SPECIAL REPORT

What's the Washington outlook now?

The midterm elections gave control of the Congress to the GOP. That could mean movement on a number of issues important to doctors.

By Wayne J. Guglielmo
Senior Editor

Tom Daschle's face told the whole story. Interviewed on ABC's Good Morning America the day after the election, the Senate Democratic majority leader looked tired and haggard—as if there had been a death in the family.

And indeed, politically speaking, there had been. In a rout of historic proportions, the GOP had not only expanded its control of the House, but regained control of the Senate.

The mood was quite different among Republicans, of course, beginning with President Bush. Almost certainly, the Republican-dominated 108th Congress will continue the president's war on terrorism, both foreign and domestic. The economy will also take center stage. But there's also likely to be activity on a number of health care fronts. Here's what we and some experts think is the likely battle plan.

Medicare prescription drug coverage. Without waiting to be asked, Bush mentioned an Rx benefit for seniors twice during his post-election news conference. Look for the administration and GOP leaders to reprise the same private-sector approach they took this past year. This session, the bill approved by the GOP-controlled House gave beneficiaries the option of working either through private prescription drug plans or Medicare + Choice.

With help from Democrats like Louisiana's John Breaux, "Republicans may be within striking distance of getting the 60 votes they need to pass a bill," says Bob Doherty, public policy expert at the American College of Physicians-American Society of Internal Medicine. Of course, gridlock is always a possibility, too. But with both parties under pressure to do something, some legislative action is likely.

Medical malpractice reform. Even before their midterm sweep, optimistic Republicans had reportedly begun mapping a postelection legislative agenda. High on their wish list was reforming the medical malpractice system—which, in states like Mississippi, Nevada, and Pennsylvania, has suffered a major meltdown this past year. Even President Bush acknowledged the problem at a speech in Mississippi earlier this year. Postelection, doctors and insurers (here's one area where they see eye to eye) will hold both the GOP leadership and the White House to their word. "Medical liability reform is our top legislative priority next session," says AMA President-elect Donald J. Palmisano.

But the fight for tort reform is likely to prove an "uphill battle," says Norm Ornstein, well-known Congress watcher and resident scholar at the American Enterprise Institute for Public Policy Research. Indeed, to pass major reforms with a narrow and nonfilibuster-proof majority, Senate Republicans will need to vote as a block and get at least some help from Democrats. (In July, the Democratic-controlled Senate defeated a medical malpractice reform amendment 57 to 42.) But even sympathetic Democrats may not be eager to displease one of their most powerful and generous constituencies—the trial lawyers.

Medicare physician payments. Few believe that the 107th Congress will do anything decisive during its lame-duck session, despite optimistic talk from the AMA and other physician groups. Next session is a different story. With yet another round of cuts scheduled to take effect Jan. 1, doctors will be pushing hard for congressional attention. Progress on prescription drugs will make payment reform easier—as will continuing media accounts of doctors closing their practices to new Medicare patients.

Universal coverage. With the resounding defeat of Oregon's Measure 23, which promised health care for all state residents, the issue at the federal level would seem as dead as the Clinton health plan. But analyst Ornstein sees universal coverage as a sleeper issue, poised to emerge. That's because it resonates more fully with mainstream Americans now than in the past, because many have found themselves without health insurance during the economic slowdown.

If proposals are forthcoming, they'll run the gamut from very expensive to more modest. At least initially, Republicans are likely to opt for a catastrophic coverage plan tied to some form of individual tax credits. This is the approach favored by the AMA, which has made the uninsured one of its top legislative priorities for 2003. Democrats will push to expand Medicare, Medicaid, and State Children's Health Insurance Program. A proposal released earlier this year by ACP-ASIM offered a blueprint for combining both these approaches.

Significant legislative action is iffy. But the issue is almost sure to gain traction during the 2004 presidential race, especially if Democrat hopefuls push ambitious health care agendas.

Patients' Bill of Rights. The Senate and House parted ways this year on the extent to which health plans could be held accountable for their decisions. The House bill, despite its narrower scope and call for expanded medical savings accounts, still raised problems for managed care companies. But fortunately for the insurance industry, trial lawyers may have replaced health plans as the enemy doctors love to hate most.

Look for lawmakers on both sides of the aisle to offer up the usual slew of patients' rights proposals. But with so much else going on, 2003 will be another year when victories in this area are likely to be more symbolic than real.

Patient safety. There was a flurry of legislative activity on the issue this session, and probably more to come next session. Both Republicans and Democrats favor a voluntary reporting system, but differ somewhat in the degree to which such information should be legally protected. "Republicans are more understanding of the need to protect confidentiality," says the ACP-ASIM's Doherty. "Medical errors that appear on the front page of The New York Times eventually drive reporting underground."

 

Wayne Guglielmo. Special Report: What's the Washington outlook now?. Medical Economics Dec. 9, 2002;79:33.