News from Capitol Hill
With the inflationary economy on everyone's mind, Congress is particularly geared to review the proposed budget sent by Carter in early January. It is an austere budget, generally reflecting a "hold-the-line" theme in health expenditures, with few proposed increases and a number of severe recisions. Carter's FY82 budget requests will be used as a departure point by appropriations committees and David Stockman, new director of the Office of Management and Budget (OMB), who plans to submit amendments to Congress in February.
In brief, the budget scenario is this:
* For two straight years the House and Senate have failed to complete work on appropriations legislation, necessitating the inexact process whereby continuing resolutions permit spending at the same level as the previous year. The Congress is now a split majority of the two houses, further lessening changes of agreement.
* The Reagan administration promises to formulate its own target list of program recisions. The amendments will be handled by Stockman, although Health and Human Services (HHS) Secretary Richard Schweiker will provide input. Stockman, a former congressman from Michigan, helped stop hospital cost containment legislation. He also favors reducing or eliminating spending programs, even those designed to reduce health expenditures, such as health planning.
* The House and Senate budget committees are ambitiously considering their own congressional priorities in chopping the budget. The House Budget Committee is chaired by Rep. James Jones (D, OK), a fiscal conservative and ambitious in his new chairmanship. The Senate Budget Committee is chaired by Sen. Pete Domenici (R, NM), who expects to work closely with Stockman and form alliances with other Republican chairman on powerful committees - Robert Dole (R, KN), chairman of the Senate Finance Committee, and Appropriations Chairman Mark Hatfield (R, OR).
Of the HHS budget, 94% is built into "entitlement" programs (Social Security, including Medicare and Medicaid) that only Congress can change. Of the total $739 billion FY82 proposed budget, a proposed $69 billion is for health care. Medicare and Medicaid together account for $56.5 billion of the health budget.
Competition Health Bill (S. 139) Proposed
Senate Labor and Human Resources Committee Chairman Orrin Hatch (R, UT) has introduced his competition model health insurance bill sponsored in the last Congress by new HHS Secretary Schweiker. Essentially, the bill limits tax exemptions for health insurance plans purchased by employers, and requires employers to offer workers a choice of health plans. It also requires plans to include catastrophic coverage for medical expenses that exceed 20% of a family's income. At a later date, the bill proposes the phaseout of many federal health programs, including health planning, PSRO, and federally-supported HMOs.
The competition health model was discussed in the January 16 final Report of the President's Commission for National Agenda for the Eighties. The report stated that the most desirable approach would be to reform the system to "stimulate competition among a diverse mix of insurers" and replace regulation with "economic incentives" for both consumers and industry.
Title XXI, Medicare Part C proposals
In a January meeting of the Forum on Long Term Care, staffs of several health comigrittees commented on what to exrSect in aging legislation during the 97th Congress. Under the proposed Title XXI, services now provided by Titles XVIII, IX, and XX would be combined, with the intent of providing greater service coordination. Eligibility for services, in particular long-term care services, would be based on functional impairment rather than on the present categorical determinations. Proposals that attack the present financing of long-term care services will receive considerable attention, as 15-25 states are reporting serious problems with Medicaid funding.
At the time of this writing committee assignments and chairmanships are being decided by Congress. Legislative calendars are thus in preliminary stages. With so much attention being given to budget cutting it is important to review the positive gains made by the previous 96th Congress. Major legislation enacted in the 96th Congress that affects the elderly and their families included:
P.L. 96-123- Labor /H EW Appropriations for 1980 and P.L. 96-369, P.L. 96-536- Continuing Appropriations for 1981.
These laws provide funding for programs under the Older Americans Act, the White House Conference on Aging, the Home Health Demonstrations project, ACTION Volunteer Programs, and the National Institute on Aging.
P.L. 96-247- Civil Rights of Institutionalized Persons Act of 1980
To protect the rights of institutionalized persons, the Attorney General is authorized to initiate civil suits in federal courts.
P.L. 96-265- Social Security Disability Amendments of 1980
This law extends coverage under Medicare for disability insurance recipients who are attempting to return to the work force. Also included in this legislation is a voluntary certification program for "medigap" insurance - health insurance policies bought by the elderly to supplement Medicare. The law provides minimum standards of liability, cancellation, and economic benefit to the insured, and criminal penalties for fraud in the sale of medigap insurance.
P.L. 96-398- Mental Health Systems Act
The Mental Health Systems Act extended the antecedent Community Mental Health Centers Act through FY81 at $85 million. It also authorized $105 million for a series of new mental health programs for the elderly.
P.L. 96-499- Budget Reconciliation Act of 1980
This act eliminates a number of existing limitations on reimbursable services under Medicare Parts A and B. It authorizes, with no deductible required from the patient, for: (1) outpatient alcoholic treatment; (2) diagnostic tests performed on a outpatient basis in a doctor's office, if tests relate to prior hospitalization; (3) minor outpatient surgery, if the physician accepts assignment under Medicare.
P.L. 96-103 and P.L. 96-526HUD Appropriations for 1980 and 1981
Included in both laws were increases from previous years for the amount of loans that could be made for housing the elderly and handicapped. Increases for 1981 made possible 17.000-20.000 more housing units.
P.L. 96-223 Crude Oil Windfall Profits Tax of 1979
This law earmarked 25°o of all tax revenues for low and moderate income energy assistance. It authorized S3.1 billion in energy assistance for FY81. distributed to states in block grants.
P.L. 96-249 Food Stamp Amendments of 1980
This increased the authorization ceiling for the food stamp program for both FY 1980 and 1981. The congressional budget officials estimated that the program would need $10.3 billion in FY 1981. P.L. 96-249 also requires annual adjustments in the food stamp budget to reflect food increases.
This list is by no means inclusive of all legislation enacted that affects services for the elderly. It emphasizes, however, the mechanism by which seemingly unrelated legislation may include a phrase, section, or major program for the elderly.
GAO Report Halts Nursing Home Regulations
Acting on orders from the Republican administration, secretarial approval of the conditions of participation for Medicare and Medicaid nursing homes was withdrawn two days after outgoing HHS Secretary Patricia Harris gave Department approval. This was possible because the General Accounting Office (GAO) did not deliver a report on the conditions as requested by the House Select Committee on Aging.
Moratorium on New Regulations
In a January 29, 1981 memorandum, President Reagan announced the establishment of a new regulatory oversight process. Fulfilling his campaign promise to decrease federal regulation, the President placed a 60-day moratorium on pending final regulations and proposed rules.
Proposed "Medigap" Rules Published
The long-awaited proposed rules that would establish the mechanism for a voluntary certification program for health insurance policies that supplement Medicare were published in the January 21 issue of the Federal Register.
Records for Hospice Demonstration Program
The January 23 Federal Register notice describes a new system of records for the Medicare and Medicaid Hospice Demonstration Program.
Charterte H. Connolly, RN, MS University of Maryland School of Nursing Baltimore, Maryland