APPROPRIATIONS STALLED; TAX CUTS ADOPTED
May 29, 2003
Appropriations Impasse Continues Over Spending Allocations
House Appropriations Committee Chairman Bill Young (R-Florida) and the GOP leadership remain at an impasse over how to divide $785 billion in fiscal year 2004 discretionary funds among the panel's 13 subcommittees.
According to reports, House Appropriations Committee Chairman Bill Young (R-Florida) has presented House Speaker Dennis Hastert (R-Illinois) with three primary scenarios for crafting the so-called 302(b) subcommittee spending allocations, but they have yet to reach an agreement.
Senate leaders and White House officials also have participated in meetings held in recent weeks. Expanding on an earlier proposal to divert money from defense to domestic programs, appropriators now propose to shift $7 billion to $10 billion from both the defense and international relations accounts to domestic subcommittees that are pressed for money. Another option proffered by Young calls for an across-the-board cut in every committee's allocation to make up for the more than $3 billion difference between the Bush budget and Congress' plan. A third option is some combination of the first two.
Appropriators say $785 billion is insufficient to cover the $7.6 billion in spending increases contained, but not funded, in the budget resolution. And while the top line number of the congressional budget is $2.2 billion less than the Bush budget, appropriators say the president's budget contains roughly $1.5 billion in fee hikes and other offsets Congress has spurned in the past, making the true difference around $3 billion.
Tax Cut Bill Includes Medicaid Relief for States
Just before leaving for its Memorial Day recess, Congress clinched a deal on a $350 billion tax relief package that includes a tax break on dividend and capital gain income. The agreement also includes a $20 billion state aid provision, of which $10 billion will be channeled to states in the form of Medicaid assistance. These added funds will be used to boost federal Medicaid matching rates by 2.95% until October 2004.
Although the $20 billion in state aid is just a fraction of the estimated $85 billion shortfall states collectively face in fiscal year 2004, the debate over whether it should be included in the tax cut plan was probably the most closely watched issue by governors across the country. Thus far at least 29 states have made cuts to their Medicaid programs as they try to resolve the worst fiscal crisis in more than 60 years. Across the country, hundreds of thousands of individuals could see their Medicaid benefits reduced or eliminated.
Medicaid is seen as a prime target for cutbacks because it typically is the second-largest item in a state budget after education. The program serves more than 47 million poor, disabled and elderly people and costs $280 billion a year, of which $159 billion is the federal share, according to the National Governors Association. States cover the rest.
Federal rules require states to offer Medicaid to certain groups, but states are free to offer broader coverage. Given tight budgets, at least 19 states currently are considering eliminating coverage for certain groups or making it harder to qualify, according to the National Conference of State Legislatures. Twenty states are looking at eliminating or reducing benefits such as glasses, dental care, chiropractic and hospice care.
Senate Committee Approves Genetic Non-Discrimination Legislation
The Senate Health, Education, Labor, and Pensions (HELP) Committee May 21 approved by voice vote a bipartisan bill (S. 1053) that would penalize health insurers and employers that discriminate based on a person's genetic predisposition toward disease.
The bill would bar health insurers from underwriting based on genetic information and establish privacy protections for genetic information. Committee aides said that the bill's privacy protections for genetic information go beyond those in privacy rules implementing the 1996 Health Insurance Portability and Accountability Act (HIPAA). The privacy rules, according to one congressional aide, allow the use and disclosure of genetic information for health care underwriting purposes, but the bill would ban such practice. Also, the bill would ban insurers from requesting, requiring, or purchasing genetic information for purposes of underwriting. More broadly, insurers would be barred from collecting genetic information prior to enrollment in any plan. The legislation also would bar insurers from asking about someone's family history for underwriting purposes.
The bill's nondiscrimination provisions would be enforced in the same manner as current law applying to health insurance, but the bill includes some procedural protections for group health plan participants, "including the ability to seek injunctive relief and to have retroactive reinstatement of coverage" in situations where a health insurer or plan is found to have violated the legislation's ban on inappropriate use of genetic information. Penalties may be payable to the individual or levied against the plan.
Committee aides said that they expected the bill to move to the Senate floor quickly.
Health Disparities Legislation to Include Health Care Access Research Grants
Senator Bill Frist (R-Tennessee) plans to introduce legislation establishing a health care access and promotion grant program to benefit disparity populations.
Frist unveiled preliminary details of the legislation, which he expects to introduce within the next few months, at the Morehouse School of Medicine in Atlanta. Building on the "Minority Health and Health Disparities Research and Education Act of 2000," the legislation would expand research at the National Institutes of Health into the sources of health disparities, and increase efforts to recruit minority scientists and research professionals into health disparity research.
The legislation also would expand research at the Agency for Healthcare Research and Quality to identify or develop and evaluate effective strategies for addressing disparities in health care delivery and to ensure research is readily disseminated and incorporated into practice. The development of programs concerned with afflictions disproportionately affecting minority or underserved populations?cancer, asthma, obesity, cardiovascular disease, HIV/AIDS and infant mortality?would receive particular attention under Frist's proposal. In addition, the legislation would formally codify in law HHS's Office of Minority Health, and officially enumerate the agency's responsibilities.
Provisions of the bill would reauthorize the Public Health Service Act Title VII Health Professionals Program and increase the level of federal support for the components of that program designed to increase the diversity of health professionals and the number of minority health professionals serving communities throughout the U.S.