Grassley says major Medicare reform is unlikely this year

By MATTHEW HAY
HHBR Washington Correspondent

WASHINGTON – Don’t count on major Medicare reforms this year. But don’t rule out incremental measures that roll back parts of the Balanced Budget Act of 1997 (BBA). That was the message Sen. Charles Grassley (R-IA) had for those who attended the Health Industry Distributors’ (HIDA; Alexandria, VA) Washington Conference on April 20.

Grassley, who heads up the Senate Special Committee on Aging, predicted meaningful reform will be caught up in presidential politics and that neither party will have the votes to get around the "stalling tactics" that will take place in the Senate this year. "For that matter, I don’t even know if it will get through the House," he said. "I don’t think there is any doubt in anyone’s mind that this program needs help and the sooner the better, but I guess that sooner now is more apt to be the Year 2001 than the Year 1999."

But Grassley said this does not preclude legislation that addresses some of the disruptions caused by the BBA. "Considering some of the changes that were made," said Grassley, "I think there is enough pressure on to make sure that some refinement of the BBA can take place this year."

Grassley said HCFA "really screwed up" development of the interim payment system (IPS) by not differentiating between high-cost states and low-cost states. But he urged the home care industry to focus on the prospective payment system (PPS) as a remedy.

Grassley also noted the failure of the Bipartisan Commission on the Future of Medicare to pass a formal recommendation earlier this year because of the supermajority requirement that demanded the support of 11 of the 17 commission members. Even though it didn’t pass a formal recommendation by that margin, Grassley said the commission has given Congress "a very good basis" for legislation that will offer "long-term solutions" to the problems confronting Medicare.

Unfortunately for the home care industry, one of the commission’s provisions that was supported by House Ways and Means Health Subcommittee Chairman Bill Thomas (R-CA) and Sen. John Breaux (D-LA), who co-chaired the commission, is a 10% co-payment for home health services.

Grassley added that the Senate Finance Committee will begin hearings on the commission’s recommendations shortly and predicted these hearings will help shape the debate. He also noted that Congress passed its budget on time earlier this month which clears the way for authorizing committees to begin putting the budget into legislation for the president to sign.