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, in 2007 Congress set out to pass a series of mini health care initiatives - which it may follow up on in 2008:

SCHIP. Congress head butted with Bush last year over expanding State Children's Health Insurance Program, which covers low income children who aren't low income enough to qualify for Medicaid. Congress, which wanted to double the scope of the act, lost. It may give it a second go in '08 though.

Medicaid. Similar to SCHIP, Medicaid helps states cover health care for the poorest kids, although the feds usually let states use Medicaid to cover kids above the poverty line. Last year, though, the feds started started crackin' the whip and giving our fewer waivers for expanded Medicaid coverage; this year Congress may act to push for more waivers to go through.

e-Health care. Congress started working a couple years back to push through a bill that would get health records out of file cabinets and into more easily accessible data bases. Given its bipartisan support - and the fact that the rest of the industrialized world has gone over to e-filing - it could pass this year.

Bargaining for cheaper drugs. The House passed a bill last year requiring the administration to negotiate down Medicare drug prices; the Senate, however, tripped over its attempt to do the same. The Senate may take a second shot this year.

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. (MedPAC, Congress' advisor on Medicare, spells out the problem - and offers some solutions). The president and Congress may also have to act this year after the "Medicare funding warning" (which sets off when certain funding levels are breached) got pulled last year. Meanwhile, Congress opted for a short term fix last year - as it's done in the past - to keep Medicare fees from dropping as they were slated to do at the end of the year, so it'll have to take a similar vote in June.

Trimming Medicare. After crossing a budgetary line (where 45% of expenses are expected to be covered by general tax revenue), Medicare "triggered" a requirement that Congress look at - but not necessarily approve - ways to trim Medicare spending. The president has proposed making richer seniors pay more for drugs, which Congress doesn't look so hot on doing; lawmakers would rather cut back on funding for higher end "Medicare Advantage" programs. It's not clear, however, that anything will get done on Medicare this year. (WP)

Reimporting prescription drugs. As part of an FDA bill passed last year, 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) Congress may revive efforts this year.

Mental health parity. The House and Senate both passed bills requiring health insurers give mental health patients equal access to care (HR 1424 & S 558). Now a final joint bill needs to be worked out; whether Bush will sign on or veto it is an open question.

Regulating cigarettes. We said a bill that would allow the FDA to regulate tobacco also had a good shot at passing last year (NYT). Clearly we were wrong, but tomorrow's another day.

Other health bills still 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.

Updated March 8, 2008

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