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Report from the Washington Office
R e p o rt fro m th e W a s h in g to n O ffic e À
HEALTH POLICY CONFRONTATION IN 1976 As the second session of the 94th Congress got underway in earnest, the stage appeared to be set for a series of continuing confrontations between the legislative and executive branches of government as both began to prepare for the elections this fall. Many of these confrontations can be expected to involve health issues. Fiscal 1976 Appropriations Override By overwhelming votes of 310 to 113 in the House and 70 to 24 in the Sen ate, the president's Dec 19 veto of the fiscal 1976 appropriations bill for the Departments of Labor and Health, Educa tion and Welfare (HR 8069) was over ridden. On that occasion, a White House spokesman said that "Congress talks a good game about fiscal responsibility, but when it comes to actually voting to save taxpayers money, they vote the same old way." On the same occasion, the floor manager of the bill in the Senate, Sen. Warren Magnuson (D-Wash) said, "Every time Congress works its will on domestic programs— people programs— we hear a resounding 'no1 from the other end of Pennsylvania Avenue." His counterpart in the House, Congress man Daniel Flood (D-Pa) said during the debate, "The question is, do you b e lieve that Congress was right in providing a modest increase in appro priations for programs like cancer research, maternal child health, mental health....or do you think that federal support should be reduced below current levels?" The vote, which marked the first
time Congress has overridden a HEW appropriations veto, unfortunately has not completely settled the issue, since President Ford has already sent (Jan 23) a proposed recision of $266.3 million in HEW health funds and a request to defer spending of $13.9 million. In both cases, Congress is not likely to go along with the requests, but instead, reject them under the new budget control law enacted to prevent impoundment of appropriated funds— thus continuing the confrontation over health program funding. Fiscal 1977--Proposed HEW Budget Before the override vote on the fiscal 1976 appropriations bill, Pre sident Ford submitted his fiscal 1977 HEW budget to Congress. The budget again was met with heated criticism from congressional leaders. Among the most controversial recommendations was the president's proposal to consolidate Medicaid and 15 other health programs into a single $10 billion block grant to the states. Distribution would be based on a formula of three factors: "the size of the states' low income population; per capita income; and fiscal effort." The proposal, which would require legislative action, was assailed by Congressman Paul Rogers (D-Fla), and Sen. Edward Kennedy (D-Mass) chairmen, respectively, of the House and Senate health subcommittees, who have spon sored legislation for separate cate gorical health programs. These critics contend that the $10 billion block grant would be $1 billion less than the current contribution to Medicaid and
would allow states to drop the $ 8 bil lion in matching funds they would be required to pay if Medicaid is contin ued in its present form. With the administration's fiscal 1977 budget now in hand, congressional appropriation committees have joined the battle by beginning their appro priation process for fiscal 1977. The House appropriations labor-HEW sub committee plans to call witnesses on the HEW budget starting about Feb 19 with hearings to be completed around April 9. In the Senate, the labor-HEW panel began on Feb 3 with hearings expected to be completed by March 9. Administration Medicare Amendments President Ford, in his State of the Union message, apparently closed the door on administration support of a comprehensive national health in surance program when he stated, "We cannot realistically afford federally dictated national health insurance providing full coverage for all 215 million Americans." As a partial al ternative, however, he proposed to submit legislation revising the present Medicare program to provide protection against catastrophic illnesses, so that no elderly person would have to pay more than $500 a year for covered hospitalization and nursing home care and no more than $250 a year for covered physician services. The president's proposal also would put a 7 % limit on increases in part A, per diem charges, and 4 % on part B, physician charges, affecting a net savings to the Medicare program estimated at $1.4 billion. These "catastrophic" health insurance plans for the elderly touched off reactions of outrage from democratic congress ional leaders, including Rep. Dan Rostenkowski (D-Ill), chairman of the House Ways and Means health sub committee, who said that the presi dent's proposal "actually creates a catastrophe" for the aged by insti tuting a 10% coinsurance payment for Medicare hospital patients from the second day of hospitalization on. Chairman Rostenkowski scheduled hearings on the administration's Medicare proposal beginning Feb 9.
Health Planning Controversy The administration's new health strategy embodying its block grant proposal has caused congressional consternation over the future of the already initiated implementation of the 1-year-old National Planning and Resources Development Act (PL 93-641). At a special briefing held on the fiscal 1977 HEW budget, department officials conceded that it would be necessary to scrap much of the plan ning law in order to implement the proposed $10 billion block grant pro gram for health. Although details of the administration's legislative package are still being developed, the major responsibility for health plan ning would be transferred to the states, leaving in doubt exactly what role, if any, would be accorded to the newly developed health system agencies (HSAs). Federal involvement, under the new pro posal, would be limited to an advisory role of formulating nonbinding "national guidelines describing a more desired distribution of health resources." At hearings held before the House commerce subcommittee on health on Feb 4, chairman Paul Rogers questioned Mr. David Mathews, secretary of Health, Education and Welfare, about this seemingly inconsistent position between the administration's block grant pro posal and present health planning law. The HEW secretary's response was general in nature, however, and left unresolved this apparent conflict in the adminis tration's position. Because of the unlikeliness of Congress accepting the administration's proposed changes for health planning, HEW program adminis trators are moving ahead to establish the national health planning network required by present law. As of Feb 4, applications have been received from over 207 organizations which seek to be designated as HSAs. The final selection process for this first re view stage is expected to be complete by late March with formal designations to be announced in April. A second review cycle is scheduled for early spring to consider applications from the remaining health service areas.
