Ann Howard

It is a given that home care will be at risk in 2007 as pressure mounts for Congress to address the physician sustainable growth rate (SGR) dilemma again, but lawmakers will be grappling with fundamental issues far beyond physician reimbursement. Key Congressional committees will look to home care in the search for SGR offsets, recycling proposals to reduce the rental period for home oxygen equipment from 36 to 13 months, eliminate the first month purchase option for power wheelchairs, and eliminate the home health agency update for 2008.

The home care community will have to work throughout 2007 to win on the merits—and to win politically as we did in 2006. Congress reached a point last year where it simply had no desire to cut home care again—even Congressional offices that may not have been completely sold on the industry's arguments, compelling as they were.

In the 110th Congress, the Democrats picked up 30 seats in the House for a 31-vote advantage, and added six seats in the Senate for a slim 51-49 majority. The new leadership is promising reform of the budget process this year. Rather than pass nine individual Fiscal Year 2007 appropriations bills that did not clear the 109th Congress, or combine them into an omnibus package, the Democrats plan to fund the government throughout the entire fiscal year on the equivalent of a continuing resolution, with no additional appropriations for the affected departments and all earmarks stripped out. Even more significant for us, the Democratic leadership plans to reinstate pay-as-you-go and budget enforcement rules that expired in 2002, wherein all spending increases and tax reductions have to be paid for by program cuts or revenue enhancements. Presumably, this means that another SGR fix will have to be fully paid for by offsetting cuts. The majority party's goal is to neither add to the budget deficit nor increase the national debt, but at the same time to address health care issues important to rank and file members.

Health care items on the Democrats' agenda for 2007 include a multiyear SGR fix, based on options the Medicare Payment Advisory Commission (MedPAC) will present in March. They also plan to seek additional funding for the State Children's Health Insurance Program to cover more uninsured children, expand embryonic stem cell research, and hold oversight hearings. Such hearings will likely highlight their displeasure with the "privatization" of Medicare through Medicare Advantage plans (Part C) and the new prescription drug benefit administered by private insurers.

Medicare prescription drug plans will consume a great deal of energy. On the agenda is allowing Medicare to negotiate discounts with drug manufacturers, permit reimportation of drugs from Canada, eliminate the penalty for late Part D enrollment, and fill the coverage gap—the so-called "doughnut hole."

Meanwhile, look for the Republicans' agenda to focus on rebalancing Medicaid between institutional and home-based services, and to provide several additional incentives to encourage beneficiaries to move into Medicare managed care plans.

Ann Howard is director of federal policy for AAHomecare, Alexandria, Va. She can be reached via e-mail: .