This year has seen a whirlwind of activity in Washington, DC—starting with CMS' rollout of the so-called competitive bidding program in 10 markets, followed by Con­gressional support to delay the program. In addition, the Medicare Im­provements for Patients and Providers Act (MIPPA) also repealed the mandate that beneficiaries assume ownership of their oxygen equipment at 36 months of rental. While these are undoubtedly positive developments for consumers and the industry alike, there remain a host of new and not-so-new challenges in the year ahead.

First, we are still waiting for CMS to issue the Medicare policy defining how and when Medicare will pay to support necessary services for beneficiaries requiring home oxygen therapy beyond the 36-month rental payment cap. Second, we are also awaiting any information from CMS about implementation of so-called Round 1.2 of the bid program.

So far, CMS' actions have been limited to its announcement that it will replace the current Program Advisory and Oversight Committee. Third, the industry will tackle (in an unprecedented manner) the fraud and abuse issues that seem to pervade the regular media. Led by AAHomecare, the industry will work with the government to identify and propose new, common-sense ways to detect and prevent fraudulent behavior.

Fourth, on a larger but increasingly important scale, the industry must be ready to engage with Congress as it tackles health care reform and Medi­care reform. Already this year, Con­gress­ional leaders have begun the process of trying to build consensus on the major health care reform issues by convening various stakeholder groups, such as hospitals, physicians, and insurance companies. Regardless of who will be living in the White House in 2009, health care reform is at the top of the agenda, as well as a key priority for a Congress that has, and will continue to have Democrats in the majority in both chambers.

When we talk about health care reform, we are talking about reducing the number of uninsured Americans via markedly different proposals espoused by Senators McCain and Obama. The health care proposal announced by McCain would reduce the number of uninsured US residents by about 21.1 million by 2010, and the plan announced by Obama would reduce the number by about 26.6 million, according to recent health policy group reports.

The McCain proposal would replace an income tax break for employees who receive health insurance from employers with a refundable tax credit of as much as $2,500 for individuals, and $5,000 for families who purchase coverage through their employers or the individual market. In addition, the proposal would allow the purchase of health insurance across state lines. Washington experts estimate that the number of residents with employer-sponsored health insurance would decrease by about 16 million, in part because some employers would drop coverage for employees.

According to a prominent health care policy report, the proposal would increase the number of residents with private health insurance by 26.5 million and reduce the number enrolled in public programs by 5.4 million. More than half of employees who would lose employer-sponsored health insurance under the proposal have a chronic medical condition that would limit their ability to purchase health insurance in the nongroup market, according to the same report—which also estimated that the proposal would cost $2.05 trillion from 2010 to 2019.

Obama's proposal would establish a health insurance "exchange" that would allow residents to choose be­tween private health plans and a public plan, with subsidies for lower-income residents, as well as expand eligibility in public programs such as Medicaid. The proposal also would require health insurers to accept all applicants, regardless of their health status.

Under the proposal, 16 million uninsured residents would obtain health insurance through public programs, and about 10 million would use the subsidies to obtain coverage in private plans. The public plan would have lower premiums as a result of lower reimbursement rates for health care providers. The report estimated that the proposal would cost $1.17 trillion from 2010 to 2019.

Many health policy experts predict that Congress likely would not approve either proposal without changes. Both plans share a significant hurdle, in that neither of the proposed plans is fully paid for.

Cara C. Bachenheimer, JD, is senior VP of government relations for Invacare Corp.
David T. Williams is a senior consultant on political and legislative affairs with Partners in Public Policy Inc.