Election 2004

The candidates face off over issues dear to HMEs WASHINGTON - Sen. John Kerry's campaign pledged to suspend implementation of the FEHPB-based price cuts to durable medical equipment and called the MMA's version of competitive bidding “nothing less than government sponsored price fixing.” The Kerry campaign issued its position on issues affecting the HME industry in response to a series of questions on the expansion of home-based health care, competitive bidding, the FEHPB-based payment rate reductions, fraud and HCPCS coding. In telephone interviews conducted in September, I put the same set of questions to senior health policy advisers at both campaigns. The Kerry spokesman addressed the questions specifically; the Bush adviser answered all four questions with a single statement. After the interviews, I transcribed the candidate's responses and returned them for editorial review. To see a transcript of each campaign's response, click here. While the Kerry policy adviser said the candidate would revisit provisions of the MMA specific to DME, the Bush campaign said the questions deserved “thoughtful review.” “However, at this point in time the administration would like to see how the reforms contained in the MMA work before proposing new initiatives,” the Bush adviser said. As in the past, both major party candidates have issued “comprehensive” position papers on healthcare which once again promises to be a major issue in a close presidential election. However, also as in the past, nether of these extensive documents address home-based healthcare and/or the issues important to the home medical equipment services HME industry. With federal spending on healthcare, especially Medicare, growing each year, and with the leading edge of the “baby boomers” now enrolling in the Medicare program, you would think the candidates would embrace an option that is reported to be 30 to 60% less expensive than facility-based care. Fundamental to this election is this plain fact: The number of Americans with no health insurance has increased by 10 million during the past four years due to the loss of 2.7 million jobs that had healthcare benefits and a huge increase (estimates of two million to 4.5 million in various reports) in the number of people who have jobs with no benefits - the so called working poor. The remainder of the uninsured are people trapped in poverty, people whose benefits have been lost due to welfare reform legislation passed during the Clinton administration and people, such as migrant farm laborers, temporary workers, children with disabilities and chronic illnesses, and people who are unable to work due to disability or chronic illness who do not qualify for Medicare or Medicaid. The lengthy healthcare plans of the Bush/Cheney campaign as well as that of the Kerry/Edwards ticket were reviewed for this analysis and are substantially different. As you would expect from an incumbent Republican who must play to the conservatives in his base, President Bush relies heavily on “market forces,” competition, and individual accountability to get America through an impending healthcare crisis. The cornerstone of his plan is to make Medical Savings Accounts (MSAs) more attractive by making all deposits fully tax deductible. Other points of interests are further privatization of Medicare and expansion of federal state partnerships (Medicaid and SCHIP) that provide coverage for children in need. Bush campaign staff estimate that these proposals will cost an estimated $70 billion to $90 billion over the next 10 years and will be paid for through savings obtained by conversion of all medical records and claims to electronic files. The healthcare plan proposed by the Kerry/Edwards ticket is designed to energize their more liberal base and is estimated by independent health economists to cost between $600 billion and $700 billion over 10 years. The cornerstones of Kerry's plan are: creating a “premium rebate pool to help pay for certain high-cost healthcare cases; removing many of the provisions of the MMA designed to insure profitability of drug companies; increase federal spending for Medicaid and SCHIP costs to 100% (currently the federal share ranges from 50% to 70%); and, establishing a pool for businesses and individuals without insurance to participate in the Federal Employees Healthcare Benefit Plan (FEHBP). As does the Bush plan, Kerry is counting on significant savings to be derived from the use of electronic medical records and mandatory electronic filing of all insurance claims. He is also looking to eliminate the tax reduction provided to the wealthiest 1% of wage earners as a means of covering the new costs associated with his plan. This statement received from the Bush/Cheney campaign documents the fact that the current administration looks at healthcare policy from 30,000 feet and leaves the detail up to Congress and lower-level administrators. Unfortunately, this practice has been disastrous for the HME services industry. The answers received from the Kerry/Edwards campaign show some knowledge of the issues facing the industry and do include a plan of action. However, the industry has been subject to similar plans of action that, all too often, produce unfavorable results. Establishment of advisory panels and study groups, high sounding as they may be, often produce reports full of inaccuracies and recommendations based on inappropriate data. One industry pundit has suggested that the issues facing the HME services industry are too insignificant to gain the attention of the occupant of the White House. Not true! The HME services industry is a key component of progressive and cost effective healthcare in America. In all probability, the U.S Senate will be evenly divided and the Republicans will retain control of the US House of Representatives. That is bad news for the HME services industry. It needs, it deserves a president that represents all components of the healthcare system. You will be voting within days after you read this column. Please take the time to read the candidates' responses carefully and to go to the campaign's Web sites and ask tough questions before going to the polls. The life of the HME services industry is literally in your hands. Regardless of which candidates you favor, the most important thing you can do this November is vote. David T. Williams is a free-lance writer with more than 25 years experience in healthcare policy and politics. Contact him at davidtwilliams@comcast.net.