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Partisan Discord Continues Over Budget Reconciliation Snafu

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Partisan Discord Continues Over Budget Reconciliation Snafu Powered By Docstoc
					       Partisan Discord Continues Over Budget
                Reconciliation Snafu
Washington Insider's Club: Issue #02-06                         February 20, 2006
   In This Issue...      Suellen Galbraith, Director for Government Relations
                         Jessica Sadowsky, Government Relations Associate

                              And You Think You Make Big Mistakes? Stakes Raised
         BUDGET
                              as Snafu Over Budget Reconciliation Bill Vote Ends
                              With House Vote to Kill Ethics Investigation.
       MEDICAID               Democrats offered a resolution in the House Thursday,
                              calling for an ethics investigation into the handling of the
       MEDICARE               final House vote February 1st on The Deficit Reduction Act
                              of 2005 (S. 1932; P.L. 109- 171). However the resolution—
     EMPLOYMENT               offered on a point of personal privilege by House Minority
                              Leader Pelosi (D- CA)—was tabled by a 219-187 vote, with
   APPROPRIATIONS             six members voting present. The vote on Thursday was an
                              indication of the escalating partisanship over an issue that
                              became public last week. Thursday’s resolution was in
                              response to the glitch created when the House voted
                              February 1st by a narrow vote of 216-14 on the $39 billion
                              federal savings bill—a bill that ultimately was shown to
                              have contained a $2 billion difference (error) in the version
  Featured Article            passed by the House from the version previously voted on
                              by the Senate. A Senate clerk inserted a $2 billion change
                              into the bill parchment before it was certified by House
                              Majority Hastert (R-IL) and Senate President Pro Tempore
                              Ted Stevens (R-AK) as the correct version and signed into
                              law by President Bush on February 8th. Claiming that the
 March 2nd ANCOR Audio        House Republican leadership knew of this error and still
   Conference: Deficit        allowed the vote and that the identical bill was not passed
Reduction Act and FY 2007     by both chambers and sent to the President for his
    Budget Proposal           signature, Pelosi and others have raised issues of abuse of
                              power, ignoring House rules, and with the Constitution
 Presidents’ Day Recess:      itself. Majority Leader Hastert told reporters Thursday that
 House Returns February       he did not know about the change before he signed the
  28th; Senate Returns        legislation. The Senate clerk then changed the number of
      February 27th           Medicare durable medical equipment rental years back to
                              the correct version voted on by the Senate. Need a
    Medicaid Advisory         scorecard? House Republicans may ultimately be required
Commission Meeting Open       to try to pass the bill again, if legal challenges are
 to Public March 13-15 in     successful. (See related article below.) However, House
          Atlanta             Budget Chairman Jim Nussle (R-IA) said Thursday that the
                              budget bill does not need to be revisited. This is not a
Kaiser Statehealthfacts.org   House matter, Nussle said, adding that a Senate clerk
 Updates Data on Medicare     should be fired for incompetency or malfeasance.
Part D "Clawback" Payment

   Pew Charitable Trust
Special Report on Medicaid
                                BUDGET
Petition Urging Ratification    Meanwhile, Back in Alabama…Attorney Files Lawsuit
 of UN Convention on the        Over Budget Bill. An Alabama lawyer has filed a lawsuit
   Rights of People with        seeking to void the $39 billion budget savings act signed
         Disablities            into law February 8 by President Bush because of the
                                above clerical error that resulted in the House and Senate
 Medicare Part D Q&A: Will      passing different versions of the bill. The $2 billion error,
the Part D assistance affect    figuring in the claim by many of an invalid law, arose over
   food stamp eligibility?      budget savings estimated from changes in rental time for
                                certain Medicare durable medical equipment. According to
                                media accounts, Jim Zeigler, a conservative Republican
                                lawyer who specializes in Medicaid cases, filed the suit in
                                U.S. District Court in Mobile, Alabama, Monday, saying the
                                measure is not a valid law because it was not passed in
                                identical form by both chambers. Ziegler told reporters in
                                Mobile: I represent older folks who are intending to get
                                Medicaid nursing home eligibility, and right now I can’t
                                properly advise them to follow the post-Feb. 8 law that is
                                unconstitutional or the pre-Feb. 8 law that is
                                constitutional. He anticipates that elderly people directly
                                affected by the new law will join the suit shortly to
                                enhance the chances that the court will grant standing in
                                the case.

