December 2000
Volume 64 |
Number 12
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WASHINGTON REPORT
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| 2000 Election
Results Promise Short- and Long-Term Impasse
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Michael Scott,
Director
This column was written just a few days after Election Day and,
in all probability, well before we know whether Vice-President
Al Gore or Texas Governor George W. Bush or for that matter House
Speaker J. Dennis Hastert (R-IL) in the event of a vacancy on
January 20 is sworn in as our next President.
This column will therefore focus on the results of the 2000
federal election of which we are fairly certain, and we will project
as accurately as possible the fate of those legislative initiatives
in the 106th Congress of particular interest to organized medicine.
GOP Retains House Control; Senate Results Not Certain
Perhaps the most significant conclusion to be drawn from the
2000 election of the House of Representatives was that the populace
was pleased with the status quo. Not only did the GOP retain a
narrow majority, but almost all incumbents seeking re-election,
whether Republican or Democrat, won by wide margins. With a couple
of close races still to be decided, it appears that out of 400
Representatives seeking re-election, only about six were defeated.
All three principal sponsors of ASA-supported anesthesia study
bills David Weldon (R-FL), Gene Green (D-TX) and Fortney Pete
Stark (D-CA) easily won re-election as did Jim Nussle (R-IA),
sponsor of the competing American Association of Nurse Anesthetists
(AANA)-supported bill. The Democrats needed a gain of seven votes
to retake control of the House, and it appears they gained only
two.
The picture appears no better in the Senate, where four and possibly
five incumbent GOP Senators lost their bid for re-election, against
only one sitting Democratic Senator. GOP losers were Senators
Spencer Abraham (MI), John Ashcroft (MO), Rod Grams (MI) and William
V. Roth, Jr. (DE); Senator Charles S. Robb (VA) was the only unsuccessful
Democratic incumbent. As this column is written, it is not yet
known whether GOP Senator Slade Gorton (WA) will defeat former
Representative Maria Cantwell, a Democrat. When all votes are
counted, however, the GOP margin can be no better than 51-49 if
Senator Joseph I. Lieberman (D-CT) remains in the Senate, or 52-48
if he becomes Vice-President and a successor (sure to be a Republican)
is named. Either majority is extremely difficult in the Senate
where 60 votes are required to invoke cloture on debate.
As expected, Senator Mike DeWine (R-OH), original sponsor along
with Harry Reid (D-NV) of the ASA-supported anesthesia study bill,
easily won re-election for a second term, but three of the subsequent
GOP sponsors Senators Abraham, Ashcroft and Grams were defeated.
Senator Kent Conrad (D-ND), principal sponsor of AANA's competing
bill, also won re-election handily.
Most notable among the GOP casualties was Senator William V.
Roth, Jr. (R-DE), who acts as chairman of the Senate Finance Committee,
the committee with jurisdiction over Medicare. With Senator Roth's
defeat, it is now clear that the chairmanship of all three congressional
Medicare committees will change next year; both Bill Archer (R-TX),
chairman of House Ways and Means, and Thomas J. Bliley, Jr. (R-VA),
chairman of House Commerce, did not stand for re-election.
Although it is reasonably clear that Senator Charles E. Grassley
(R-IA) will become Senate Finance Committee chairman, spirited
contests are expected for the chairmanships of the two House committees.
Contesting for the Ways and Means chair will be Representatives
Philip M. Crane (R-IL) and William M. Thomas (R-CA), and for the
Commerce chair, Representatives W.J. Billy Tauzin (R-LA) and Michael
G. Oxley (R-OH).
Fate of Health Care Bills at Mercy of Lame Ducks
When Congress recessed shortly before Election Day, it was apparent
that the only two major health care bills enjoying any chance
of passage were the so-called Medicare give back bill (H.R. 5291)
and the somewhat controversial pain management promotion bill
(H.R. 2260), the terms of both of which had been added to the
GOP's scaled-back tax bill (H.R. 2614). The Needlestick Safety
and Prevention Act (S. 3067/H.R. 5178), discussed in my last column,
was signed by the President on November 6.
