Bush, Kerry and Their Health Care Plans

The home health industry has learned a few things about Washington and politics over the years. One is that presidential candidates usually have little or nothing to say about the business; this year is no exception. Another is that most home-health policy is made in Congress and carried out by bureaucracies of the executive branch. Such detail work is well under the presidential radar.

“It's more important what Congress does and who wins in congressional elections than who wins for the presidency,” says Jim Walsh, president of VGM Management, Ltd., and general counsel of The VGM Group. Presidents do have definite, and sometimes detailed, ideas on health care, but they tend to focus on the big players. “People don't sit around and say, ‘Let's see what our health care policy for HME is,’” he says. “They think in terms of doctors and hospitals, not HME.”

But Walsh and other long-time observers know something else: Ideas have consequences, often unintended or unforeseen. And federal policy initiatives, in and beyond health care, can have an indirect but profound impact on small, little-noticed industries that depend heavily on the government for their economic well-being. HME fits that description, and it could well be affected by this year's presidential election no matter who wins.

Four years ago, for instance, then-candidate George W. Bush promised to push for a Medicare prescription drug benefit. He finally got a drug plan through Congress in 2003. But in the process, the HME industry suffered what many would call collateral damage. As part of the Medicare drug bill — and as a way to help defray the new program's high cost — Congress decided to push ahead with nationwide HME competitive bidding. The bill also has led to a sharp reduction in reimbursement for respiratory drugs already covered under Medicare, along with payment cuts on a number of other staple products.

Bush the candidate may not have had HME on his mind in 2000 or in 2003. But in an indirect way, he was making HME policy all the same.

This year, Bush and his challenger John Kerry have staked out health care policies with clear differences, both in detail and in basic philosophies about the role of government and markets. What's not clear, now as in campaigns past, is how home care will fare when Congress and the bureaucrats translate these presidential initiatives into laws and regulations.

Here is what the two men, based on their past statements and campaign documents, have in mind for health care in general, and what their plans might imply for home care.