3/5/01
Environmental Scan of Capitol Hill
Christina A. Metzler
Sweeping changes happened in Washington with the establishment of the 107th Congress of the United States and the inauguration of George W. Bush as the 43rd president.
The numbers on Capitol Hill seemed initially a recipe for deadlock: The Senate is composed of 50 Democrats and 50 Republicans; the vice president acts as president of the Senate and has a vote when the Senate is tied on a decision, giving the Republi-cans a majority effectively. The House moved closer to even representation, but the Republicans held a 221 to 212 majority. Although storms do still erupt, the atmosphere seemed to be straining toward good sailing weather. Issues still divide the two parties and will become more pronounced when the chambers move past initial organizing steps to confront prescription drug coverage for Medicare beneficiaries, reforming the Medicare system, tax cuts, and education.
For the occupational therapy profession, all of these issues have implications.
Prescription drugs: President Bush has proposed a program to assist poor Medicare beneficiaries. It would send lump sums to states over the next 4 years only if they choose to participate. States would have to create new programs to implement this effort. Demo-crats have criticized the proposal for its failure to provide the benefit to all. Republicans have criticized the proposal because they believe that drug coverage should only come with a complete overhaul of the Medicare program. About one third of all seniors have no prescription insurance. With cost estimates ranging to and beyond $40 billion over 5 years, any drug benefit would almost certainly have an impact on virtually all other federal spending.
Medicare reform: In 1999, the Bipar-tisan National Commission on the Future of Medicare (see http://thomas. loc.gov) presented a proposal that was introduced as a bill in the 107th Con-gress by Senator John Breaux (D-LA), in conjunction with key Republican senators. This plan would set up various private insurance plans, in addition to traditional Medicare, with Medicare paying a portion of the premium. Annual Medicare spending is more than $200 billion per year, and the proposal is said to reduce spending and provide some protection against the baby boom drain on the program. Although it would add some drug coverage, critics have said that this proposal would inevitably lead to a cutback in actual future benefits, when private companies could not continue to profitably serve beneficiaries for the amount Medicare would pay. But changing Medicare may also provide new opportunities for entrepreneurial efforts (e.g., private practice) to meet beneficiary needs in a cost-effective manner. On the policy questions, tying any new prescription drug benefit to Medicare reform presents risks of significant change or reductions in access to the traditional benefits. Yet the move to have drugs available may drive the train and achieve the overall reform that has evaded previous Congresses.
Education: Recent data show that more than one quarter of AOTA members work in schools or early education. The Individuals With Disabilities Education Act (IDEA) funds these programs. President Bush declared a disability policy agenda in his New Freedom Initiative (see www.whitehouse.gov), including that he would pursue full funding for IDEA to relieve expenses now incurred by local school districts and states. Disability advocates are evaluating this proposal because it may be linked to flexibility around federal rules, which some believe could reduce access to services. But the overall education objective of the president will be a key issue on Capitol Hill, so IDEA funding will probably move with it.
Tax reductions: President Bush has staked out tax cuts as a critical platform. His proposal started at more than $1 trillion, but with recent projections of tremendous surpluses, calls for even more tax cuts have been heard up and down the K Street lobbyist corridor in Washington as well as on the Hill. The relevance of taxes to Medicare and other spending is that, as always in Washing-ton, proposals are often viewed as cars of a train. There needs to be an engine with enough political steam to pull other cars. The tax cuts issue is likely to be the engine for many of the president's proposals and for other proposals from both sides of the aisle in Congress.
All of these very large systems will be creating the climate on the Hill this year, but smaller issues of direct concern to occupational therapy practitioners will also be in the mix. Expand-ing home health access to occupational therapy, vision rehabilitation benefits under Medicare, opportunities for personnel preparation and fieldwork funding, managed care regulation, and mental health parity will all be peeking out from behind these grand issues. AOTA will be working to promote the profession and empower you to do likewise. Watch the Web site at www.aota.org for up-to-date information.
Christina A. Metzler is the director of AOTA's Federal Affairs department.