HEALTH POLICY CONFRONTATION IN 1976 As the second session of the 94th Congress got underway in earnest, the stage appeared to be set for a series of continuing confrontations between the legislative and executive branches of government as both began to prepare for the elections this fall. Many of these confrontations can be expected to involve health issues. Fiscal 1976 Appropriations Override By overwhelming votes of 310 to 113 in the House and 70 to 24 in the Sen ate, the president's Dec 19 veto of the fiscal 1976 appropriations bill for the Departments of Labor and Health, Educa tion and Welfare (HR 8069) was over ridden. On that occasion, a White House spokesman said that "Congress talks a good game about fiscal responsibility, but when it comes to actually voting to save taxpayers money, they vote the same old way." On the same occasion, the floor manager of the bill in the Senate, Sen. Warren Magnuson (D-Wash) said, "Every time Congress works its will on domestic programs— people programs— we hear a resounding 'no1 from the other end of Pennsylvania Avenue." His counterpart in the House, Congress man Daniel Flood (D-Pa) said during the debate, "The question is, do you b e lieve that Congress was right in providing a modest increase in appro priations for programs like cancer research, maternal child health, mental health....or do you think that federal support should be reduced below current levels?" The vote, which marked the first
time Congress has overridden a HEW appropriations veto, unfortunately has not completely settled the issue, since President Ford has already sent (Jan 23) a proposed recision of $266.3 million in HEW health funds and a request to defer spending of $13.9 million. In both cases, Congress is not likely to go along with the requests, but instead, reject them under the new budget control law enacted to prevent impoundment of appropriated funds— thus continuing the confrontation over health program funding. Fiscal 1977--Proposed HEW Budget Before the override vote on the fiscal 1976 appropriations bill, Pre sident Ford submitted his fiscal 1977 HEW budget to Congress. The budget again was met with heated criticism from congressional leaders. Among the most controversial recommendations was the president's proposal to consolidate Medicaid and 15 other health programs into a single $10 billion block grant to the states. Distribution would be based on a formula of three factors: "the size of the states' low income population; per capita income; and fiscal effort." The proposal, which would require legislative action, was assailed by Congressman Paul Rogers (D-Fla), and Sen. Edward Kennedy (D-Mass) chairmen, respectively, of the House and Senate health subcommittees, who have spon sored legislation for separate cate gorical health programs. These critics contend that the $10 billion block grant would be $1 billion less than the current contribution to Medicaid and
would allow states to drop the $ 8 bil lion in matching funds they would be required to pay if Medicaid is contin ued in its present form. With the administration's fiscal 1977 budget now in hand, congressional appropriation committees have joined the battle by beginning their appro priation process for fiscal 1977. The House appropriations labor-HEW sub committee plans to call witnesses on the HEW budget starting about Feb 19 with hearings to be completed around April 9. In the Senate, the labor-HEW panel began on Feb 3 with hearings expected to be completed by March 9. Administration Medicare Amendments President Ford, in his State of the Union message, apparently closed the door on administration support of a comprehensive national health in surance program when he stated, "We cannot realistically afford federally dictated national health insurance providing full coverage for all 215 million Americans." As a partial al ternative, however, he proposed to submit legislation revising the present Medicare program to provide protection against catastrophic illnesses, so that no elderly person would have to pay more than $500 a year for covered hospitalization and nursing home care and no more than $250 a year for covered physician services. The president's proposal also would put a 7 % limit on increases in part A, per diem charges, and 4 % on part B, physician charges, affecting a net savings to the Medicare program estimated at $1.4 billion. These "catastrophic" health insurance plans for the elderly touched off reactions of outrage from democratic congress ional leaders, including Rep. Dan Rostenkowski (D-Ill), chairman of the House Ways and Means health sub committee, who said that the presi dent's proposal "actually creates a catastrophe" for the aged by insti tuting a 10% coinsurance payment for Medicare hospital patients from the second day of hospitalization on. Chairman Rostenkowski scheduled hearings on the administration's Medicare proposal beginning Feb 9.
Health Planning Controversy The administration's new health strategy embodying its block grant proposal has caused congressional consternation over the future of the already initiated implementation of the 1-year-old National Planning and Resources Development Act (PL 93-641). At a special briefing held on the fiscal 1977 HEW budget, department officials conceded that it would be necessary to scrap much of the plan ning law in order to implement the proposed $10 billion block grant pro gram for health. Although details of the administration's legislative package are still being developed, the major responsibility for health plan ning would be transferred to the states, leaving in doubt exactly what role, if any, would be accorded to the newly developed health system agencies (HSAs). Federal involvement, under the new pro posal, would be limited to an advisory role of formulating nonbinding "national guidelines describing a more desired distribution of health resources." At hearings held before the House commerce subcommittee on health on Feb 4, chairman Paul Rogers questioned Mr. David Mathews, secretary of Health, Education and Welfare, about this seemingly inconsistent position between the administration's block grant pro posal and present health planning law. The HEW secretary's response was general in nature, however, and left unresolved this apparent conflict in the adminis tration's position. Because of the unlikeliness of Congress accepting the administration's proposed changes for health planning, HEW program adminis trators are moving ahead to establish the national health planning network required by present law. As of Feb 4, applications have been received from over 207 organizations which seek to be designated as HSAs. The final selection process for this first re view stage is expected to be complete by late March with formal designations to be announced in April. A second review cycle is scheduled for early spring to consider applications from the remaining health service areas.