Under some proposed state Medicaid plans (such as Pennsylvania), spending caps could make power wheelchairs out of reach. Demystifying the political process is the first step toward stopping these plans.

David N. Fiorini

Have you ever heard of Coca-Cola, Pepsi, McDonalds, or Burger King? Sure you have. These corporations spend millions of dollars on advertising. Even though they know you have heard of them, they continue to advertise.

The same should be applied to campaigning or lobbying. The only difference in advertising between these major corporations and the DME industry is the audience. The DME industry should be spending money on local campaigns and lobbying efforts to make the state legislatures aware that we exist.

Like many states, Pennsylvania’s Department of Public Welfare is projecting an $800 million deficit in the Medicaid budget for fiscal year 2005-2006. One of the proposed changes to assist in the Medicaid cuts is to place a $5,000 cap on DME for adult patients. For the chronically ill patient or for people with a “mini-hospital room” in their home, the cap will exhaust their benefits in no time. In addition, any power wheelchair will exhaust the $5,000 Medicaid cap instantly.

To add to the problem, the language in the proposed budget act will give the Pennsylvania Department of Public Welfare the full authority to change the amount of the cap without going to legislation or any type of regulatory process. Therefore, the department will have the authority to change the DME cap to $1,000 or to whatever amount they choose with only a 30-day notice to the provider community.

This type of legislation can be defeated, but it will take effort from the provider community. Providers need to be involved with their local politics. The provider does not need to be running for office, but he needs to support the candidates that will protect his interests. To prevent legislation that causes damage to the provider community or to create legislation that assists the provider community, you need to have an understanding of the political process of a bill.

I’m Just a Bill
There are five steps for a bill to become law for your state. The steps are: introduction of legislation, committee deliberation, floor action, resolution, and action by the Governor. This process must occur before a bill is sent to the Governor of your state to sign into law.

The first step is introduction of legislation. Ideas for bills can come from anyone, although only a member of your state assembly or your state senate can introduce legislation. Most state budgets are usually developed in the governor’s office, and a member of the state legislature is assigned to introduce the budget as a bill. All bills are assigned a number respective of the appropriate chamber that introduces the legislation.

Once legislation is introduced, it is referred to the committee that has jurisdiction over the subject contained in the bill. A bill may be sent to a single committee (single referral), several committees at once (multiple or joint referral), from one committee to another (sequential referral), or different parts of a bill may be sent to different committees (split referral). Most budgets usually follow the path of a split referral. After a committee receives a bill, it is usually passed on to a subcommittee. Most of the work is done at the subcommittee level.

The subcommittees will conduct public hearings, mark up the bill offering their own views, suggest amendments, and create a final draft to be voted on for approval. If a majority supports the bill, it is “reported out.” If the legislation does not receive majority support, the bill dies. After a subcommittee reports out legislation, the full committee will go through the same consideration process. If the committee approves a bill, it is reported out to the respective chamber for floor action. A report is usually prepared by the committee chair that describes the intent of the legislation, its impact on existing laws and programs, and views of dissenting members.

Next, legislation is placed on the respective chamber’s calendar for debate by the full chamber. Bills may originate in one chamber and, upon passage, move to the opposite chamber to repeat the approval process. Both chambers must pass identical bills for the legislation to be sent to the governor for approval. However, most bills are changed from one chamber to the other.

So, the assembly and the senate will form a conference committee to reconcile any differences between the bills. The conference committee is made up of conferees of both chambers. The chambers may instruct their conferees on acceptable compromises. Once differences are resolved and a conference report is generated, both chambers must once again vote to approve the legislation. If no agreement is made, the bill dies at this stage.

Action by the Governor
When a final version of the bill has been written, presented, and accepted by both chambers, it is voted upon. If passed, it is sent to the governor to be signed into law. The governor has the right to veto a bill. If the governor vetoes a bill, the legislation goes back to both chambers for a vote. A two-thirds vote in both chambers will overturn a veto and the legislation becomes law.

Some states allow the governor to have line-item vetoes. This means certain aspects of the legislation may pass while others need to follow the veto process.

The Founding Fathers made the process of creating legislation difficult to protect citizens. In the process, the supplier has plenty of opportunity to express views of legislation and protect the provider community. A simple letter to your representative is all you need to do.

By understanding this process, providers can communicate with legislators and protect their interests. Providers should budget the costs of joining their state associations into their expenses and support those associations’ lobbying efforts.

Here at the Pennsylvania Association of Medical Suppliers, we will continue to fight legislation that is damaging to the provider community and support positive legislation. However, the state associations can’t do it alone. The provider community must become more involved in local politics.

David N. Fiorini is executive director of the Pennsylvania Association of Medical Suppliers.