Managed Care Reform: Wait Until Next Year for House, Senate

WASHINGTON--Despite increasing complaints from physicians andpatients, don't look for Congress to take any action in 1996 toremedy the problems that have evolved with the growth of managedcare, a key Senate aide said at the national meeting of the Associationof Community Cancer Centers (ACCC).

"I don't think we will see a massive regulation bill thisyear for managed care," said Mark H. Smith, legislative assistantto Sen Connie Mack (R-Fla). "There is a very keen awarenessthat something needs to happen. But if the Democrats add managedcare to the Kassebaum-Kennedy health care bill, we will go anotheryear without health reform."

However, Mr. Smith added: "Stay tuned." If the Republicanswin control of Congress again in November, he predicted therewill be a growing movement to address problems arising from thelimits placed on patients' access to physicians and therapies."The members of Congress hear a lot about managed care,"he commented.

Mr. Smith made his remarks at an ACCC breakfast meeting, wherehe and Rep. David L. Hobson (R-Ohio) gave their assessments ofmedical and health issues pending in Congress.

'Congress Has Been Generous'

Rep. Hobson, who serves on both the House Appropriations and Budgetcommittees, noted that Congress had been generous in appropriatingresearch funds for fiscal 1996, with the National Institutes ofHealth receiving $11.9 billion.

"That's $174 million more than the President's request and$624 million more than in 1995. The National Cancer Institute'sfunding is $2.2 billion, which is $31 million more than the President'sbudget request and $114 million more than last year," Rep.Hobson said. "Clearly there is a strong emphasis on the benefitsthat research brings to America."

Both speakers expressed frustration over the failure of Republicansand Democrats to reach agreement on significant Medicare reforms.

"I'm hoping the President will be more willing to work withus on some of these things," Rep. Hobson said. "Thenumbers are pretty close." He believes that "we canbe caring as well as cost effective. I think this society willcome together; I think that can be done. But I'm not sure it canbe done in an election-year cycle."

Mr. Smith foresaw relatively little movement in efforts to changeMedicare, whose costs, he said, are increasing at about 10% peryear in federal expenditures alone.

"At this point, it is very doubtful that anything major isgoing to happen with Medicare," he said. "Essentially,the only things in Medicare that you can look for having a realpossibility of getting through, in terms of cancer, are increasedbenefits for cancer screening." This includes attempts toincrease the mammog-raphy benefit so that it meets the AmericanCollege of Radiology, American Cancer Society, and National CancerInstitute guidelines.

He added that there is a good possibility this year for coveragefor oral drugs for cancer, such as tamoxifen.

Mr. Smith gave a more upbeat assessment about changing the nation'swelfare and Medicaid programs. "I think there is a greatpossibility," he said. The reform proposal advanced by thenation's governors offers a very broad concept, but not a specificbill, he noted. Congress must now shape that concept into legislationthat maintains the provisions and goals of the governors proposals'while meeting the budget deadline.

"It's going to be difficult, but we obviously believe wecan do it this year," Mr. Smith said. "The challengeis going to be keeping all the governors on board for what theCongress wants to do."

Both speakers seemed uncertain about the possibility of enactingthe Kassebaum-Kennedy health care reform package. But Mr. Smithsuggested support exists within both parties for such proposalsas:

Eliminating the practice of denying insurance or raising ratesfor pre-existing conditions.

Increasing portability of insurance.

Allowing small businesses to form purchasing cooperatives sothey can buy affordable insurance for their employees.

Rep. Hobson predicted passage of a bill he has introduced designedto simplify the way the nation sets and adopts uniform standardsfor financial and administrative health data. Currently, the HealthCare Financing Administration can adopt standards and mandatetheir use by the private sector.

Rep. Hobson's bill requires that such standards aim to reduceadministrative costs and be developed by a standards-setting groupaccredited by the American National Standards Institute. The Congressmanargues that his bill will result in taxpayer savings of up to$90 billion a year by identifying claims that Medicare pays bymistake.

"I understand the White House has agreed to the languagein the bill," Rep. Hobson said. "As far as I can tell,the House likes it, the Senate likes it, and I think it is goingto happen."