Final Negotiations Begin On Stimulus That Includes Billions For Medicaid, Health IT

February 12, 2009 at 11:00 am Leave a comment

Congressional and White House leaders on Tuesday began meetings to reconcile the $820 billion House (H.R. 1) and $838 billion Senate (S. 1) versions of the economic stimulus package that include billions of dollars related to health insurance programs and health information technology, the New York Times reports. Some participants in the talks said they aim to reduce the final package to around $800 billion, and officials believe the discussions are on track to finalize the legislation by the end of the week (Herszenhorn/Zeleny, New York Times, 2/11). Although both chambers are in agreement over the central provisions of the legislation, “negotiations are expected to be contentious” as lawmakers attempt to wrangle competing expenditures without losing support of the three moderates — Sens. Olympia Snowe (R-Maine), Susan Collins (R-Maine) and Arlen Specter (R-Pa.) — who provided the only Republican support in Tuesday’s 61-37 Senate vote, the Washington Post reports (Murray, Washington Post, 2/11).

The health care-related differences between the Senate and House bills that are expected to be discussed include proposals in the House bill to subsidize private health coverage for the unemployed and to offer temporary Medicaid coverage to people who cannot afford private insurance (New York Times, 2/11). The Post reports that a “conflict is brewing” over how to distribute $87 billion included in both bills for Medicaid spending. Each version of the bill has a different strategy for distribution in small and large states, with the Senate bill favoring small states (Washington Post, 2/11).

The Post reports that both chambers of Congress “appear headed for a clash” over provisions related to health IT, specifically how to protect patient privacy in electronic health records. Both bills include $20 billion to “jump-start” creation of a national system of EHRs, but at the “heart of the debate is how to strike a balance” between patient privacy protections and expanding access to growing databases of health-related information, according to the Post. The House bill supports strict protections advocated by consumer groups, while the Senate bill endorses more limited safeguards that are supported by business interests, the Post reports. Additionally, the House bill expands the right of a patient to know who has been given access to his or her health information, while the Senate bill would allow the HHS secretary to determine how to address the issue. The Senate also blocked an effort to require patient notification after unintentional disclosures of health information (Nakashima, Washington Post, 2/10). According to CongressDaily, the Senate bill includes about $16 billion in Medicaid and Medicare incentives for health IT, which is about $2 billion less than the House bill.

Critics of the Senate bill, including the American Civil Liberties Union and Patient Privacy Rights, argue that its changes weakened privacy protections to safeguard consumers’ personal information. For example, the House bill required certain firms to get permission before distributing marketing materials and limited the amount of money chain drug stores and others could make selling medical data, CongressDaily reports (Noyes, CongressDaily, 2/11). Other groups prefer the Senate bill, according to the Post. Mary Grealy — president of the Healthcare Leadership Council and a spokesperson for the Confidentiality Coalition, which includes groups like the American Hospital Association and Blue Cross and Blue Shield — said the Senate “really did address many of our concerns.” She added, “We want to make sure that privacy provisions don’t become a barrier to improving quality and safety, getting information to patients that would be useful” (Washington Post, 2/10).

Reprinted with kind permission from You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.



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