Tick tock, tick tock

Thursday, July 31, 2003

WASHINGTON, June 30 - The Senate and House both passed versions of Medicare reform legislation in late June that included very different proposals for how to cut DME expenditures.

The House reform includes competitive bidding for DME. The Senate does not, but includes a 7-year CPI freeze for DME and a provision that calls for HME providers to becomes accredited.

A conference committee composed of members from each chamber will hammer out what the final bill looks like. The President wanted a bill on his desk by July 30; at press time, it was uncertain whether lawmakers would be able to reconcile their differences and meet that timetable.

After a week-long July 4th recess, the two versions were scheduled to meet head to head in a conference committee. The House brought legislation that squeaked by in a full chamber vote largely along party lines 216-215. The Senate mustered stronger support to pass its legislation 76-21.

Historically, according to Invacare’s director of government affairs Dave Williams, the House prevails in conference with the Senate.

“These guys [in the House] are street fighters while the Senate is more genteel,” said Williams.

But, as Williams and others point out, the issue is far more complicated than who can take who in high-tech brawl.

“If the House version were to go through as is, they’d lose the Democratic vote,” said John Gallagher, The VGM Group’s vice president of government affairs. “ “They’d lose the bi-partisanship in the Senate because the Democrats there would see too much [tilted toward] the PPOs, HMOs and privatization.”

If the Senate muscles through its version, the House conservatives will back off, said Gallagher. “They’ll see it as too big an entitlement,” he said.

Congress has yet to disclose which members of Congress will sit on the conference committee when Congress reconvenes, but insiders say Bill Thomas (R-Calif.), a tenacious supporter of competitive bidding, and Sen Charles Grassley (R-Iowa) are likely bets.

The HME industry, as represented by the voice of AAHomecare, has declared support for the Senate version of the legislation. Indeed, The VGM Group underwrote part of a fund-raiser for Grassley over in June. And Invacare CEO Mal Mixon hosted a fundraiser for Grassley a week later.

Whether competitive bidding or the CPI-freeze emerges from the conference committee is anyone’s best guess. Heartened by the president’s declaration of support for the Senate bill, and the close, partisan call in the House, Williams and Gallagher are betting the Senate’s version prevails, though their margin of comfort is slim.

Another scenario says everything prevails.

“You could still have a CPI freeze while they get competitive bidding off the ground, or IR cuts take effect,” said Cara Bachenheimer, a healthcare attorney at Epstein Becker & Green in Washington.

She doesn’t think that will happen. “They’ll take either the House or Senate DME provisions,” she said. HME
Announced Senate Conferees
Chuck Grassley (R-Iowa),
Orrin Hatch (R-Utah),
Don Nickles (R-Okla.)
Jon Kyl (R-Ariz)
Bill Frist (R-Tenn)
Max Baucus (D-Mont.)
Jay Rockefeller (D-W.V.)
Tom Daschle (D-S.D.)
John Breaux (D-La.)
Announced House Conferees
Bill Thomas (R-Calif.)
Tom DeLay (R-Texas)
Mike Bilirakis (R-Fla.)
Billy Tauzin (R-La.)
Nancy Johnson (R-Conn.)
House Conferees
John Dingell (D-Mich.)
Charles Rangel (D-N.Y.)
Source: AAhomecare