Where we are

Sunday, November 30, 2003

Editor, HME News

It’s Nov. 12 as we’re going to press, and those members of Congress who’ve been charged with reconciliation of each chamber’s Medicare reform proposals have yet to pull it off. They’ve resolved lots of issues, and according to a Robert Pears report in today’s New York Times, it looks as if there may be some compromise on the reconciliation’s greatest sticking point - the privatization of Medicare. (The House Republicans have floated a compromise that would delay competition between traditional Medicare and managed Medicare.)

And yet, the issue of competitive bidding and/or a CPI freeze for durable medical equipment is still outstanding. It is unresolved. Grassley and Thomas are each dug in and splattered with mud from the fight on this one issue alone.

Just a few days ago, a letter surfaced that put a really sharp arrow in the quiver of those who believe competitive bidding is a raw deal for Medicare beneficiaries. In the letter, five members of Congress have objected to competitive bidding on the grounds that such a program would disenfranchise African-Americans and create two classes of home care in Medicare.

In a letter that Edolphus “Ed” Towns, D-N.Y., addressed to the reconciliation committee’s leaders Oct. 30, Towns described the two classes as “(1) an urban class subjected to sub-standard care provided by the lowest bidder, and (2) a suburban/rural class receiving quality-based care derived from existing market forces.”

Towns’ s letter presumes a proposal that would implement competitive bidding only in those Metropolitan Statistical Areas (MSAs) with populations that exceed one million.

It’s going to be tough for competitive bidding’s greatest booster, Rep. Bill Thomas, R-Calif., to steer around the flight of this arrow.

“This is almost brilliant,” said the VGM’s Group’s vice president of government relations, John Gallagher. “If it sticks - if competitive bidding is discriminatory to minorities - then that may put a nail in the coffin of NCB.”

All along, says Gallagher, the industry has been supporting Grassley and his interest in keeping competitive bidding out of rural areas. “While we were all looking in one direction, we might have been looking in the other, at the cities,” he said.

In recent periodicals that circulate widely on Capitol Hill - CQ Today and Roll Call - reporters have identified the competitive bidding issue as a relatively minor one but have acknowledged that the issue has loomed disproportionately large at the reconciliation committee.

It’s important to remember that the forces that have kept competitive bidding at bay did not do so without tremendous support from the industry. It’s pie-in-sky to think that Grassley, or the Ohio Republicans (see news story, page 4), or Sen Mary Landrieu, D-La., would have persevered against competitive bidding unless they were repeatedly reminded that competitive bidding is a raw deal for beneficiaries.

“It’s really due in large part to grass roots at the state level,” said Seth Johnson, AAHomecare’s director of public policy. “There have been all kinds of faxes and phone calls flying into their offices.”

We don’t know yet whether the industry will face competitive bidding in the next year, or three years. If the initiative is forestalled, the industry will have to work twice as hard to cut off the legs of the next competitive bidding ogre. In the meantime, it’s heartening to know that advocacy works and that arrows sometimes hit their marks.