Congress Returns to
Key Votes
Ronald Szabat, J.D., L.L.M., Director
Governmental and Legal Affairs
he fractured 109th Congress returned to Washington
in late January for its Second Session, and its first
actions are sure to set the tone for the rest of the
year. In the Senate, a threatened filibuster of the
nomination of Judge Samuel Alito to become a Supreme
Court Justice failed to materialize as many Democrats
joined Republicans in not blocking the vote that gave
way to this important life appointment.
Yet,
on the heels of this apparent thaw in icy relations,
Senate Minority Leader Harry Reid (D-NV) lost no time
in denouncing the President’s well-delivered
State of the Union address, claiming that President
Bush says one thing and does another. Of note, Democrat
messaging has continued to evolve in an attempt to
find a firm base, presently rooted in opposition to
the Iraq war, poor domestic economic performance and
emphasis on common shared American values.
Business as usual or simply repositioning for the
fall mid-term elections? Probably a little of both.
At about the same time, in early February, all eyes
turned to the scandal-ridden House of Representatives
where initial votes banned former Members who are
now registered lobbyists from access to the House
floor and gymnasium. Interestingly enough, some 50
Members of Congress voted against this House Resolution,
meaning that its significance was far from major.
Fast-tongued Representative Barney Frank (D-MA) quipped
that perhaps this reform should have instead required
lobbyists to yield exercise equipment to current Members
of the House.
Humor aside, a further package of other tougher “lobby
reforms” may soon be forthcoming and voted on
by the House and Senate. Organizations such as ASA
must sit up, take notice and speak out as necessary.
In the march to stem so-called “special interest”
influence, the bulk of legitimate lobbying, by knowledgeable
and well-behaved individuals familiar with the Congressional
process who are simply trying to help ensure good
government, could be hurt. This would not be a plus
for democracy or anesthesiologists, for example, who
like most physicians suffer under enormous government
regulation, red-tape and unreasonable governmental
price-controls.
If anyone thinks that grassroots lobbying alone can
turn around thorny issues like reform of the Medicare
anesthesiology teaching rule, think again. Our experience
trying to work through the Centers for Medicare &
Medicaid Services (CMS) bureaucracy on this matter
for the last several years is instructive. Stated
more bluntly, we will need full access to Congress
by both our in-house and hired lobbyists, as well
as our dedicated grassroots anesthesiologists and
many others to succeed on the range of key ASA issues.
If Congress makes access to its elected Members more
difficult, so too will be the path of our worthy efforts.
On a brighter note, the House also recently voted
positively, although by a narrow margin of 216-214,
to pass the Deficit Control Act of 2005. Of interest,
13 Republicans bolted to join a solid Democrat minority
in opposing the measure. This bill, which trims some
$40 billion in federal spending over five years, is
a mixed blessing for organized medicine. Of major
note, thanks to concerted ASA lobbying, it averted
— for one year only — the 4.4-percent
Medicare cuts that were mandated by law under application
of Medicare’s Sustainable Growth Rate (SGR)
formula. At the same time, cuts in the bill will make
Medicaid physician services more costly for the poor,
through increased cost-sharing. Under the new law,
there also is the possibility that loans for medical
students and others may become more expensive to service
because of higher interest rates.
Not included in this mammoth budget reconciliation
bill were so-called “pay for performance”
requirements that would tie future Medicare payments
to still undeveloped quality measures. ASA, working
with the American Medical Association and a host of
physician organizations, had worked hard to ensure
that draconian language in the earlier Senate budget
reconciliation bill was stripped from the final conference
bill. That language would have imposed cuts on top
of cuts for all Part B services. Curiously, only one
nonphysician organization had endorsed this approach,
breaking inexplicably from a working coalition of
all physician and other health professional groups.
Finally, the closely watched House leadership elections
in the Republican caucus resulted in a major shake-up
and a new order in that body. Following close voting
in a three-way race, the new House Majority Leader
is John A. Boehner (R-OH), replacing Acting Majority
Leader Roy Blunt (R-MO). The caucus also voted for
Representative Blunt to serve as the House Majority
Whip, a position he previously held. Representative
Adam Putman (R-FL) will assume the post of House GOP
Policy Committee Chair.
Interesting times, indeed. Under its new leadership,
these votes should presage an end to the tough sledding
of the last year for the House GOP, as it has tried
to accommodate both moderates and conservatives and
struggled to maintain its very control of Congress.
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