No Choice Here

Children vs. seniors? What an outrageous showdown. Yet that's exactly the match the House of Representatives has set up in its expansion of the State Children's Health Insurance Program — and seniors might not win.

With Congress under a “pay as you go” mandate, the House had been expected to fund an expansion of SCHIP with a higher cigarette tax. But when push came to shove as it often does in Washington deal-making, representatives balked at raising the federal tax to the 61 cents that was needed and held it down to 45 cents a pack.

When their plan stopped short of financing the entire $50-billion program (SCHIP covers low-income children whose families don't qualify for Medicaid), House members turned elsewhere for money. And also as happens so often on Capitol Hill, they turned to Medicare benefits and DME.

The House version of the Children's Health and Medicare Protection Act, or CHAMP, would now fund SCHIP though payment cuts to Medicare Advantage plans and reimbursement reductions for health care providers. The latter include shortening the home oxygen rental cap to 18 months and eliminating the first-month purchase option for power wheelchairs.

Whether home care providers can maintain the service necessary in supplying those products is already questionable given the cuts that will be imposed by DMEPOS competitive bidding. Under the House bill's new parameters, it would clearly be a goner.

Perhaps the bill's greatest irony is that it holds Medicare's oxygen benefit hostage to a break for tobacco companies. COPD is the fourth leading cause of death in the U.S. and, so far, oxygen therapy is the only treatment that can extend the life of these patients. Currently, about a million Medicare beneficiaries depend on oxygen for their survival.

Incidentally, the American Lung Association estimates that 80 to 90 percent of COPD deaths are caused by smoking.

Granted, the House measure isn't signed yet, and it could be tough getting the bill's provisions onto the president's desk. They must first be reconciled with the Senate's version of the bill, which is funded by the higher 61-cent tax and does not include the DME cuts. In the meantime, the tobacco industry is bound to lobby against any cigarette tax increase, and the managed care industry will surely work to keep health plans from being cut.