Bush administration to limit role in health care


Published: Sunday, January 20, 2008 at 10:34 p.m.
Last Modified: Sunday, January 20, 2008 at 10:34 p.m.

WASHINGTON - The Bush administration's health agenda this year will consist largely of fending off Democratic lawmakers until a new president and Congress take charge.

In a preview of what is ahead, Health and Human Services Secretary Mike Leavitt says the administration will work to limit the government's role in the delivery of health care. That goal is at odds with several Democratic proposals, such as giving the health chief the power to negotiate drug prices and greatly increasing enrollment in federally sponsored health insurance for children.

Leavitt sees the philosophical divide playing out in numerous ways before the November elections. The year, he predicted, "will be replete with the kind of conflict this town is famous for."

Most policy analysts see little chance for compromise on almost all the major health issues before Congress a view shared by the top Republican on the House Energy and Commerce Committee, which oversees most health issues.

Based on last year's experience in the first year of Democratic control, "I'm not expecting too much cooperation or bipartisanship," Texas Rep. Joe Barton said. "I would assume that all that gets done will be the things that absolutely have to get done."

Democrats will try to keep attention on a proposed expansion of the State Children's Health Insurance Program. The party sees this program as the most practical way to increase coverage to 4 million children, said Democratic Rep. Frank Pallone of New Jersey, who heads the health subcommittee.

Under the program, the government and states subsidize insurance for children in low-income families that do not qualify for Medicaid. Leavitt often refers to the children's insurance program as government-run health care. Pallone, however, notes that private insurers routinely contract with states to administer the benefit.

The administration is "into this ideological labeling of everything, even when there's no basis for it," Pallone said. "That makes it difficult. But look, we're going to be practical and we're going to see if we can come to an agreement with them."

Democrats, with some Republican support, will try on Wednesday to override President Bush's veto of a bill that would basically double spending on the program, to $12 billion annually. A similar vote last year fell 13 votes shy.

Democrats also are focused on trimming payments to private health insurers that serve older people and the disabled. Democratic Sen. Max Baucus of Montana, who heads the Senate Finance Committee, has said a hard look at the payments and the marketing practices of insurers is long overdue.

The insurance companies provide coverage to about 9 million people through a program known as Medicare Advantage. The government, on average, spends about 12 percent more for beneficiaries treated through Medicare Advantage than it does for those in traditional Medicare. Under regular Medicare, the government simply reimburses a provider a set rate for a particular service.

But Leavitt said the administration will not support cutting money for Medicare Advantage.

"We want to protect it, enhance it and expand it as a tactical approach to entitlements in general," Leavitt said.

Agreement could come on a separate health-related issue, food safety. Barton said Rep. John Dingell, chairman of the House Energy and Commerce Committee, has told him he would like to work with Republicans on the issue.

"I think we would support more inspectors," Barton said. "I think we would support foreign inspections where we go into processing plants overseas like the FDA (Food and Drug Administration) has the right to do here."

Democrats will try to allow more poor people with Medicare coverage to qualify for extra financial help, and they are promising continued reviews of insurers' marketing practices.

About the only legislation that both Democrats and Republicans view as having to pass would eliminate a pay cut for doctors who treat the elderly and disabled. The doctors were scheduled to take a 10-percent rate cut beginning Jan. 1 until Congress granted a six-month reprieve.

As part of that expected bill, the administration wants to require that doctors adopt electronic record keeping. Those who do not buy such technology would get paid less than the doctors who do.

Such records can help coordinate patient care, potentially reducing health costs. The widespread adoption of electronic records furthers the administration's priority of creating a marketplace that gives people more information about the quality and price of the care they receive, Leavitt said.

Pallone said Democrats back the idea of electronic records, but he will not support requiring doctors to go along with the technology as a basis for their Medicare payments.

"It just becomes an excuse to reduce their rates," Pallone said.

Leavitt hinted that Bush will continue to recommend a slowdown in Medicare and Medicaid spending, but he declined to get specific.

Also at issue is an anticipated Democratic effort to allow the FDA to regulate tobacco. Leavitt said he opposes giving the agency that responsibility because some people could get a false sense of security about the safety of tobacco products.

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