Bills in Brief

It took over a decade for health care reform to lose its Clinton-era-induced taboo status - but while health care policy is coming back in vogue, America will likely have to wait until 2009 before any major reforms become ripe for passage.

In the meantime, Congress may pass a series of mini health care inititiatives - which citizenJoe will do its best to keep track of here:

SCHIP. The State Children's Health Insurance Program, which covers low income children who aren't low income enough to qualify for Medicaid, is up for renewal this year - and Dems (with the help of moderate Republicans) are locking horns with president to try to double the scope of the act. In late September, the House and Senate passed a bill that would increase spending on SCHIP to $60b over five years (up from $25b), paid for by a 61cent tax on ciggies.

The president vetoed the high price act but signaled he'd like to compromise on a cheaper bill. Although the Senate has enough votes to override the veto, the House failed in its first attempt to clear the veto threshold. (WP) 

The extra coverage would place about 4 million new kids under SCHIP's umbrella (up from 6 million), making a big dent in covering the 9 million kids who are said to be uninsured. (Those are the numbers that are being widely reported in the big dailies, but Heritage, a conservative think tank, thinks fewer than 2 million will gain coverage; their analysis shows 2.4 million new kids under SCHIP, but 1 million of them leaping from private plans.)

The president, who proposed a $5b increase over five years, says the bill goes too far, allowing states to cover kids at up to 400% of the poverty level. The Urban Institute, a left of center think tank, says that, while in theory states could choose to cover kids at 400% of the federal poverty level, very few today choose to cover kids above 200% of poverty, so it's unlikely. They predict that 78% of kids coming on to SCHIP would be from below the 200% marker.

The House passed a second version of the bill in October to try to win over more Republicans, making it
clear that illegal immigrants couldn't be covered, lowering the income
threshold to 300% above poverty and easing adults off SCHIP (in some states parents of eligible kids could also get covered) - but it doesn't look any more likely to override the expected presidential veto. (WP, NYT)

e-Health care. Congress started working last session to push through a bill that would get health records out of file cabinets and into more easily accessible data bases.

Bargaining for cheaper drugs. The House passed a bill requiring the administration to negotiate down Medicare drug prices; the Senate, however, tripped over its attempt to do the same.
It's not clear if the Senate will take a second shot.

Refiguring doctors' fees for Medicare. Right now doctors' fees under Medicare depend on how fast the economy grows - not how much care they provide, how well they provide that care or how much their costs are. Congress may try to switch up that formula this year, but there's no saying how. MedPAC, Congress' advisor on Medicare, spells out the problem (and offers some solutions). Meanwhile, Congress could just opt for a short term fix - as it's done in the past - to keep Medicare fees from dropping as they are slated to do - but CongressDaily says that'd cost about $50 billion (we think they mean over five years).

Beefing up the FDA. The House and Senate passed a final Food and Drug Administration reauthorization bill in September, 2007, giving the agency more power to direct drug companies complete clinical trials, post their results and change drug labelling. The bill also ups the feed drugs companies have to pay the FDA. (NYT - see also the WP's FDA bill at a glance.)

Reimporting prescription drugs. As part of the FDA bill, senators tried to okay the importation of prescription drugs from Canada and a couple other rich countries - but an amendment that said any imported drug had to be blessed by the administration first, in effect killed any hopes of cheaper drugs coming over the boarder. (NYT)

Mental health parity. Bills in the House and Senate would require health insurers give mental health patients more access to care (HR 1367 & HR 1424 & S 558).

Regulating cigarettes. A bill that would allow the FDA to regulate tobacco also has a good shot at passing this year. (NYT)

Other health bills in the wings include: a bill barring discrimination based on what's in your DNA; and a bill to keep drug companies from paying generics not to sell their drugs.

The president's proposals

The president has two plans to promote health coverage for the uninsured: one would let families (and singles) buy health plans with tax exempt earnings at the same time as taxing "cadillac" employer-sponsored health plans; another would give states flexibility to shift their Medicaid funds to cover low-income health plans. Experts
are mixed on how those plans would pan out (WP & WP), but the question may be moot considering it's doubtful Congress would touch either.

Updated October 6, 2007

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