Picture Clears as Congress Nears Action on Budget Issues
As this column goes to press the week of October 21, key committees in the Senate and House are preparing to take action on budget reconciliation, the process by which Congress specifies how it will reach spending targets set by the 2006 budget. After weeks of struggling, the outlines of spending cuts (and new spending) are becoming much clearer.
Chair Charles Grassley (R-Iowa) announced that the Senate Finance Committee will begin working on the budget package on October 24. The Finance package offers good news for APA members because it
replaces the projected 4.4 percent reduction in the Medicare physician payment update with a positive 1 percent update. The change means a net gain of nearly $11 billion over 10 years. | |||||
includes a version of the APA-supported Family Opportunity Act, which allows families with incomes of up to 300 percent of the poverty level to purchase Medicaid coverage for disabled children. | |||||
mitigates the impact of changes to targeted case management. | |||||
includes about $2 billion in Hurricane Katrina health-related relief. | |||||
The package achieves most of its net Medicare and Medicaid savings of $10 billion through restrictions on asset transfers for nursing-home eligibility, changes in drug pricing and pharmacy payments, and repeal of a Medicare fund for special payments to Medicare Advantage plans.
Notably, the Finance Committee markup includes a phase-in of pay for performance for physicians. We are analyzing the proposal and will provide detailed information later. “Value-based” payments to physicians submitting required quality data would begin in 2009; quality-improvement data measures would be developed in consultation with impacted practitioners.
The picture in the House is less clear; the GOP leadership has deferred action pending resolution of disagreements over how to achieve the net savings target of $50 billion, up from the $35 billion called for in the budget. What's likely is that key committees in the House will start work in late October on a package of savings within their jurisdiction. The major committees charged with the heavy lifting are Ways and Means, Energy and Commerce, Education and Workforce, and Agriculture. Programs on the table for cuts include Medicare (elimination of or cut in the Medicare stabilization fund), Medicaid (where cuts reportedly will mirror much of the Finance package), along with pension fund premiums, cuts in student loan programs, and savings from farm and other payments.
Earlier this month, the House appeared to be ready to consider an across-the-board 2 percent cut in domestic discretionary spending, but support has waned.
As of press time, the House leadership was still attempting to find the votes to pass a package that would increase savings from mandatory programs to $50 billion from the $35 billion originally called for in the 2006 budget. The GOP leadership postponed action late October, when spending reductions will be achieved in key House committees.
Programs on the table for cuts include Medicare (where Ways and Means may cut the Medicare stabilization fund designed to bolster drug and health coverage), Medicaid (where cuts include changes to pharmacy payments, new copayments for enrollees, and restrictions on asset transfers for nursing-home care), along with pension fund premiums, cuts in student loan programs, and savings from farm and other payments.
APA and other health and mental health advocates have strongly objected to mandated cuts that target health programs for the poor and elderly. APA joined with other members of the Campaign for Mental Health Reform in strongly opposing reconciliation efforts to cut vital Medicaid programs such as targeted case management and rehabilitative services and expressing concern about copayments for Medicaid enrollees.
APA has also joined with 250 medical, health, mental health, and other organizations in urging the speaker of the House and the Senate majority leader to acknowledge the immediate and long-term mental health needs of Americans impacted by Hurricane Katrina by passing a comprehensive mental health parity law in 2005.
APA is separately urging Congress to act on APA-supported legislation to end Medicare's historic, discriminatory 50 percent coinsurance requirement for outpatient psychiatric services, to restore benzodiazepines to the list of medications that must be covered under the new Medicare Part D prescription drug program, and to clarify Part D coverage rules impacting medications used in the treatment of addictions.
Capitol Hill Symposium
As part of 2005 Mental Illness Awareness Week, APA and the National Alliance on Mental Illness (NAMI) hosted their annual luncheon in late September for members of Congress and their aides focusing on posttraumatic stress disorder (PTSD) and trauma research (Psychiatric News, October 4). Following introductory remarks by APA President Steven Sharfstein, M.D., attendees heard from Thomas Insel, M.D., director of the National Institute of Mental Health; researcher Roger Pitman, M.D.; Col. E. Cameron Ritchie, M.C., an Army psychiatrist who advises the Army's surgeon general; David Post, M.D., a past president of the Louisiana Psychiatric Medical Association; and Harold Ginzburg, M.D., a Louisiana psychiatrist who is a victim of Hurricane Katrina and has treated many evacuees.
The speakers addressed PTSD research, postcombat needs of soldiers, and ways in which relief workers have addressed PTSD and other mental health issues as part of the hurricane response efforts.
Reps. Grace Napolitano (D-Calif.), Howard Coble (R-N.C.), Dutch Ruppersberger (D-Md.), and Patrick Kennedy (D-R.I.) made brief remarks. After the lunch, staff of APA's Department of Government Relations took Drs. Post and Ginzburg to meet with members of the Louisiana congressional delegation.
Privacy Under Patriot Act
APA has joined with other organizations to oppose provisions in the Patriot Act allowing seizure of medical records. APA supports Senate language to offer greater protections to health and mental health records. APA also objects to“ gag order” language that forbids physicians from informing patients or other parties that records have been taken.
DGR Staffing Changes
I'm pleased to announce the addition of two members to our DGR lobbying team. Clare Jenkins joins APA as our House lead on major issues including nondiscriminatory coverage of treatment for mental illness and all issues related to Medicare. Clare joins us after serving as legislative assistant for health to Rep. Earl Pomeroy (D-N.D.), a member of the House Ways and Means Committee.
Tom Leibfried joins us as Clare's counterpart lead lobbyist for related issues in the Senate. Tom arrives at APA from the National Council for Community Behavioral Healthcare, where he led the government relations operation. Both have demonstrated interest and expertise in health and mental health issues. ▪
