Absence of Medicare provisions in SCHIP bill changes the stakes

Powerful interest groups are ready to put some muscle behind passing legislation to expand the State Children’s Health Insurance Program (SCHIP) next week but the absence of Medicare language changes the stakes for many of them.

{mosads}When the House considered its version of the SCHIP measure in August, it contained boosts or cuts in Medicare funding for a plethora of industries, which brought out their big guns to help pass, alter or scuttle the measure.

Although those groups also offered practically universal support for reauthorizing SCHIP, their primary interests lay in the Medicare language.

With the Democratic leadership of the House and Senate poised for new floor votes on an SCHIP-only package next week, some lobbying organizations with a stake in the Medicare provisions will be looking past SCHIP to restaging those fights.

At the top of the list of Medicare items to be considered is a looming 10 percent cut in payments to physicians, which the House-passed bill would have prevented.

The House bill also included advantageous language for hospitals and new benefits for Medicare enrollees. On the other side of the coin, House Democrats paid for those new expenses, and their $50 billion SCHIP expansion, with cuts to health insurance plans in Medicare Advantage and to a variety of Medicare providers ranging from nursing homes to oxygen equipment suppliers.

Senate Finance Committee Chairman Max Baucus (D-Mont.) has indicated all year that he wanted to move on separate Medicare legislation but that activity on that priority has not yet reached full speed.

The AARP and the American Medical Association (AMA) this week launched another round of their joint advertising campaign on SCHIP and Medicare. The ads caution Congress against putting off action the physician payment cut until the “11th hour.” The advertisements are scheduled to run during the SCHIP debate and through the end of the month.

The AARP and the AMA have endorsed both the Senate’s SCHIP-only bill and the House’s SCHIP-Medicare bill and will continue to support the SCHIP measure the Democratic leadership hopes to get to President Bush before the program expires on Sept. 30, both organizations made clear. Bush has vowed to veto the $35 billion bill.

While these groups were among the many that lent considerable support to passing the House bill last month, they haven’t decided on a strategy for next week’s debate.

“I don’t know where we’re going to focus our money and our efforts,” AARP spokesman Drew Nannis said. “We still need to see what [the] final legislation is going to look like.”

The Democratic leadership might not need much help from the outside to get its rank and file on board with its SCHIP bill, given the political stakes, Nannis said. “If a deal is cut, they’re not going to have any trouble getting it through the House and the Senate,” he said.
Indeed, although the House Democratic leadership has had to sell its caucus on an SCHIP-only bill that is expected to closely mirror the Senate-passed version, the passage of an SCHIP bill before Sept. 30 is one of the party’s top priorities for the year.

This motivation is intensified by a desire to put a bill in front of the president before the program expires, thus allowing Democrats to lay the blame at his feet for not completing the SCHIP reauthorization on time. If Bush vetoes the bill as promised, Congress would have to extend the program’s current authorization for an undetermined amount of time.

Although adopting a Senate-passed, 61-cent increase in the cigarette tax, compared to 45 cents in the House bill, would cause discomfort for some tobacco-state Democrats, moving ahead with an SCHIP-only measure is likely to win over some moderate Republicans.

The SCHIP bill will be able to count on the enthusiastic and active support of a number of groups. For example, the liberal advocacy Families USA plans a push next week along with some its allies, and SCHIP is a the heart of the children’s advocacy group First Focus’s agenda.

In addition, the cigarette tax on its own has brought on board the American Cancer Society and others in the anti-tobacco lobby. The cancer society plans to activate its grassroots network to push for the SCHIP bill next week.

America’s Health Insurance Plans, which strongly opposed the Medicare Advantage cuts in the House bill, plans an ad campaign next week backing the SCHIP-only bill.

Other organizations that stood to lose from the House version might simply sit out the SCHIP debate, which would reduce the pressure on lawmakers from outside groups.

The Alliance for Quality Nursing Home Care, for instance, mounted an aggressive campaign against the Medicare cuts in the House bill but is looking ahead to the upcoming Medicare debate.

Moreover, alliance President Alan Rosenbloom indicated, divorcing Medicare from SCHIP could help nursing homes make their case against the proposed cuts. Because of the combined price tags of the SCHIP and Medicare measures are expected to be smaller than under the House bill, Congress’s need for budgetary offsets might be lesser. “Some of the pressure to find offsets to cuts would be alleviated,” he said.