Elections boost GOP health care agenda
This year's unfinished business -- Medicare prescription drugs,
medical tort reform and health insurance access -- will spill over into
next Congress.
By
Joel B. Finkelstein, AMNews staff. Nov. 25, 2002.
Additional information
Washington -- Now that Republicans control both the House and Senate,
President Bush's health care plans are expected to take center stage,
according to political analysts. That will shift the tenor of the debate
on a variety of physician issues, from liability insurance reform and
health insurance access to Medicare prescription drugs and patient
protections.
But with the GOP maintaining only a narrow majority in the Senate, the
Republican health agenda will not necessarily be a slam dunk. Republicans
could still face stiff opposition from Senate Democrats.
A top item on Republicans' list of health care initiatives will be
passing a Medicare prescription drug benefit.
GOP control of both chambers of Congress gives a boost to the
Republican vision of a drug program -- one that relies on private insurers
to offer the benefit. But Democrats will still push for their proposal,
which includes a federally managed benefit.
The price tag will continue to cause controversy. Democrats favor
spending far more on a drug benefit.
President Bush will have to remain flexible on appropriations levels to
avoid getting bogged down in opposition as congressional Democrats try to
increase funding levels. The sluggish economy and Republicans' attempts to
pass new tax cuts could make funding a drug benefit program that much more
difficult, political analysts said.
Premiums rose 20% for ob-gyns and 26% for internists between last
winter and summer.
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But despite tight economic times, "we are going to have a prescription
drug benefit pushed through," predicted Norman J. Ornstein, PhD, resident
scholar at the American Enterprise Institute.
Pharmacy discount cards may prove an attractive option for lawmakers,
as there is growing experience with this approach and it will cost the
government relatively little to administer, said Diane Rowland, ScD, of
the Kaiser Family Foundation.
As for comprehensive Medicare restructuring, any proposal likely would
face an uphill battle in Congress, Dr. Ornstein said.
Addressing medical liability woes
The burgeoning medical liability insurance crisis also may get
lawmakers' attention next year, many experts predicted. With increasing
reports of doctors leaving medical practice because they cannot afford or
get liability insurance, the American Medical Association and other groups
are pushing hard for tort reform.
The Association also will press Congress to prevent continued Medicare
physician payment cuts, which it says are hurting access to specialty and
primary care physicians, said AMA President Yank D. Coble Jr., MD. At
press time, it was unclear whether Congress in its lame-duck session would
address Medicare physician payment before closing the current legislative
session.
"These two things are creating an enormous barrier to care, and not
only for seniors," Dr. Coble said. While specialists, such as
obstetrician-gynecologists and emergency department physicians, have been
the hardest hit by medical liability insurance problems, he noted, primary
care physicians are also starting to feel the pinch.
Rates are rising fastest in states without noneconomic damage caps.
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Dr. Coble said the current state of medical liability law rewards
lawyers and a few patients, while the majority of patients who have been
injured get nothing. States that have adopted their own rules to limit
jury awards for noneconomic damages seem to be avoiding the crisis
situation seen in other states, which are losing doctors and medical
facilities to out-of-control liability insurance premiums.
The AMA's position has been echoed by the Bush administration. A recent
report from the Dept. of Health and Human Services showed that
professional liability insurance rates are rising at an increasing pace.
Premiums rose nearly 20% for obstetrician-gynecologists between last
winter and summer and more than 26% for internists. The report also found
that rates are rising fastest in states without limits on noneconomic
damages, ranging from 36% in Nebraska to 113% in Virginia.
Earlier this year, Bush called for federal tort reform, including caps
on noneconomic damages and punitive damages, structured payouts, a statute
of limitations on malpractice suits and a provision requiring doctors to
pay only the portion of damages for which they are personally responsible.
The House in September passed a tort reform bill including many of
those provisions, but Democratic opposition in the Senate has prevented
action there. Democrats are likely to continue their fight against
sweeping reform next year, experts predicted.
But GOP control of the legislative and executive branches could result
in federal court appointments that swing decisions in favor of states
trying to pass their own versions of tort reform.
Expanding health insurance access
The GOP takeover also will affect the debate about how to reduce the
number of uninsured Americans, which reached 41.2 million last year.
"We may see a modest effort for the uninsured, such as a tax credit to
help people pay for private insurance," said Robert Blendon, ScD, director
of the Harvard University Program on Public Opinion and Health and Social
Policy. But expect Republicans to spend less on health insurance reforms
than the Democrats would like, he added.
Tax credits synchronize well with the Bush administration's embrace of
tax cuts, but they have been a hard sell with most Democrats, who say the
tax credits do nothing for the working poor.
Republicans may be able to pass a tax-credit bill if it is generous
enough to help more low-income Americans, political analysts said.
"There is going to be a lot of attention around the public health care
system," predicted Kaiser Family Foundation's Dr. Rowland. The Bush
administration may seek to further boost the public health infrastructure
by way of homeland security and bioterrorism legislation.
Experts predicted that patients' bill of rights legislation may not
find its way back on the congressional agenda next year.
"HMO reform has pretty much fallen off the radar screen," said
Whitfield Ayres, PhD, whose firm conducted a pre-election survey for the
Pharmaceutical Research and Manufacturers of America.
That survey showed that, across the board, managed care reform was the
most important issue for just 1% of voters. In a separate survey, the
Kaiser Family Foundation found that managed care reform was the top health
care issue for 2% of the voters.
Health care issues that don't get addressed by Congress, such as a
patients' bill of rights, may fall to the states, though the new governors
will be severely restricted by growing budget crises created by
overspending during the 1990s, the weakened economy and reduced federal
health care spending.
Despite their budget problems, "there is no question you may see a few
more states getting into HMO reform," said Dr. Blendon.
Big gubernatorial wins for Democrats may reflect disgust with the
current state of the economy, Dr. Ornstein said, but could prove a curse
if the economy continues to falter. "This is not going to be a good time
to be a governor."
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ADDITIONAL INFORMATION:
Voters ho-hum on health
Health care was not a key issue for most voters in the Nov. 5
elections. Only 9% of likely voters named health care issues as their
priority, compared with 21% who named the economy and jobs. When likely
voters were asked to identify what aspects of health care were of most
concern, the breakdown was:
Prescription drug costs: 25%
Health care costs: 18%
Uninsured: 18%
Medicare/Medicaid/elderly care: 14%
HMO reform: 2%
None: 12%
Don't know: 15%
Source: National Public Radio/Kaiser Family Foundation/Harvard
University survey
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Weblink
Congressional election tracking
survey, National
Public Radio/Kaiser Family Foundation/Kennedy School of Government,
(http://www.kff.org/content/2002/3299/)
Report, "2002 Pre-election Survey of Likely Voters Regarding Health
Care Issues," sponsored by PHRMA, in pdf (http://www.phrma.org/publications/publications//2002-11-06.609.pdf)
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Copyright 2002 American Medical Association. All
rights reserved.
