Some Lawmakers Reject Cuts To Medicare, Medicaid

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Senate Democrats andadministration officials on Tuesday "sparred" over "unrealisticassumptions" on health care spending and other issues related to thefiscal year 2009 budget request that President Bush released on Monday, CQToday reports (Clarke/Higa, CQ Today, 2/5). According tothe AP/Philadelphia Inquirer, "lawmakers made it plain thatthey would ignore the president's proposals to cut Medicare and Medicaidspending" (Taylor, AP/Philadelphia Inquirer, 2/6).

During a Senate Budget Committee hearing, White House Office of Management and Budget Director Jim Nussle discussedprovisions in the budget request that would seek to reduce spending and growthin entitlement programs, such as Medicare and Medicaid. "Democrats havecriticized those proposals, and Nussle challenged them to put their own ideason the table," CQ Today reports (CQ Today, 2/5).Nussle appeared "combative" during the hearing, "returningcriticism of the budget with attacks on lawmakers ... and challenging them tojoin Bush in curbing the rapid growth of benefit programs," according tothe AP/Inquirer (AP/Philadelphia Inquirer,2/6).

Treasury Department Secretary Henry Paulson also discussed theprovisions during a Senate Finance Committee hearing. Sen. Pat Roberts (R-Kan.)criticized provisions that would reduce Medicare reimbursements for physiciansand other health care providers (CQ Today, 2/5). He said,"The Medicare cuts are not realistic," adding, "I urge you totake another look at that, 'cause it's just not gonna happen" (Hess, CongressDaily,2/5). Committee Chair Max Baucus (D-Mont.) said, "A realistic budget wouldreveal the surprising truth that the long-run problem is not an entitlementsproblem," adding, "It's a health care problem" (CQ Today,2/5).

CQ HealthBeat on Tuesday examined reaction tohealth care provisions included in the budget request. According to CQHealthBeat, although the budget request received support from a fewhealth care industry groups and congressional Republicans, "it was prettymuch all downhill from there."

The "budget and the reaction it caused clarifies that any effort to goafter entitlement costs will entail intense political controversy by touchingon major spending reductions, benefit changes or tax increases, or somecombination of those factors," CQ HealthBeat reports (Reichard,CQ HealthBeat, 2/5).

Family Planning Funding

The proposed budget wouldcut an estimated $3.3 billion in federal funding over five years for familyplanning services under Medicaid, BNA reports. Under the proposal,the federal government would align the match rates with a state's regularmedical assistance percentage.

The Medicaid cuts would "drastically limit the ability of alreadycash-strapped states to maintain current levels of health insurance coverage,potentially forcing them to increase cost sharing, cut provider payments and/orreduce benefits," House Energy andCommerce CommitteeChair John Dingell (D-Mich.) said in a statement. He added, "The proposedMedicaid cuts include $14.6 billion in cuts as a result of regulatory actionstaken by this administration to rewrite program rules that have been unchangedby Congress in more than a decade" (BNA, 2/5).

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Bush's proposal also provides $300 million for the Title X family planningprogram in FY 2009, the same level as FY 2008. The proposal includes levelfunding requests for the Title V abstinence-only education program andAdolescent Family Life Act programs. Bush proposed a $27.7 million fundingincrease for HHS' Community-Based Abstinence Education Program,which would bring total funding for the program to $141 million, and hisabstinence education funding requests total $204 million, the same figure herequested in FY 2008 (President's budget, 2/4).

FDA

In other budget news, HouseDemocrats are "bypassing FDA to score a budget proposal that reflects whatthey consider the real needs of the agency" after the budget request"left them scratching their heads," CongressDailyreports.

In a letter on Monday, House Oversightand Government Reform Committee Chair Henry Waxman (D-Calif.) and Dingell asked the FDA Science Boardsubcommittee on science and technology to determine the amount of fundsrequired to modernize the agency. They wrote, "We are deeply concernedthat the budget submitted by the president is grossly inadequate to meet themany challenges at FDA as identified by the Science Board," adding,"It barely covers the cost of inflation and continues the trend of theinadequate budgets of previous years that have led to the current crisis at theagency."

Gail Cassell, chair of the subcommittee and vice president of scientific affairsat Eli Lilly, on Tuesday said she plans to involve as manymembers as possible to meet the request from lawmakers, although she did notprovide a timeline. Asked whether FDA requires more funds than the budgetrequest would provide, Cassell said, "Absolutely. No question aboutit" (Edney, CongressDaily, 2/6).

Opinion Piece

The U.S. can "maintainspending on valued domestic programs, preserve Social Security and Medicare,the Bush tax cuts and whittle the federal operating deficit to more reasonablelevels" through a "modest amount of shared sacrifice and awillingness to ignore the scare tactics of special interest groups,"Steven Pearlstein writes in a Washington Post opinion piece.

According to Pearlstein, "Medicare and Medicaid present the most difficultbudget challenge." He recommends that lawmakers "limit the percentageof growth in spending for these programs each year to the growth in nationalincome -- and leave it" to the Medicare PaymentAdvisory Commissionto "make the best use of that fixed -- but still generous -- budget."He writes, "Relying on MedPAC would free these programs from the politicalinfluence of the special interests -- providers, drug makers, insurers,advocates for the poor and the elderly -- who have fought off all attempts torein in runaway entitlement spending."

In addition, among other proposals, Pearlstein recommends that lawmakersrequire military families and retirees to "make modest copayments on theirhealth insurance and Medigap policies," a proposal that "could easilysave $2 billion a year." He also recommends that lawmakers limit the taxdeductibility of employer-sponsored health insurance.

He concludes, "I can't say whether this modest proposal would solve thefederal budget crisis once and for all. What I can say is that they'd get us aheck of lot closer than where we are now -- which, as far as I can tell, isnowhere" (Pearlstein, Washington Post, 2/6).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.

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