News in brief - June 23, 2003

Medicare drug bill to include geographic payment equity - House passes abortion bill - The cost of universal insurance - Nebraska high court upholds malpractice award caps - Health coverage bill offered in House - Judge gives class-action status to Oklahoma Medicaid lawsuit

Medicare drug bill to include geographic payment equity

A bipartisan Medicare outpatient prescription drug bill will include provisions to even out Medicare pay disparities between urban and rural physicians and hospitals.

The measure, which is being advanced by Senate Finance Committee Chair Charles Grassley (R, Iowa) and Ranking Member Max Baucus (D, Mont.), would modernize Medicare by adding new managed care options. It also would provide a voluntary prescription drug benefit for beneficiaries without forcing them into managed care plans.

At press time, the bill had not been introduced, and Grassley and his aides were mum about the specific physician payment provisions, saying only that key measures from Grassley's amendment to the recently passed tax cut bill would be included. That amendment, which House and Senate negotiators cut from the final version of the tax measure, would have eliminated reductions in Medicare payments stemming from the use of geographic adjusters in the physician fee schedule.

The amendment also included savings to offset the resulting increase in Medicare spending on physician services. Savings came from cutting payments for drugs provided in conjunction with physician office visits. But oncologists and hematologists say they rely on overpayments for those drugs to make up for shortfalls in Medicare practice expense payments.

Senate Majority Leader Bill Frist, MD (R, Tenn.), said he would push for a vote on a Medicare prescription drug benefit before the July 4 recess.

House passes abortion bill

The House has joined the Senate in passing legislation to make illegal the abortion procedure called intact dilatation and extraction by some and partial-birth abortion by others. Now the two bodies will have to work out differences between the two bills. President Bush has said he would sign the resulting measure. The House bill includes an exception to save the life of a woman, but not to protect the health of a woman. The Senate bill contains a health exception; however, it is expected to be stripped out during negotiations with the House. Similar state bills, lacking the health exemption, have been defeated by constitutional challenges. Several pro-choice and medical groups have vowed to oppose a federal law in the courts.

The cost of universal insurance

Extending health coverage to everyone currently without insurance would raise total health spending by between 3% and 6%, or less than one percentage point of the gross domestic product, according to a report by the Kaiser Commission on Medicaid and the uninsured.

The report showed that it would take an additional $34 billion to cover the uninsured through a public program or $69 billion through private options. The total cost of paying for the health care needs of the uninsured would be these amounts plus $99 billion in medical care the uninsured already receive. More information can be found online (www.kff.org/content/2003/20030604).

Nebraska high court upholds malpractice award caps

The Nebraska Supreme Court in May upheld the state's $1.25 million cap on damages awarded in medical malpractice cases. The court rejected an argument that the cap violates a constitutional guarantee that people be treated equally. The plaintiffs argued that a cap unfairly creates two classes of medical malpractice litigants, those who will have their expenses covered and those who won't because the cap won't allow for it.

Health coverage bill offered in House

A sweeping measure to address the problem of the uninsured was recently introduced in the House. The Health Coverage, Affordability, Responsibility and Equity Act was penned with help of the American College of Physicians and has wide support from physician groups.

The bill would create a refundable tax credit for individuals and families with incomes at or below 200% of the poverty line. Under the bill, local purchasing pools of affordable health plans would be made available to these tax-credit recipients. Small companies also would be able to buy into the state-run networks. State Medicaid programs would be expanded to cover everyone at or below 100% of the poverty level. An identical bill was introduced in the Senate May 8.

Judge gives class-action status to Oklahoma Medicaid lawsuit

Oklahoma children who are eligible for Medicaid can join a lawsuit that aims to ensure that Medicaid patients get care comparable to children covered under private insurance, a federal judge ruled May 30.

U.S. District Court Judge Claire V. Eagan in the Northern District of Oklahoma gave class-action status to a case that the Oklahoma chapter of the American Academy of Pediatrics and parents of children receiving care through Medicaid brought against the state's Medicaid program. The OKAAP and parents want to see an increase in physician reimbursement rates that would encourage physicians to participate in Medicaid.