Congress has been so active on issues affecting the HME services industry that everyone has rightly been focused on House and Senate races, whom to support and how to support them. But there is another race this year that deserves our attention. John F. Kerry is the de facto Democratic nominee to challenge George W. Bush for the office of President of the United States, and this race is as important as any congressional race.

You don’t have to look that far back to see what kind of damage can be done to the HME industry by executive or administrative action. The December “clarification” of the Medicare coverage guidelines for power wheelchairs was the product of the executive branch of government. No congressional action mandated this clarification and, while Congress was asked to intercede, the clarification was rescinded at the agency’s own initiative. It would be nice to say that this issue is behind us, but it now appears that Centers for Medicare and Medicaid Services (CMS) rescinded the clarification so they could clean up the process, not the outcome.

Over the years, there have been several other administrative initiatives that have had a dramatic and negative impact on the HME services industry. That is why who will occupy the White House is as important to the industry as who chairs the House Ways and Means Committee.

It is time that Mr Kerry and Mr Bush write home health care position papers and begin to take our industry seriously. The first step in that direction is for the HME services industry to join together with consumer groups and develop a set of questions that will stimulate thoughtful discussion between the candidates and their staff. Some suggestions for questions to be asked of these candidates are:

• Do you support funding for long-term care of people with disabilities, chronic health conditions, and those who are counted among the frail elderly in the home—the least restrictive and most cost-effective environment?

• Do you accept the fact that technology has advanced well beyond the definitions used in the Healthcare Common Procedure Coding System (HCPCS) and that the system is in need of a complete overhaul if Americans are to have access to appropriate technology and services?

• As president, would you insist the Medicare policy development be fair and equitable—including the supplier appeals process—to ensure that ethical providers of HME are not punished for the bad acts of a few scoundrels?

• Will you direct CMS to conduct an actuarially sound study intended to identify the cost of the service component of providing HME, home respiratory care, and rehab and assistive technology? If so, assuming that that study identifies real and reasonable costs, will you support a restructuring of the Medicare fee schedule to reflect and reimburse providers for the cost of the service component of the HME benefit?

There are undoubtedly many more questions that could and should be asked of candidates for president. However, lengthy questionnaires generally do not attract attention in presidential campaigns. The purpose of the question-and-answer is to alert the next administration that forces are in play that threaten the health of the HME and home health care industries. The industry has a general idea of how many small businesses are affected by CMS policy. But the numbers that will get these questions the attention they deserve are the number of beneficiaries affected and the potential savings of home health care over facility-based care.

The cover letter accompanying the questionnaire can contain the demographic information described above, and should be signed by as many trade groups, consumer organizations, and advocacy groups as possible.

The early selection of the Democratic nominee has jump-started the campaign season. Television is already awash in political commercials from both campaigns. The industry must act now to put its issues in the hands of the candidates and their campaign staff. Answers to the questions presented above will go a long way toward identifying positions on important HME industry issues, to which the next administration can be held accountable.

We all know that home health care is the answer. Our goal must be to get President Bush and Senator Kerry to know and say the same thing.

Cara C. Bachenheimer, JD, is vice president of government relations for Invacare Corp, Elyria, Ohio. David T. Williams is a consultant for political and legislative strategy.