Less than a week before Christmas, the Senate and House passed a bare-bones Medicare package that primarily contained a six-month “doc fix” provision, ensuring that physicians did not receive a payment cut this month. This small Medicare package contained no cuts or provisions related to home medical equipment, including power wheelchairs and oxygen.
While this gives us a short-term sigh of relief, the Medicare proposals contained in earlier House and Senate Medicare packages in 2007, specifically oxygen payment cuts and elimination of the first-month purchase option for power wheelchairs (with an exception for high end rehab), will undoubtedly be on Congress' Medicare agenda this spring as Congress develops a new Medicare package.
With the limited six-month “doc fix,” physicians will be in the same bind again come July 1, 2008. And Congress has other unfinished business it will seek to get through the more conservative Senate.
In 2007, we managed to have payment cuts to the Medicare oxygen benefit become a “controversial issue,” the critical criterion for being excluded from the Medicare-State Children's Health Insurance Program (SCHIP) extension bill that Congress cobbled together in the last week of the session. We did that by shoring up critical support from key senators who actively communicated to the Senate leadership their concerns with cuts to this benefit.
Key leaders in this effort included Sens. George Voinovich, R-Ohio; Pat Roberts, R-Kan.; John Isakson, R-Ga.; Sheldon Whitehouse, D-R.I.; Tim Johnson, D-S.D.; and Susan Collins, R-Maine. All of these senators stepped up because of constituents who took the time to educate them on the issue and its impact on the providers and beneficiaries in their respective states. That was a great start, but we need to increase that list of senators in 2008.
In the end in that same Medicare bill, Congress merely extended the SCHIP program at current funding levels until March 2009. As 2007 progressed, it became increasingly clear that reaching an accommodation between the White House and the Democratic leadership on SCHIP was too steep a political mountain to climb. If Democratic leaders went too far in trying to overcome Republican concerns about expanding eligibility and overall spending levels, they risked losing support from within their own party.
Thus, with the SCHIP program set to expire and nearly half of the states facing funding shortfalls, Congress set aside plans to expand SCHIP and simply passed an extension of the existing program.
It is probably premature, though, to say that SCHIP is no longer part of the 2008 political landscape. Some analysts predict congressional Democrats could still introduce legislation to expand the program so that Republicans are forced to go on record as being “anti children” in an election year.
House and Senate Democrats are also considering using this year's budget as a weapon to bypass Senate Republican filibusters and ensure politically popular legislation reaches the president's desk. Democrats could move a budget reconciliation package that would allow legislation on a broad array of programs and tax policy to pass with a simple majority under strict time limits. In contrast, non-budget reconciliation bills, such as the Medicare bill passed in December, require 60 votes to avoid a Senate filibuster and obtain the approval of that chamber.
Such a package would either provide Democrats with a major accomplishment heading into the 2008 elections, or very likely would be vetoed by the president. This would arm Democrats with an election-year issue that would appeal to their liberal base and lawmakers alike who are unhappy with the majority's inability to get more done in 2007.
Given the 2008 landscape, we need to gear up our grassroots efforts since Medicare discussions will begin much earlier than usual in the year. Providers across the country must contact their senators and representatives with key talking points on the home oxygen and power wheelchair issues impacting our business.
A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 440/329-6226 or by e-mail at cbachenheimer@invacare.com.
