office (Noyes, CongressDaily, 2/10). Under the House version, $2 billion would be set aside for discretionary funding (Schatz et al., CQ Today, 2/9). In addition, the Senate version would cap at $1.5 million the amount that critical-access hospitals -- often those in rural areas that are in need of additional funding -- could receive to purchase health IT. The change "could set up a fight" between Senate and House lawmakers from rural areas, CQ Today reports;
  
  
• NIH funding: The Senate bill added $10 billion for NIH medical research and facility improvement (Armstrong, CQ Today, 2/9).
  
  
• Pandemic flu preparedness: The Senate recently stripped the $870 million for pandemic flu preparedness from its bill, while the House version still includes $900 million for flu;
  
  
• Prevention, wellness programs: The amended Senate package eliminated $5.8 billion set aside for grants and contracts for prevention and wellness programs -- such as health screenings, immunizations and nutrition counseling -- while the version passed by the House includes $3 billion for such programs (Schatz et al., CQ Today, 2/9); and
  
  
• Privacy protection: The House version of the economic stimulus package favors "strict protections [for electronic health records] advocated by consumer groups" that would expand a patient's right to know who is granted access to their health information, while the Senate "is poised to endorse more limited safeguards urged by business interests" and defer access issues to the HHS secretary, according to the Washington Post (Nakashima, Washington Post, 2/10).

Another area of contention is $1.1 billion for comparative analysis research included in both versions of the stimulus package, which the pharmaceutical, biotechnology and medical device industries are lobbying to have stripped or amended from the final bill, the Wall Street Journal reports. The Partnership To Improve Patient Care -- which includes the lobbying bodies of the drug, device and biotech industries in addition to patient advocacy groups and medical professional associations -- is warning of a possible "slippery slope" where the government cuts useful treatments because of costs, according to the Journal. The Journal reports that the coalition is working to give the industries some say over what to research with the $1.1 billion (Mundy, Wall Street Journal, 2/9).

Obama News Conference
President Obama on Monday stressed the importance and need for swift passage of the economic stimulus package during a town hall meeting in Indiana and at his first primetime news conference, the New York Times reports (Stolberg/Cooper, New York Times, 2/10). He said that failure to act swiftly will mean "[m]ore people will lose their homes and their health care," and "our nation will sink into a crisis that, at some point, we may be unable to reverse" (Condon, CongressDaily, 2/10). Obama said that the stimulus bill "is not perfect. No plan is. I can't tell you for sure that everything in this plan will work exactly as we hope, but I can tell you with complete confidence that failure to act will only deepen this crisis as well as the pain felt by millions of Americans" (Meckler/Weisman, Wall Street Journal, 2/10). Obama will attend a town hall meeting in Florida on Tuesday where he will be introduced by Gov. Charlie Crist (R), "one of the few Republicans who are backing the plan in the face of conservative complaints about its size and scope," the Post reports (Kornblut/Fletcher, Washington Post, 2/10).

Editorials

• Chicago Tribune: The Senate in its stimulus package is "right to recognize that" expanding government-sponsored health programs, as the House-sponsored bill would do, "is a debate for another day," a Tribune editorial states. Although House Democrats insist that many of the proposed health provisions, such as additional Medicaid funding for states and expanded eligibility for Medicare and COBRA, "are stopgap measures," the editorial states that "once these benefits are extended, it will be politically difficult, if not impossible, to scale them back to pre-crisis levels." The expanded programs will "add more Americans to government-sponsored insurance rolls and encourage already strapped companies to drop health coverage," which will "drive up government costs and reduce private competition," according to the Tribune. It adds, "Many Americans want health care reform," and "there's plenty of room to improve the system, to cut costs and deliver better care and coverage." However, the editorial concludes, "Serious reform of a system this complex requires a lot more debate than this has received" (Chicago Tribune, 2/10).
  
  
• New York Times: "When members of the House and Senate sit down this week to craft a final version of their differing bills, they must include the most effective provisions -- those that provide powerful stimulus and help those Americans who are most in need," a Times editorial states. The editorial continues, "Aid to the states is excellent stimulus because the money is funneled quickly to public employees, private contractors and beneficiaries for public programs." According to the editorial, "The Senate bill falls short" because it "provides $40 billion less to the states than the House version" and "shortsightedly fails to include a $10 billion provision that would allow states to temporarily offer Medicaid coverage to uninsured people who are unemployed" (New York Times, 2/10).

Opinion Piece
"If Congress insists on a third federal bailout of state Medicaid programs this decade, then at the very least it should aim to not have any more in the future," former House Speaker and founder of the Center for Health Transformation Newt Gingrich and the center's state project director Jim Frogue write in a St. Paul Pioneer Press opinion piece. The two conditions placed on last year's bailout of Detroit's Big Three automakers -- that the "money was a loan" and that "it came with key requirements for fundamental restructuring designed to ensure permanent solvency" -- should "be a part of any Medicaid bailout and the latter should aggressively target the tens of billions of dollars in fraud and abuse that occurs in Medicaid annually," the piece states.

The authors add that states "should have to apply individually for their loan with a detailed plan for serious, long-term reform," including making all Medicaid claims and patient encounter data accessible to the public via the Internet; insisting on increased use of "electronic remittances/electronic fund transfers for accuracy to and from providers"; requiring states to develop "aggressive predictive modeling prior to payments being sent to providers"; and requiring "biometric identification for all Medicaid patients to access services." They write that "[t]axpayers cannot afford" a fourth bailout of Medicaid programs (Gingrich/Frogue, St. Paul Pioneer Press, 2/10).

Broadcast Coverage
NPR's "All Things Considered" on Monday reported on Obama's town hall meeting in Elkhart, Ind., to discuss the stimulus package (Horsley, "All Things Considered," NPR, 2/9). "All Things Considered" also reported on the Senate cloture vote to end debate on the package (Welna, "All Things Considered," NPR, 2/9).

WBUR's "Here and Now" on Monday reported on Obama seeking public support for the stimulus package and his press conference. The segment includes comments from Greg Ip, U.S. economics editor for the Economist (Young, "Here and Now," WBUR, 2/9).

WBUR's "On Point" on Tuesday reported on Obama's "recipe for recovery" with the economic stimulus package. The segment includes comments from Gerald Seib, executive Washington editor of the Wall Street Journal; Raghuram Rajan, professor of finance at the University of Chicago's Booth School of Business and former chief economist at the International Monetary Fund; and Diane Brady, senior editor at BusinessWeek (Ashbrook, "On Point," WBUR, 2/10).

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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