As to the Medicare bill, both the President and GOP leadership
in the House and Senate had agreed on the need to ameliorate (give
back) prospective reimbursement cuts to providers called for by
the Balanced Budget Act of 1997. By the time of pre-election recess,
however, it was apparent that the White House and GOP leadership
principally disagreed as to the extent to which payments to health
maintenance organizations (HMOs) would be increased relative to
the limitation on cuts to hospitals, nursing homes and home health
agencies. Apparently not in controversy was a provision of the
bill that would delay until 2002 implementation of proposed regulatory
changes to the ambulatory surgical center payment system, at which
time new payment rates would be phased in over a four-year period.
Inclusion of the pain management provisions in the tax bill was
calculated to lessen or eliminate the possibility of a filibuster
in the Senate if it had been brought to the floor on a stand-alone
basis. Although the bill deals extensively with the promotion
of effective pain relief for terminally ill patients, it also
bars the use of federally controlled substances in connection
with assisted suicide, a practice authorized in Oregon under limited
circumstances.
It does not take an acute political observer to figure out that
the identity of the next President would significantly impact
not only the tax provisions of H.R. 2614, but the Medicare give
back provisions as well. If the next President is to be Vice-President
Gore, then working out a compromise with President Clinton is,
for the GOP congressional leadership, far more worth the candle
than if the next President is one of their own with whom they
can more easily reach agreement early in the 107th Congress.
There were two additional pending bills of principal interest
to physicians relating to collective negotiations with insurers
(H.R. 1304) and to protection of patients against HMO abuses,
such as the recent draft bill authored by Representatives Tom
Coburn (R-OK) and John Shadegg (R-AZ). Both bills, however, were
already dead or terminally ill by the start of the pre-election
recess. The collective negotiation bill died in the early fall
for want of any GOP support in the Senate, notwithstanding broad
bipartisan support on the House. In a real sense, the reason for
its demise is identical to the reason for failure of the 106th
Congress to agree upon managed care protection legislation: that
is, the strong influence of the insurance industry and American
business on the Senate leadership.
As this column is written, the unfinished congressional business
includes the Medicare give back bill and three appropriations
bills. It is simply not possible to predict at this time whether
the GOP will work out its differences with the President so that
these bills can be completed. If not, then the best guess is that
the GOP will propose a continuing resolution until some time early
next year. It is not clear whether President Clinton would agree.
Amended Anesthesia Study Bill Fails to Gain Support
As ASA members are already aware, Representatives Weldon and
Green introduced in early October an amended anesthesia study
proposal (H.R. 5286) designed to offer accommodation to AANA interests
while at the same time adhering to the principle of physician
involvement in every anesthesia procedure. In essence, the bill
called for adoption of a new Medicare standard permitting either
medical direction, medical supervision or closely defined physician
collaboration with a nurse anesthetist. The bill also contemplated
a four-year study of anesthesia outcomes in each of the three
authorized delivery modes. AANA responded with a series of attack
ads, mocking and mischaracterizing the proposal as well as denigrating
in a variety of ways the role of anesthesiologists in the delivery
of anesthesia care in this country.
Efforts by Dr. Weldon to advance the revised proposal with the
House GOP leadership and to include its terms in the Medicare
give back bill ultimately did not succeed. This congressional
scenario stands in sharp contrast to the willingness of the Administration
to accord the issue of physician supervision the careful study
that ASA believes it deserves. As of this writing, more than five
months have passed since the Health Care Financing Administration's
(HCFA's) proposed rule was sent to the Office of Management and
Budget (OMB), and the matter is still under review. ASA is aware,
moreover, that a number of Democratic leaders in both the Senate
and the House have communicated to OMB their deep concern about
the HCFA proposed rule. Because of the concerns exhibited at OMB,
ASA believes that there is a good chance that the issue will
be put over to the next Administration, notwithstanding intense
pressure from AANA and the Department of Health and Human Services
to the contrary.
ASA Washington Office • 1101 Vermont Ave., N.W., Suite
606 • Washington, DC 20005 • (202) 289-2222 • mail@ASAwash.org
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