Unfinished business: Congressional agenda 2004

From tort reform to health insurance access, lawmakers are likely to revisit health care problems they can't seem to solve.

By Tanya Albert, Joel B. Finkelstein and Markian Hawryluk, AMNews staff. Feb. 2, 2004.

The health care issues facing Congress this year are, borrowing the words of Yogi Berra, "like déjà vu all over again."

Although Congress passed the Medicare reform bill late last year, lawmakers were unable to make progress on many of the policy questions most important to physicians. Included in that list of unfinished business are tort reform, help for uninsured Americans and lasting relief for the financially troubled Medicaid program.

The Medicare reform bill's passage hasn't even taken that issue off the agenda, as many lawmakers are now intent on fixing what they view as major flaws in the law.

Here is a look at how debate on these unresolved issues is shaping up.

There's a reason why most significant Medicare legislation over the past two decades has passed in odd years. Federal elections happen in even years.

With both congressional and presidential races looming in November, physicians can expect little definitive action on Medicare this year. But that doesn't mean lawmakers won't try. Most efforts will focus on fixing perceived problems with the Medicare reform package passed last year.

For physicians, the new Medicare law provides a two-year reprieve from payment cuts, but it necessitates further action to avoid draconian reductions in 2006. Congress likely will begin discussion on revamping the formula used to update Medicare's physician fee schedule.

That formula relies on estimates to establish a yearly spending target. If estimates are accurate, the target rises at the same rate as the gross domestic product. But if actuaries miscalculate or if spending for physician services misses the mark, the formula makes a correction in the next update. That has led to large payment increases and decreases over the years and has forced Congress to step in for the past two years to avoid deep cuts.