House, Senate Poised To Approve Budget Resolutions; House Republicans Unveil Budget Prop.That Would Gradually Eliminate Medicare Fee-for-Service Plans

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Public Health
Article Date: 03 Apr 2009 - 3:00 PDT

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The House and Senate on Thursday are expected to pass their respective fiscal year 2010 budget resolutions (HConRes85, SConRes13), though both resolutions provide "little guidance on how to pay for a health care overhaul," the AP/Philadelphia Inquirer reports (Taylor, AP/Philadelphia Inquirer, 4/2).

Despite the dearth of direction on health care reform in the resolutions, legislators on Wednesday did address several health care-related provisions in the proposals. The Senate voted 44-54 to reject an amendment (S.AMDT.793) to its resolution that would have prevented federal health care programs from denying coverage for any drugs, procedures or services on the basis of data obtained from comparative effectiveness research (Angle, CQ Today, 4/1). Senate Minority Whip Jon Kyl (R-Ariz.), who sponsored the amendment, said that President Obama's FY 2010 budget proposal plans to use data from comparative effectiveness research to ration health care through the influence of federal health programs. Senate Finance Committee Chair Max Baucus (D-Mont.) called Kyl's proposal "an ostrich amendment, a heads-in-the-sand amendment" (Clarke/Krawzak, CQ Today, 4/1).

House Republican Alternative
House Republicans on Wednesday unveiled their FY 2010 budget alternative that includes provisions that gradually "would end Medicare as it is presently known" by eliminating the traditional fee-for-service aspect of the program, the AP/Inquirer reports. Under the proposal, U.S. residents ages 54 and younger at the time of the bill's enactment would, upon becoming eligible for Medicare at age 65, be enrolled in private health insurance plans and receive a subsidy on their premiums. U.S. residents ages 55 and older would still be enrolled in the traditional Medicare program upon reaching the eligible age (AP/Philadelphia Inquirer, 4/2).

The proposal also would grant Medicaid payment increases to states based only on inflation and would maintain Medicare spending at current levels, although the plan "didn't include much detail on how the health care savings would be achieved without compromising care," Roll Call reports (Dennis [1], Roll Call, 4/1). House Budget Committee ranking member Paul Ryan (R-Wis.), who developed the proposal, said, "If we don't reform our entitlement programs, they go bankrupt and people's benefits get cut automatically" (Taylor, AP/Boston Globe, 4/1).

Democratic Response
Rob Nabors, deputy director of the White House Office of Management and Budget, criticized the Republican plan for its Medicare and Medicaid cuts. Nabors added, "What they are essentially saying is, we are going to cut the program but we aren't going to do anything to cut health care costs" (Dennis [2], Roll Call, 4/1). White House chief of staff Rahm Emanuel added, "If this is an April Fool's joke, it is not very funny" (Hulse, New York Times, 4/2).

According to the AP/Inquirer, Democrats said the proposal would result in "sharply higher costs" for seniors because the premium subsidy likely would not keep pace with health care inflation (AP/Philadelphia Inquirer, 4/2). Democrats also said that the plan would continue to provide tax breaks for high-income individuals while negatively affecting U.S. residents who rely on Medicare, CQ Today reports (Clarke/Krawzak, CQ Today, 4/1). House Majority Leader Steny Hoyer (D-Md.) said, "If, in fact, the Republicans are achieving the ends that they say they are achieving, they do so by employing draconian means" (AP/Boston Globe, 4/1).

According to the New York Times, the GOP proposal "has no chance of passing" and is mostly intended as a response to Democratic criticism that Republicans had not offered any budget alternatives (New York Times, 4/2). Senate Republicans do not plan to offer an alternative plan, "preferring to go after the Democratic budget amendment by amendment," CQ Today reports (Clarke/Krawzak, CQ Today, 4/1).

Contention Continues Over Reconciliation
According to the AP/Inquirer, the "most contentious question" in the budget resolution process continued to be whether or not to employ budget reconciliation to move health care reform through Congress. The House resolution includes budget reconciliation language to advance health care reform legislation (AP/Philadelphia Inquirer, 4/2). According to the AP/Boston Globe, House leaders insisted that they have a "filibuster-proof bill" -- via the budget reconciliation process, which requires only 51 votes to avoid filibuster as opposed to the typical 60 -- in the event bipartisan negotiations on health care reform break down. Although the Senate version does not include budget reconciliation instructions, at the behest of Senate Republicans, "it seems increasingly clear" that a final House-Senate compromise resolution would allow the reconciliation process, according to the AP/Globe (AP/Boston Globe, 4/1). According to CQ Today, reconciliation is a "powerful tool at the majority's disposal" that many Democrats believe "would be foolish to shelve" while attempting to move Obama's agenda (Clarke/Krawzak, CQ Today, 4/1).

Reform the 'Big Remaining Prize'
In related news, Politico on Thursday examined how bipartisan votes against using the budget reconciliation process for a climate control initiative "raised the stakes further for health care reform as the big remaining prize for the White House in the budget debate" (Rogers, Politico, 4/2).

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