Congressional Debates Over Health Issues Expected In Congress

Several debates over health care issues are expected this year in Congress. These debates will be primarily focused on containing medical costs, including medical malpractice caps and potential cuts in Medicaid and Medicare. The Congress also may consider legislation to offer health care coverage for some of the 45 million uninsured Americans. President Bush laid out his priorities for the new year in his State of the Union address and is expected to deliver his FY 2006 budget to Congress in early February. The following is a summary of issues that ASH is monitoring:

Medicare Modernization Implementation -
The Medicare Modernization Act (MMA), which will begin offering drug coverage in 2006, will begin to be implemented, and policymakers are expected to challenge various provisions. Of particular interest to hematologists will be discussion about the adequacy of physician reimbursement. Another issue expected to draw attention is drug reimportation. Democrats plan to push for the importation of less expensive drugs into the United States to cut prices for consumers and Medicare. The Bush Administration, however, has already expressed resistance, citing concern about whether importation could be done safely.

Medicare Cuts -
The President's pledge to reduce the deficit in half by 2009 means that Medicare is a likely target for budget reductions. Finding savings in the program will not be easy, however. Medicare hospital payments have been a traditional source, but data from the Medicare Payment Advisory Commission (MedPAC) show that hospital Medicare margins fell to negative 1.9 percent in 2003.

Medicaid Reforms -
House Energy & Commerce Chairman Joe L. Barton (R-TX) plans to conduct comprehensive hearings on overhauling Medicaid, with an aim of curbing program spending to pare the budget deficit. Senate Democrats recently wrote to President Bush outlining their opposition to Medicaid reforms that cap federal spending or undermine the program's coverage entitlement. The National Governors' Association also has begun to mount a bipartisan lobbying effort to ward off new federal limits on Medicaid.

Health Coverage for the Uninsured -
Republicans plan to provide tax credits for individuals to buy insurance. They also want to expand tax-preferred health savings accounts and allow businesses to pool their resources to buy health insurance that would not be subjected to state coverage mandates.

In addition to the issues summarized above, please see the related story on NIH reauthorization.

New Medicare Physician Reimbursement Methodology

On January 1, the Centers for Medicare & Medicaid Services (CMS) began implementation of the new Medicare Average Sales Price (ASP) pricing information for chemotherapy drugs and supportive care drugs. The ASH Committee on Practice is closely monitoring the impact of ASP on hematologists as well as developing relationships with the Congress in order to position the Society in a credible place should it need to propose legislative remedies to the new Medicare reimbursement methodology. For more details about ASP, including a link to the CMS actual payment amounts, please visit the ASH Web site. In addition, the ASH Web site includes information about the new Cancer Care Demonstration project.

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