MILES TO GO

August 8, 2006

After a month-long recess, Congress will return to work in September with a lot of promises to keep, and many miles to go before it sleeps.

That should come as no surprise, given that lawmakers have amassed a grand total of about 65 legislative workdays since Congress first convened at the end of January.  Since then, none of the major (or minor) decisions that are required on the federal budget—not to mention energy policy, defense, immigration and health care—have yet been finalized.

Moreover, Congress seems as far away from resolving them as it has been all year. In fact, there has been so little serious discussion of key issues that the overall debate has barely moved since January.

Congressional leaders are hoping that a few weeks at home would help put the issues into better perspective for lawmakers, allowing them to return to work with a strengthened spine, a renewed feeling of party loyalty, or a message or two from their constituents. Or maybe not.  Previous congressional recesses—and there have been several this year—have not seemed to clarify matters; if anything, the issues have gotten further muddled as concerns over the economy, high gas prices and the Iraq war have grown.

GOP leaders have set September 29 as their target adjournment date, allowing only three weeks time for legislative work before lawmakers return home to campaign.  But with mid-term elections fast-approaching, the chances grow slimmer that lawmakers will find the will or the way to make tough choices.  Which makes it very likely that Congress will put off any serious decisions until after the November mid-term elections.

This may be the best—or possibly worst—example of how political considerations now seem to trump everything else when it comes to decision-making in Washington.  But unlike what Robert Frost wrote in another poem, ultimately Congress will have more than two roads to choose from.

Several Spending Bills Remain in Limbo

When Congress returns to work after Labor Day, lawmakers will have 15 legislative work-days to decide which, if any, of the eleven appropriations bills will be passed before the end of the federal fiscal year on September 30.  Thus far, all eleven spending bills have been passed by the House; only one—Homeland Security—has cleared the Senate.

The betting is that Defense, Military Quality of Life/Veterans Affairs, and Homeland Security will get the nod, leaving work on the remaining bills until after the elections.  As a result, several key bills, including Labor-HHS-Education, will once again be folded into a stop-gap continuing resolution, where programs will continue at restricted operating levels.  For how long is anyone's guess.

Senate Majority Whip Mitch McConnell (R-KY) said he expects that a lame-duck session would wrap up its work before Thanksgiving, while House Majority Leader John Boehner (R-OH) believes Congress will be in session through much of December.  In either case, it seems certain that at least some of the spending measures will eventually be folded into an omnibus bill.

Lawmakers Call for Early Action on Medicare Physician Payments

Momentum continues to grow to stave off scheduled cuts in Medicare payments to physicians before Congress adjourns for the campaign's homestretch. Unless lawmakers act before the end of the year, Medicare physician payments are scheduled to be cut nearly 5 percent under the current formula. Eighty senators recently wrote Senate Majority Leader Bill Frist (R-TN) and Minority Leader Harry Reid (D-NV), urging them to take action.

A letter spearheaded by Senators Jon Kyl (R-AZ) and Debbie Stabenow (D-MI) urges the two Senate leaders to call up legislation to block the impending cuts before Congress adjourns, arguing that the projected cuts "will destabilize the Medicare program and put at risk all patients' access to health care."  A similar letter was circulated in the House by House Ways and Means Health Subcommittee Chairwoman Nancy Johnson (R-CT) and Rep. Benjamin Cardin (D-MD).

House Energy and Commerce Chairman Joe Barton, while supporting the temporary fix, said it does not get to the root problem of skyrocketing Medicare costs and the uncertainty in the system.  His Democratic counterpart, Rep. John Dingell (D-MI), recently introduced legislation providing a two-year fix with increases of between 2 percent and 3 percent in 2007 and 2008, which he said would give Congress time to negotiate a permanent solution.  Another committee member, Rep. Michael Burgess (R-TX), also introduced a physician payment fix bill.

Despite growing support, however, the costs associated with such measures will weigh heavily in the final decision-making.  The Congressional Budget Office estimates that a two-year fix with a 1.5 percent increase would cost $26 billion over five years, while simply freezing physician payments at their current rate for one year -- which Congress did last year -- would cost nearly $11 billion over five years. Any move to stave off the cuts will likely necessitate a renewed debate over offsets. The issue is so complex and politically radioactive that despite newfound momentum, lawmakers may decide to wait until after the elections to tackle it.

Health IT Legislation Clears House

By a 270-148 vote, the House July 27 approved the Health Technology Promotion Act of 2006 (H.R. 4157) that supporters say would spur development of health information technology by health care providers.  The health IT bill now will go to a House-Senate conference. The Senate in November 2005 passed legislation (S. 1418) that differs significantly from the House measure.

The legislation, a compromise between two slightly different health IT bills produced by the House Energy and Commerce and Ways and Means Committees, would codify the Bush administration's national coordinator office for health IT, create statutory safe harbors to allow hospitals and other providers to provide physicians with health IT software and hardware, and require the government to develop a health IT strategic plan.

In addition, the legislation: (1) mandates the replacement of ICD-9-CM with both the ICD-10-CM and ICD-10-PCS (Procedure Coding System). The replacement would apply to services furnished on or after October 1, 2010, including under Medicare Part A, and (2) requires the HHS Secretary to establish expedited procedures for adopting updates to standards that enable the electronic exchange of health data.

Senate Committee Targets Health Spending on Medicare

The Senate Budget Committee has approved legislation (S. 3521) designed to slow federal spending and reduce the federal budget deficit through a host of provisions, including a Medicare spending reduction trigger and a commission to recommend ways to slow health care and entitlement spending.

The proposal, titled the "Stop Overspending Act of 2006," was billed by its author, Committee Chairman Judd Gregg (R-N.H.), as a way to enforce spending discipline on Congress.

The legislation would establish a Medicare spending warning similar to that included in the 2003 Medicare prescription drug law and incorporated into the annual report of the Medicare Board of Trustees.  If the general fund contribution (i.e. taxpayer dollars) to Medicare is projected to exceed 45 percent within the next seven years, the bill would allow the Budget Committee chairman to send a funding warning to the Senate.  If the warning was sent in two consecutive years, a parliamentary point-of-order could be made to block any additional Medicare spending that is not offset by cuts elsewhere in the federal budget.  The point-of-order would be canceled only if legislation is passed that brings Medicare spending under control.

Gregg said entitlement spending must be slowed because it is on track to consume increasing amounts of GDP.  Federal spending currently comprises 20 percent of GDP, but if nothing is done, in 25 years Medicare, Medicaid, and Social Security alone would consume 20 percent of GDP.

The bill also would establish a National Commission on Entitlement Solvency to produce reform proposals for entitlement programs.  The commission would be required to draft legislation by May 1, 2007, "to restore the long-term solvency of Social Security, Medicare, and Medicaid." Its recommendations would be given fast-track protections in Congress and could be approved by a simple majority vote.