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Groups step up pressure as House begins moving on $100B SCHIP bill
The Hill - 7/25/2007
Lobbying, organizing and grassroots efforts to advance federal coverage of children’s healthcare are intensifying this week as the House begins the difficult task of moving a massive bill through a divided chamber.
The Energy and Commerce Committee is scheduled Wednesday to mark up a bill that is expected to expand the State Children’s Health Insurance Program (SCHIP) by $50 billion, stop a scheduled cut in Medicare fees to doctors and increase spending on rural healthcare programs. The total cost is reported to be up to $100 billion.
By early afternoon Tuesday, the contents of the bill remained in flux, with language affecting physicians, health insurance companies and tobacco sellers unsettled. Committee Republicans had not been provided with legislative language as Democrats also were still at work trying to win over their own caucus. The markup, which had been slated for 10 a.m., was postponed until 4 p.m.
To finance the expanded spending, the House Ways and Means Committee is expected to mark up legislation later in the week that would reduce payment rates for private health insurance companies under Medicare Advantage and to hike taxes on cigarettes and other tobacco products.
The Senate Finance Committee last week approved its own SCHIP bill, which would add $35 billion to the program and be offset by a 61-cent tobacco tax increase.
Although the panel reported the bill on an overwhelming 17-4 vote, President Bush vowed a veto and his allies in the Senate and the House decried the SCHIP measure as an expansion of federal intrusion on the healthcare market and the tobacco tax increase as unwelcome and unnecessary.
Bush has proposed adding $5 billion to SCHIP spending.
The statutory authorization for SCHIP expires on Sept. 30, which provides Congress with a tight timeline to complete its work, a fact that the National Governors Association reminded lawmakers of in a letter on Sunday.
Throughout the year, legislators have named the beginning of the August recess as their target for completing SCHIP, which would give them just two weeks to get the bill through both chambers and conference committee — not to mention past a presidential veto.
The tobacco industry and its partners, such as retailers, are lined up on the other side in opposition to a tax on their products being used to finance the healthcare program expansion.
Meanwhile, America’s Health Insurance Plans (AHIP) and its health plan members are working to persuade Congress that Medicare Advantage plans provide valuable services to beneficiaries that justify their additional costs, which average 12 percent per beneficiary above the cost of insuring a person under traditional Medicare, according to a federal advisory committee report. AHIP plans to announce its own television campaign Wednesday.
AHIP, however, has been a vocal supporter of the extension and expansion of SCHIP.
Wednesday morning, a coalition of hospital, physician, labor union and activist groups is staging a press conference to unveil the results of an opinion poll showing public support for the SCHIP expansion. The Catholic Health Association of the United States (CHA), which mainly represents hospitals, organized the event.
These groups range from the AFL-CIO and the Service Employees International Union (SEIU) to the American Medical Association (AMA), the Federation of American Hospitals, the liberal healthcare group Families USA and the children’s advocacy group First Focus.
The diversity of the coalition, members of which have been heavily engaged in lobbying and grassroots organizing to promote the SCHIP expansion, underscores the magnitude of the aid outside interest groups are bringing to bear to help the Democratic majority in Congress enact what leadership has designated as one of its top priorities for the year.
SEIU, for example, already joined with Families USA and liberal advocacy group MoveOn.org on a $1.2 million television advertising campaign to push for the SCHIP bill and tobacco tax. On Tuesday, SEIU said it would build on that effort with a grassroots organizing campaign featuring targeted telephone calls to House Democrats and an online petition.
The AMA teamed with AARP last week to unveil a $1.3 million national TV ad buy to support the House legislation. The bill is expected not only to prevent the physician payment cut but to do so in a way that would not cause Medicare beneficiary premiums to rise.
The AARP, SEIU and the Business Roundtable project they will draw more than 2,000 to a rally of their own Wednesday morning, though its focus will not be on SCHIP but on healthcare reform more broadly under their joint “Divided We Fail” campaign. Nevertheless, AARP lobbyists will be joining other groups in pushing the SCHIP-Medicare bill this week.
The AARP, the physician groups and the hospitals groups, including the CHA and the Federation of American Hospitals, have been actively engaged in lobbying and public outreach on the SCHIP and Medicare legislation, but could find themselves in a predicament similar to AHIP’s.
For example, although physicians need action to prevent their payments from dropping 10 percent on Jan. 1, a realignment of fees among specialists could splinter the community.
If the final package includes unfavorable language regarding Medicare payments to hospitals, that industry also could be in a politically difficult position.
Executives at two hospital groups said they are optimistic about the bill’s effects on their members and vowed that their support for an SCHIP expansion was not contingent on other issues.
“We’re not going to be dissuaded from being supportive of healthcare for children of the working poor just because there might be unintended negative consequences for us,” said Sister Carol Keehan, CHA president and chief executive.
Federation of American Hospitals President Chip Kahn said that although the bill has not been finalized, he expects his members to come out OK. “From what I understand, the trade-offs are there but the positive changes outweigh the negatives by a good piece for hospitals,” he said.
“It’s all up in the air until it’s passed and signed,” Keehan noted.
Other provider groups may not fare so well. In anticipation of a possible freeze in Medicare payment rates, a small trade association representing for-profit nursing homes announced its own ad campaign on Monday. The first wave of ads sponsored by the Alliance for Quality Nursing Home Care will target the districts of freshman Democratic Reps. Jason Altmire (Pa.), Baron Hill (Ind.), Steve Kagen (Wis.), Ron Klein (Fla.) and Tim Mahoney (Fla.).
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