                                Talk of Budget Reconciliation Oversight Hearings
                                and Possible Technicles Bill. While ANCOR and other
                                national groups are disappointed that the House
                                marginally passed S. 1932, there may be some hope that
                                Congressional oversight hearings this year will focus on
                                Medicaid provisions of concern such as Medicaid waivers,
                                quality, and S-CHIP. It remains unclear as to whether
                                Congress will take up a technicles bill (used to make
                                corrections in legislative language, not major changes to
                                policy) this year for the Deficit Reduction Act (DRA)
                                passed in February. Without legislative changes to the new
                                Medicaid policy in the DRA, rulemaking—the next step—
                                does not provide a real opportunity for the regulatory
                                process to soften the significant program changes.




                                MEDICAID
                                Cuts to Medicaid Come with Political Risks.
                                Thursday’s Wall Street Journal reported that states are
                                facing political risks in scouring their Medicaid programs
                                for savings. Some states, such as Florida and Vermont
                                have placed limits on how the state will pay for Medicaid
                                medical costs, while others—like Tennessee—have wound
   :: sgalbraith@ancor.org      up cutting hundreds of thousands of individuals off of
  :: http://www.ancor.org       Medicaid. The aggressive Missouri cuts made last year in
                                eligibility and program changes resulted in 100,000
                                beneficiaries losing coverage. However, Governor Matt
      :: 703-535-7850           Blunt (R-MO) states that the cuts have generated political
                                heat. Nearly 68% of state residents opposed the cuts, with
                                only 33% approving of the governor’s job performance.
 The WSJ also reported that some health care experts say
 changes directed at low-income individuals don’t deal with
 the biggest driver of Medicaid costs—long-term care for a
 relatively small number of beneficiaries who are elderly or
 have disabilities.

 Kaiser Executive Director’s Analysis in CMS
 Subscription Journal. Diane Rowland, executive vice
 president of the Kaiser Family Foundation, authored the
 article Medicaid at Forty in the Winter 2005/2006 issue of
 Health Care Financing Review. The article examines
 Medicaid’s evolution in its role as a health insurer for low-
 income families, a source of health and long-term care
 (LTC) coverage for people with disabilities, and as the
 supplement to Medicare for low-income aged and disabled
 Medicare beneficiaries.

 HSAs: A Way to Address the Uninsured or Bad
 Medicine? The President’s State of the Union Address and
 FY 2007 promoted health savings accounts (HSAs—
 formerly called medical savings accounts in the 1990s) as
 a way to address the 45 million uninsured, pressure on
 Medicaid, and employee-employer health care
 arrangements. HSAs are the centerpiece to federal policy
 for addressing access to healthcare in the FY 2007 budget
 proposal, calling for $59 billion in federal revenue for HSA
 subsidies and tax incentives. Congress will include HSAs in
 the upcoming budget debates. In an interview with Jim
 Lehrer on PBS Thursday, Dr. Karen Davis, President of The
 Commonwealth Fund, said that HSAs were the wrong
 prescription for the nation’s health care system. More is
 available on the PBS commentary and Dr. Mongan’s
 analysis of HSAs on The Commonwealth Fund website.




 MEDICARE
 Democrats Prepare Legislation That Would Alter
 Medicare Drug Benefit. Some House and Senate
 Democrats on Wednesday proposed legislative changes to
 the Medicare prescription drug benefit that they said would
 ensure beneficiaries could obtain medications with fewer
 problems. Representative John Dingell (D-MI.) and
 Senators Richard Durbin (D-IL) and Debbie Stabenow (D-
 MI) said Democrats will propose that Medicare drug plans
 be required to provide beneficiaries with a 60-day supply
 of any drug that is not covered by the plan. In addition,
 the proposed legislation would create a standardized
 appeals process, with medications provided during the
 appeal. The legislation also would prohibit drug plans from
 eliminating medications from a formulary once a
 beneficiary has enrolled or from raising the cost of the
 drugs in midyear.

 Energy and Commerce Committee Question HHS
 Secretary. Members of the House Energy and Commerce
 Committee on Wednesday questioned HHS Secretary Mike
 Leavitt about the new Part D drug benefit. Leavitt said
 problems with the drug benefit can be corrected through
 administrative action and do not require legislative fixes.
 However, he added that he would work with Congress to
 address issues with the drug benefit, including concerns
 about the May 15 enrollment deadline.

