National Institutes of Health Reform Act of 2006

NATIONAL INSTITUTES OF HEALTH REFORM ACT OF 2006 -- (Senate - December 08, 2006)

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Mr. GRASSLEY. I wish to engage my colleague Senator BAUCUS in a colloquy concerning the Tax Relief and Health Care Act of 2006. This bill contains a provision that would allow certain Medicare Advantage plans to enroll individuals at any time during the year. I am concerned about this provision for two reasons: No. 1, the effect it will have on the Medicare Advantage program, and No. 2, the process by which it was included in this package.

Mr. BAUCUS. I thank you for bringing this provision up for discussion. I have concerns as well.

Mr. GRASSLEY. Under current law, beneficiaries can decide to stay in the traditional fee-for-service program or enroll in Medicare Advantage plans during the annual open period, which lasts from November 15 to December 31. They can also make certain changes one time between January and March of the following year. I remember how much time and effort we spent designing these enrollment policies when we worked together on the Medicare Modernization Act of 2003. Wouldn't you agree this provision is a significant policy change?

Mr. BAUCUS. That is an understatement. This provision would allow some but not all types of Medicare Advantage plans to enroll individuals throughout the year. Only those plans that do not offer prescription drug coverage will be given this special treatment. This may sound like a small change because it only affects a certain type of Medicare Advantage plan. But it creates an unlevel playing field between plans with no drug coverage and Medicare Advantage plans that have decided to offer prescription drug coverage.

Mr. GRASSLEY. That is exactly my concern, too. I am also disappointed in the process that led to the provision being included in the final bill. We had an understanding that we would only include agreed-upon extensions and must-do health items in the package and not make major policy decisions that had not gone through the regular process. This provision does not meet that standard.

Mr. BAUCUS. No, it does not. In fact, I soundly rejected the proposal during the negotiations with our House colleagues. They were clearly informed of my position on the matter. Our final agreement did not include this provision.

Mr. GRASSLEY. It disturbs me, that this major policy change--one that treats some plans unfairly--was included at last minute by the House rules committee. I do not operate like that, and I know you do not, either. Unfortunately, we are stuck with this provision for the time being. But I assure of my commitment to working with you as soon as possible next year to revisit this provision.

Mr. BAUCUS. I thank my colleague and good friend from Iowa. I look forward to working with you next year on this and all of the business we will have before our committee.

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Mr. GRASSLEY. Thank you, Senator Rockefeller. We share an interest in making sure that States have adequate Federal funding to cover children through CHIP. No one wants to see children lose coverage, and we hope the provisions in this bill will help States on a temporary basis until we have time to work out a more permanent solution to the CHIP financing structure. Now I know that there are a lot of concerns about this package. And I want to make it clear that Senator Baucus and I thought this was what we could pass right now. We are hopeful that we can pass this package here in the Senate and then get House agreement tonight or tomorrow so that we can forestall these shortfalls for the first part of the year.

I want to make it clear, however, that nothing in this package binds us for CHIP reauthorization next year. There is discomfort with the CHIP provisions on both sides of the aisle. But Senators are willing to compromise in order to get something done for children before we go home. Therefore, we should put aside our differences and individual gripes in order to get something productive passed.

Mr. BAUCUS. I want to associate myself with the remarks of the chairman. This bill is so important, so vital to the lives of hundreds of thousands of children who need health coverage. I am so proud that the Senate and the House were able to get together and work out a deal to get this done this year. I was disappointed we weren't able to include this in the tax extenders package that Senator Grassley and I worked on, so it is very gratifying to know we were able to do this. I want to especially thank Chairman Grassley and his staff, Becky Shipp, for their dedication to this effort and commitment to the program. I would also like to thank Chairman Barton and his staff, Ryan Long, for their willingness to help in this process, and Congressman Dingell and his staff, Bridgett Taylor and Amy Hall, for their dogged determination to get this done.

I also agree with Chairman Grassley in his view that the CHIP provisions in this bill will not set a precedent for reauthorization next year. Instead, this is a temporary fix--a downpayment toward addressing a long-term problem of increasing demand for CHIP and not enough Federal funds to go around. In an ideal world, Senator Grassley and I would have liked to put new money on the table to fully fund the shortfalls. However, we are operating under significant budget constraints. This package represents what we think we can do now, despite those constraints. We know we will need to revisit this issue next year, either as part of the reauthorization of the CHIP program, or apart from that, to address the remaining CHIP shortfalls so that no State has insufficient funds to provide health coverage for children. I am heartened by Senator Grassley's strong commitment to the program that we will be able to work together in this critical effort to shore up our Nation's safety net for low-income children.

Mr. ROCKEFELLER. Your comments are helpful because I think Members are concerned that accepting this CHIP shortfalls proposal means they will be giving tacit approval to other provisions in the bill that they don't really support--such as decreasing the CHIP allotment from 3 years to 2 1/2 years, or putting restrictions on how States can use the redistributed money, for example. But what I hear both of you saying, I think, is that the CHIP provisions in this package are causing a little bit of pain for everyone, but that the benefits of getting something done now far outweigh the downsides and that nothing in this CHIP package binds us as we move to reauthorize the program next year.

Mr. GRASSLEY. I understand the concerns of our colleagues. Certainly, there are those who think we should have gone further in this proposal. There are Senators who support going from a 3-year allotment structure to a 2-year allotment structure immediately. And there are Senators who want to put greater limits on how CHIP dollars can be spent, to ensure program spending prioritizes children first. Senator BAUCUS and I developed a CHIP proposal that is somewhere in between but is a proposal that meets our ultimate objective of keeping children covered. We can have a policy debate about the merits of various proposals when we reauthorize the program next year. Nothing in this package precludes us from doing that.

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