Critical health decisions await the next Congress

WASHINGTON–As they prepare to exercise their new-found legislative power, Republicans in Washington have made health reform their No. 1 target.

But while efforts to defund or derail the overhaul law will no doubt be center stage come January, a host of other health care policies could be also be tweaked or significantly revamped as the power shifts in Congress.

Republicans may try to push forward on long-held priorities, such as medical malpractice reform and altering Medicaid. And they will be forced to deal with other dicey questions, like what to do about looming cuts to Medicare physician payments.

Meanwhile, initiatives that Democrats had hoped to press, such as allowing Medicare to negotiate with pharmaceutical companies on drug prices, will likely be dead on arrival.

“I’m more than a little panicked,” Ellen Andrews, executive director of the Connecticut Health Policy Project, said of the possible changes coming from Washington.

Other health care advocates, including doctors and hospital groups, are still sorting out what the redrawn political landscape will mean for their legislative priorities.

For Connecticut doctors, the new Congress could be a mixed bag. The biggest concern for most physicians is a 23 percent cut in Medicare reimbursement rates, scheduled to take effect Dec. 1.

The American Medical Association, along with state-level doctors’ groups, is aggressively lobbying Congress to block that pay cut from going into effect. They also want a more permanent fix to the federal formula that sets reimbursements, which calls for a series of future payment reductions, including one for January 2011.

“To be looking down the barrel of a 25 to 30 percent reduction is huge,” said Ken Ferrucci, a lobbyist with the Connecticut State Medical Society. If the cuts become law, it would translate into $360 million in lost revenue over the next 13 months for Connecticut doctors, according to the society’s figures.

Democrats, while they still hold power during the lame-duck session, may approve yet another temporary fix to the payment rates and then dump the longer-term problem in the GOP’s lap.

“It’s not unreasonable for the Democrats to say, ‘You won the election–You deal with this’,” said Henry Aaron, a health policy expert at the left-leaning Brookings Institution.

Since Republicans swept to power in large part on a pledge to cut federal spending by $100 billion, it’s unclear how they will navigate this pricey quandary. A full-fledged fix to overturn the reimbursement reductions would cost an estimated $300 billion over ten years.

Ferrucci and others say they’re waiting to see how the GOP might move forward. If Congress doesn’t respond to doctors’ pleas, seniors might carry more sway.

“Our members don’t really care what party the legislators are in,” said Jennifer Millea, a spokeswoman for AARP Connecticut. “They’re worried if this cut goes through, they will no longer be able to see their doctor. So we’re working very hard to get the best and longest solution that we can to prevent this cut and make sure Congress addresses it with a permanent fix.”

Doctors might find a warmer reception when they press their No. 2 agenda item: medical malpractice reform. This issue is particularly salient in Connecticut, where doctors pay some of the highest malpractice insurance premiums in the country.

“We hope this will get some attention” in the next Congress, Ferrucci said.

It almost certainly will. Republicans have long pushed for caps on jury awards in malpractice suits as a way to lower doctors’ insurance premiums and trim health care costs. Addressing the issue of “junk lawsuits” is part of the GOP’s repeal-and-replace strategy for health reform.

Aaron, of the Brookings Institute, said if lawmakers are in the mood to compromise on any health care issues next year, malpractice reform could be it.

“There’s a deal to be made here,” he said. He noted that some Democrats have called for a new arbitration system that handles some patients’ claims through negotiation instead of a legal battle. If Republicans agree to that, he said Democrats may very well accept some limits on damage awards.

President Barack Obama has already signaled an interest in the issue, although Congressional Democrats have traditionally opposed lawsuit caps. Opponents say such limits close off a legitimate avenue of recourse for patients who received harmful medical care, while supporters say it forces doctors to order unnecessary tests to shield themselves from frivolous claims.

Whether Republicans tackle larger health-care policy questions, such as the ballooning costs of Medicare and Medicaid, remains to be seen.

In the House GOP’s “Pledge to America,” the new leaders said only that they wanted to provide a “full accounting” of entitlement programs and would prevent the “expansion of unfunded mandates.”

Some advocates, like Andrews, worry this vague language will, in practice, mean Medicaid reimbursement cuts. That, she said, would further restrict access to the health care safety net program for the poor, even as its rolls swell.

“If you put another 150,000 people into Medicaid in Connecticut but don’t pay doctors and hospitals enough, then patients are not going to have anywhere to get care,” she said.

Stephen Frayne, a lobbyist with the Connecticut Hospital Association, said federal reimbursement rates for Medicare and Medicaid are already woefully inadequate and the stewardship of those programs going forward is a top concern.

“It’s hard to imagine it could get much worse than it is,” he said. “But I think if they become overly zealous in their desire to cut the existing level of funding, we’re basically going to see more institutions close, more mergers, and reductions in access to service.”

Andrews said she’s also worried about a gamut of lower-profile issues, such as the funding included in the stimulus bill to help health care providers implement health information technology systems. That funding has yet to be doled out, and as Republicans look for money to squeeze from the federal budget, that could become a target, she fears.

At a news conference Wednesday, the presumptive House Speaker John Boehner, R-Ohio, steered clear of such policy minutia, taking only a few questions about tax cuts and other matters before heading back into his office to plot out the GOP transition.

His spokesman, Michael Steel, said later that Republicans weren’t ready to delve into these policy questions quite yet.