Michael Levin-Epstein
Washington Watch

In the aftermath of the Sept. 11 terrorist attacks, health care issues have taken a back seat to more pressing matters. In fact, in a city that thrives on policy discussion, most lobbyists, association executives, and politicians are incredibly reluctant to talk about legislative and regulatory issues affecting managed care.

Instead, Washington insiders are asking each other these questions:

  • How much will the new emphasis on homeland security keep regulators, administrators, and legislators from health care issues?
  • How will increased defense spending affect domestic initiatives, such as health care?
  • How quickly, and to what extent, will lawmakers and regulators be able to shift some attention back to Medicare reform, patients' rights, and the needs of the uninsured?

"Right now, it's a breach of etiquette to be talking — at least publicly — about your domestic agenda when you have American service men and women fighting overseas," says one veteran Capitol Hill lobbyist. As if to illustrate, a representative of the American Association of Health Plans says that AAHP president Karen Ignagni doesn't wish to make any public statements at present on the status of health care matters in Congress. "We're not sure that would be appropriate," he said.

Several key congressmen also are shying away from public commentary. "Give it a few more weeks," an assistant to one long-time senator said. "Right now, most of these things are on hold. It's kind of a World War II situation: Everything didn't stop because of the war, but the war got the headlines while the day-to-day work went on. That's what we're seeing."

"It's a very different mood in Washington right now," says one veteran health care lobbyist who asked not to be identified. "It's difficult to understand how the political animal functions in the middle of a war. We're not used to this, and it's not a comfortable position to appear to be promoting your interest during a time of national tragedy and conflict."

Top health concern

There is one health care item that's getting attention in Washington, however: the Centers for Disease Control's National Pharmaceutical Stockpile (NPS) program. The NPS program was established to ensure the availability and rapid deployment of life-saving pharmaceuticals, antidotes, and other medical supplies and equipment necessary to counter the effects of nerve agents, biological pathogens, and chemical agents.

Not many in Washington were familiar with the program, until anthrax hit the headlines. Now, CDC gets more than 500 phone calls a day about anthrax. "We're swamped," says a CDC spokeswoman. And lawmakers are asking their staffs to brief them about anthrax and the stockpile — ASAP.

The Department of Health and Human Services is responsible for the public health response to any biological or chemical attack, as well as for disease surveillance and medical preparedness. HHS Secretary Tommy Thompson admits, "There are questions about how prepared our nation is to respond to a biological attack, and rightfully so."

Thompson told a congressional committee, "We are prepared to respond, but there is more we can do — and must do — to strengthen our response." That means such efforts as reducing the health care regulatory burden have been pushed back, he says.

Meanwhile, Senate Majority Leader Tom Daschle, who before Sept. 11 had been pushing for Medicare reform and patient-rights legislation, has had his attention diverted to more urgent matters. Daschle had expressed concern over an amendment to the Republican budget resolution that would allocate "only $153 billion over 10 years to fund a Medicare prescription drug benefit."

Now, many Democrats see a deficit looming, particularly if defense spending continues to mount. That would make it much more difficult to come up with a meaningful prescription-drug benefit, which is supported by key members of both parties.

Not all is forgotten

Some matters unrelated to terrorism are not totally taboo, however. John Stone, an aide to Republican Rep. Charlie Norwood of Georgia — influential on health care issues — says that the current emphasis on national security does not mean that efforts to deal with other issues have stopped completely.

"We need to show that you can't shut down the domestic agenda of the United States by terrorist action," says Stone. "I think Congress will look at ways to get agreement at the highest level on these issues. It provides additional emphasis for coming up with a compromise on patients' rights. Right now, that's lying in the lap of Sen. Daschle."

In addition, there is at least one new initiative gaining ground in Congress. House Energy and Commerce Committee Chairman Billy Tauzin recently unveiled the Medicare Regulatory, Appeals, Contracting, and Education Reform Act of 2001 (the Medicare RACER Act), sponsored by Reps. Patrick Toomey, a Pennsylvania Republican, and Shelley Berkley, a Nevada Democrat.

Tauzin says the RACER Act will open all Medicare contracts to competitive bidding by 2008, require contractors to provide responses to written beneficiary and provider inquiries within 45 days, ensure better communication between HHS and Medicare providers, create an expedited process for appeals of claim denials, and provide an education and training program for Medicare contractors.

Regarding regulation, a spokesman for HHS says that revisions to the Medicare+Choice program are moving ahead — as are efforts to secure additional funding for the program. But those initiatives aren't high profile, even though congressional committees are working on the issue, spurred by the latest round of Medicare HMOs backing out of the program.

Then there is the Health Insurance Portability and Accountability Act. Four House Ways and Means Committee members, Chairman Bill Thomas, ranking member Charles Rangel, Health Subcommittee Chairwoman Nancy Johnson, and ranking member Fortney "Pete" Stark sent a letter to colleagues in October, urging them "to express our concern about recent efforts to delay administrative-simplification provisions" to HIPAA, and noting that by HHS estimates, the so-called simplifications will result in net savings of $29.9 billion over 10 years.

HHS is struggling with this thorny issue — made more difficult by continuing disagreements among segments of the health care industry.

The American Hospital Association and the Association of American Medical Colleges have indicated their support for moving ahead with implementation, while the Health Insurance Association of America and the American Association of Health Plans want to modify the new rules.

The bottom line: Congress is still looking to wrap up in November for a long holiday recess. Whether that happens will depend on the war. Some observers think that because the nation is on a war footing, Congress may be staying in Washington longer than usual.

Whether that translates into increased attention to non-homeland security issues is uncertain.

Michael Levin-Epstein

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