We must ensure that the Hobson-Tanner bill passes both the House and the Senate this year. No small order, but experience has shown that grassroots advocacy—including the involvement of consumers—can work.

By all accounts, 2007 will be a busy year for Medicare issues in Congress, with the Part D prescription drug benefit, physician payment, and the beginning of debate on the future of federal entitlement programs taking center stage. Congressional scrutiny of the new Medicare prescription drug benefit, physician payment, and Medicare reimbursement for managed care plans will coincide with numerous other initiatives and actions by CMS to implement payment changes for DME suppliers, as well as for other providers.

On Capitol Hill, the Democrats have already approved pay-as-you go rules, requiring any new spending to be paid for, which will hamper passage of many initiatives. Insiders are predicting that health care issues will become one of Congress' top priorities this year. This was evidenced as House Democrats submitted legislation (HR 4) 1 day after convening and passed the measure the first week of the new Congressional session. The bill would authorize the federal government to negotiate with pharmaceutical manufacturers regarding the prices Medicare pays for prescription drugs. However, few believe this bill will pass the Senate in the same form. Even if the measure is passed, President Bush has promised to veto it.

In his FY 2008 budget proposal, President Bush is expected to put forward Medicare spending reductions. While most believe that the White House will propose severe Medicare cuts, Democrats in both the House and Senate will pronounce all such cuts "dead on arrival." The new political dynamics in the House and Senate will make it difficult to move Medicare legislation in 2007.

Congress also is likely to examine ways to get more low-income program enrollees coverage under the Part D drug benefit. Lawmakers could push for other incremental changes to the drug benefit, including the areas of pharmacy contracting, beneficiary open enrollment policies, and the overlap of Part B and Part D drug coverage in outpatient settings.

Filling the so-called "doughnut hole" in the Medicare Part D benefit coverage is on Congress' radar screen, but filling it completely would be prohibitively expensive; estimates are that it would cost $400 billion over 10 years. Congress could take steps to begin to fill it by allowing more low-income individuals to qualify for help by revisiting the assets test, which could keep more enrollees out of the hole since low-income individuals are not subject to the doughnut hole under the Medicare drug law. Because surveys have shown that seniors are essentially happy with the Medicare drug benefit, Congress will have to tread carefully when proposing changes to it.

Crafting a new physician payment system under Medicare also will challenge lawmakers. MedPAC is expected to issue a report on the issue early in 2007, which will contain reform recommendations lawmakers could draw from. In the waning hours of the 109th Congress in December 2006, Congress passed legislation eliminating a scheduled 5% Medicare payment cut for physicians scheduled to be implemented January 1, 2007, and also included a 1.5% bonus for physicians reporting quality data.

Medicare payments to managed care plans also will be the subject of Congressional scrutiny. Democrats are concerned that Medicare is paying managed care plans as much as 119% of fee-for-service rates.

Under the Medicare Modernization Act of 2003, Medicare's trustees must determine whether projected general revenue funding exceeds 45% of Medicare financing within the next 7 years. If the Medicare trustees make such a determination 2 years in a row, a Medicare funding warning will be given, mandating that the president propose legislation to respond to the warning in his next budget submission. The law then requires Congress to consider the proposal on a fast-track basis. The trustees issued their first warning in early 2006 and are likely to issue a second one in 2007, triggering the drug law provision and likely a discussion on entitlement spending.

It is within this context that the HME industry must carefully communicate and lobby our key priorities to ensure passage into law. On both national and grassroots bases, we must educate lawmakers about the need to fix Medicare payment for oxygen so that equipment ownership does not transfer, and ensure that payment continues as long as the medical need continues. We must ensure that the Hobson-Tanner bill passes both the House and the Senate this year. No small order, but experience has shown that grassroots advocacy—including the involvement of consumers—can work. So let's get moving on the work we have ahead.

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