By Kerry Young, CQ Roll Call
June 13, 2016 -- Lawmakers last week considered policy changes for Medicare, but they may struggle to find paths to quickly clear even those proposals that have strong bipartisan support.
Senate appropriators offered several suggestions for the federal health program for the elderly and disabled in the report accompanying their draft fiscal 2017 Labor-Health and Human Services-Education bill (S 3040). The previous day, Rep. Pat Tiberi, R-Ohio, chairman of the House Ways and Means Health Subcommittee, heard from more than 20 colleagues at a bipartisan June 8 hearing on Medicare.
The appropriators' directions to Congress are likely to take effect eventually, with lawmakers expected to complete fiscal 2017 appropriations either later this year or early next year. Less certain is the outcome for bills from Ways and Means. The committee easily moved a package (HR 5273) of Medicare hospital and insurance policy changes through the House by voice vote on June 7, but the Senate Finance Committee has not yet made plans to consider it.
Lawmakers lack a pathway to scrutinize Medicare in the way they use an annual authorization bill to oversee the Pentagon, which now spends roughly as much as Medicare each year. The Senate likely will soon pass the fiscal 2017 defense authorization bill (S 2943), a more than 1,600-page measure that gives lawmakers an annual vehicle for altering Pentagon polices. Through both the defense authorization and appropriations bills, Congress takes a close look at the Defense Department, which will spend about $576 billion in fiscal 2016, according to White House budget figures.
Medicare will pay out about $589 billion this year to doctors, hospitals and other providers of health care, as well as insurers. The program is funded largely through mandatory funding, which continues running largely without annual actions by Congress. In recent years, lawmakers tucked Medicare fixes into the so-called "doc fix" bills that were repeatedly passed to block slated pay cuts. The enactment of a physician reimbursement overhaul (PL 114-10) last year brought an end to these vehicles. Without an urgent deadline, lawmakers have less incentive to act on Medicare.
Still, Tiberi and colleagues are building the case for changes to the program, one of the major long-term liabilities for the federal budget. Medicare spending may rise by 26 percent to $743 billion in 2021, while the Pentagon's budget may rise less than a percent to $582 billion, according to the administration. Aging of the baby boomers will increase the financial burden of Medicare in the years ahead.
Rep. Peter Roskam, R-Ill., argued at the Ways and Means hearing for using so-called smart cards for Medicare beneficiaries as ways to cut down on fraud. Roskam last year introduced a bill (HR 3220) to establish a pilot program to test such electronically readable cards, similar to credit cards, for use by people enrolled in Medicare. Recent estimates pegged Medicare's rate of improper payments at 12 percent to nearly 13 percent, including waste, fraud, abuse and reimbursements made in error. In February, the Government Accountability Office said its research indicated use of electronically readable smart cards might have stopped 22 percent of fraud cases studied.
"Marinate on that for a second, when we are running around here, grubbing around, looking for nickels and dimes" in terms of budget savings, Roskam said.
Roskam asked that the committee move on his bill, which has six Democratic cosponsors and 13 Republicans.
Directions to the Centers for Medicare and Medicaid Services on Medicare in the Appropriations report also can be considered bipartisan. The panel on Thursday passed the underlying Labor-HHS-Education bill, 29-1.
In a report accompanying the bill, the appropriators backed the idea of using more smart cards for Medicare. They also suggested CMS consider a demonstration project on support services available for people caring for family members with Alzheimer's disease. Counseling and support for these caregivers may help those with the debilitating disease reside in their homes longer, which reduces federal medical expenses, the appropriators said in the report.
Some of the Medicare proposals reviewed this week would challenge the Obama administration. Rep. Robert J, Dold, R-Ill., presented to the Ways and Means Committee a bill (HR 5122) to block Medicare's plans to test an alternative form of payment for drugs administered in doctors' offices. Another sponsor, Rep. Tom Price, R-Ga., on Friday released a statement criticizing CMS' response to concerns that he and colleagues raised about the plan.
Price on June 8 presented a bill (HR 4848) before the Ways and Means Committee that challenges a different Obama administration Medicare payment demonstration. Price, an orthopedic surgeon, is seeking to change a CMS program that rewards or docks hospitals' reimbursement based on how well people fare after knee and hip replacements. Although this project began in April, the Price bill would delay the full implementation of the program until January 2018 to give doctors time to adjust and avoid penalties next year.
The test, known as Comprehensive Care for Joint Replacement Model, is talking place in 67 selected regions of the country. Past CMS tests were voluntary. In the hip-and-knee test, hospitals in the selected zones are been compelled to participate, an approach with which Price disagrees.
"How it can be a demonstration project and be mandatory is beyond me," he said at the Wednesday hearing.