Medicare Compliance & Reimbursement

Many industry groups think the new Democratic Congress is a boon for health care. The presumptive new House Speaker, Rep. Nancy Pelosi (D-CA), will have a busy first 100 hours when the January 2007 session begins. And many industry groups believe that her work during those 100 hours will make health care providers and consumers happy.

Pelosi promised to reform Medicare Part D and make strides to harness skyrocketing prescription drug costs as part of her "100-hour plan." Industry leaders are waiting to see if the new Democratic majority in Congress will throw out the legislation that bans Medicare from negotiating drug prices with pharmaceutical manufacturers.

"The Medicare bargaining issue may open the door to legislation that enables U.S. residents to re-import drugs from Canada and other countries, as well as securing greater transparency in Medicare drug pricing," Ron Pollack, the executive director of Families USA, said in a Nov. 8 statement. Families USA had recently released a controversial report that accused the federal government of sugarcoating 2007's Part D plan offerings -- specifically the plans that offered coverage for the Part D "doughnut hole" (see Medicare Compliance Week v60n42, "Industry Groups Argue Over Part D Doughnut Hole").

"When Part D plans seek rebates from the drug companies, they are required to pass on only some unidentified portion of those rebates to seniors and taxpayers," Pollack explains. "Neither seniors nor members of Congress are informed about the rebate portions retained by plans, and Congress may decide to make these transactions transparent and to force the plans to pass on all of the savings," he hopes.

But what Families USA and other consumer groups are most hopeful about is the State Children's Health Insurance Program's fate in the new Congress' hands. SCHIP is due for its 10-year authorization next year, and "due to its broad bipartisan support, SCHIP no doubt will be reauthorized," Pollack says. "However, since approximately 9 million children continue to be uninsured, the real question before Congress is whether the reauthorization process will expand health coverage and provide adequate SCHIP funding for those children who don't have coverage and whose families can't afford it," he maintains.