 Florida, Massachusetts and New Jersey Take Action
 on Part D. Florida has asked CMS for an extension of the
 February 15th deadline (until March 8th) for federal
 reimbursement to states to cover the cost of prescription
 drugs for dual eligibles. Massachusetts has received an
 extension until March 15th to cover the cost of duals’
 medications. Massachusetts has paid $16.9 million for dual
 eligibles’ drugs and $2.3 million to provide treatments for
 beneficiaries under a state assistance program. New
 Jersey has requested an extension for the cost of duals
 who experience problems with access to Part D. In its
 letter to CMS, New Jersey officials state that they have
 found no evidence that sufficient improvements have been
 made to the Medicare prescription drug benefit to ensure
 the most vulnerable clients...will be adequately served
 should we turn their drug coverage over to Medicare and
 its contractors. New Jersey claims it has paid $42 million
 for dual eligibles’ drugs since January 1st.




 EMPLOYMENT
 Lawmakers Cool To Job Training, Education Program
 Cuts. The Bush administration's proposal to establish new
 accounts for workers to select their own job training or
 education programs got a cool reception Thursday from
 both parties on Capitol Hill. House Labor-HHS
 Appropriations Subcommittee Chairman Ralph Regula, (R-
 OH), and others on the panel appeared nonplussed by the
 suggested program. The Administration's FY07 budget
 proposal for the Labor Department included an overall cut
 of 3.9 percent, but would allocate $3.4 billion to provide
 states with funds to give unemployed people or those
 wishing to change jobs with $3,000 "career advancement
 accounts," which are renewable for one year. Individuals
 could use their accounts to pay for the job training
 programs of their choice, something the administration
 says will put people in charge of their own training. But
 Regula worried that the program would detract from
 existing one-stop career centers that provide job search
 assistance and counseling, and that the proposal lacked
 accountability. Others were concerned that the $3,000
 would not cover tuition at many academic institutions.




 APPROPRIATIONS
Fewer Earmarks Expected This Year. Although House
members can ask, fewer will hear yes to requests for
earmarks in the 13 annual appropriations bills. With
lobbying scandals adding new pressures to reduce special
projects for members and with the 13 appropriation
cardinals grappling with even tighter non-defense
domestic discretional allotments, Representatives are
already hearing warnings about their member requests for
their home districts. House members face a March 16th
deadline to Appropriations subcommittees for district
earmarks. The Interior and Environment subcommittee
has been limited to five earmarks an individual member
can request; Agriculture and Energy and Water
subcommittees have been told there will be a limited
number of earmarks and they will be rank; and Labor-
HHS-Education committee has been warned of limited
earmarks—this following last year’s inclusion of no
earmarks due to the low allocation.

Billions in Hurricane Relief, But Glitch May Mean
Zero for Texas. Congress is now debating a Presidential
request for $19.8 billion in federal funds for states directly
affected by hurricanes Katrina and Rita. However, there
may be zero for Texas. Apparently, Texas officials
discovered Thursday that a communications glitch
between Washington and Austin glitch ended up with the
White House not including specific projects for Texas.
Congressional debate on the $19.8 billion measure will
produce an allotment for each state directly affected by
Hurricanes Katrina or Rita. The Texas list of $2.1 billion in
hurricane expenses arrived in Washington Thursday
morning, too late to be considered by the White House
before the Bush administration delivered the spending bill
to Congress later in the day.

Save Your Quarters. States Wanting to Inject Money
Into Road Projects—Competing for Dollars with
Education and Health Care Programs—Are Turning to
Toll Roads. An injection of new money for transportation
projects is on the table in a number of states that are
projected to run surpluses this year, though roadwork will
be competing for dollars with schools and health care. The
longer-term problem is that the largest source of funding
for the nation’s roads and transit systems—state and
federal gasoline taxes—cannot keep up with demand for
road construction and its spiraling costs. Following three
years budget woes and stagnant transportation spending,
states are embarking on a road-building binge. However,
they still struggle with how to pay for new pavements.
One answer increasingly is pay- as-you-go for motorists.
Toll roads are booming because gas tax revenues are
woefully inadequate to pay for constructing and improving
highways. California, Florida and Texas are adding toll
lanes or turning existing lanes into pay-as-you-go roads.
Georgia is debating charging a toll on an existing road,
and Colorado and Virginia are considering toll lanes in
sections of interstates. Lawmakers are debating a proposal
from Governor Mitch Daniels (R- IN) to lease the 157-mile
Indiana Toll Road to a consortium of foreign companies for
$3.85 billion.

				
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