Secretary of Health and Human Services (HHS) Tommy Thompson testified before the House Ways and Means Committee on February 10, and before the Senate Budget Committee on February 12. After highlighting a number of the administration’s accomplishments in 2003, he said that President Bush’s FY2005 budget of $580 billion for HHS would enable Americans to “receive new health benefits and services, be better protected from the threat of bioterrorism, benefit from enhanced disease detection and prevention, have greater access to health care, and…see improved social services through the work of faith- and community-based organizations and a focus on healthy family development.”
Secretary Thompson summarized the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA)(P.L. 108-173), pointing out those provisions of the law that will be applicable in 2004. In June, all Medicare beneficiaries, except those eligible for Medicaid drug coverage, will receive Medicare-endorsed drug discount cards providing savings of 10 to 15 percent for prescription drugs. The Medicare+Choice program will be replaced with the new Medicare Advantage program operated under Part C of Medicare. Under the Medicare Advantage program, private managed care plans will receive an increase in funding to provide additional benefits to Medicare beneficiaries, lower premiums and cost-sharing, and improve provider access in their networks. Secretary Thompson said that the additional funding also will “encourage more private plans to enter the Medicare market, improving beneficiaries’ overall access to care.”
Secretary Thompson cited HHS reports that estimate implementation of the MMA to cost $534 billion over 10 years, which contradicted the Congressional Budget Office’s (CBO) original scoring of the bill at $395 billion. Many members of the committee brought up the discrepancy during the question and answer session, and Secretary Thompson explained, “The two sets of estimates provide a reasonable range of possible future cost scenarios for Medicare spending. The tremendous uncertainty surrounding estimates of the newly enacted Medicare law has resulted in a plausible range of estimates of future cost scenarios for Medicare spending, from the $395 billion estimate from CBO to the $534 billion estimate from the Medicare actuaries.”
Much of Secretary Thompson’s testimony highlighted the new initiatives contained in the FY2005 budget, including the Marriage and Healthy Family Development program. Stating, “While government cannot create good marriages, it can play a role by providing resources and expertise so that individuals and couples are better prepared to form and maintain happy and healthy families,” Secretary Thompson explained that the budget would include a total of $120 million under the Temporary Assistance for Needy Families (TANF) program “to support research demonstrations, and technical assistance primarily focused on family formation strategies and healthy marriages.” He also noted that the budget would include $50 million for grants “to improve outcomes for children by encouraging the formation and stability of healthy marriages and responsible fatherhood, and to assist fathers in being more actively involved in the lives of their children.” The budget proposal also would double funding for abstinence education, including $186 million for grants to develop and implement abstinence education programs for adolescents aged 12 through 18; $50 million for state abstinence education grants; $26 million for abstinence activities under the Adolescent Family Life program; and the creation of a new public awareness campaign “to help parents communicate with their children about the health risks associated with premarital sexual activity.”
In his opening statement, Rep. Pete Stark (D-CA) commented on the President’s new initiative. “For us politiciansI would say this in a bipartisan sensethe record of presidents and members of Congress as being representatives of strong marriages is pretty shabby…It seems to me that $1 billion could be better spent on allowing mental health to have equal stature in health insurance and that getting professional treatment might be a better way to help families stay together and grow together than going out and finding some new experts in teaching people how to be married.”
Finally, Secretary Thompson outlined the proposal to improve the nation’s child welfare system. The budget would include an option for states to receive funds in an allotment, “allowing them more flexibility in the operation of their child welfare programs.” Under the proposed plan, child support enforcement agencies would be notified if a child with a medical support order loses health care coverage so the agencies could assist families in providing continuous health care coverage. In addition, states would have the authority to consider both parents’ access to health care when establishing medical child support orders, with the option of enforcing these orders against both custodial and non-custodial parents. The budget also would provide $140 million for the Independent Living Program, $60 million for the Independent Living Education and Training Vouchers program, and $505 million for the Promoting Safe and Stable Families program.
During the question and answer session, Rep. Jim McDermott (D-WA) cited a recent report on national health care disparities that was altered from its original draft before being released by HHS in December 2003. He accused Secretary Thompson of rewriting the report by striking 30 references to racial and ethnic disparities and a definition of disparity that was included in the original draft. Secretary Thompson explained that the mistake would be rectified and the original report will be released without any of the changes. Rep. McDermott thanked Secretary Thompson, stating, “The disparities in health care in this country are atrocious and I think it shouldn’t be a partisan issue.” Secretary Thompson responded, “It is not a partisan issue.”
Rep. Jennifer Dunn (R-WA) expressed her concern with the rising number of Americans who do not have health insurance and asked Secretary Thompson to outline his proposal to provide affordable health care coverage to more individuals. He responded that the United States “should try to move a lot faster towards a more uniform system as far as a computerized system for practicing medicine.” He also said that Congress should consider making the 2001 and 2003 tax cuts permanent and should allow states to set up a purchasing pool for the uninsured, under which insurance companies would receive a tax credit for providing low rates to individuals included in the pool. Secretary Thompson encouraged Congress to increase funding for community health centers and to focus more resources towards the prevention of chronic diseases, such as diabetes, obesity, and alcoholism.
At the Senate Budget Committee hearing, Democrats focused the majority of their questions on the new Medicare prescription drug benefit, with several Senators criticizing current television ads aimed at educating seniors about the new benefit. Alleging that the ads appear to be “political spots,” Sen. Kent Conrad (D-ND) asked Secretary Thompson if he would be willing to suspend the ad campaign while the General Accounting Office launches an investigation into whether the campaign is an illegal use of taxpayer dollars.
“I will go back and take a look at the ad,” responded Secretary Thompson. “I happen to disagree with you. I don’t think that the ad is political.”
In responding to questioning from Sen. Ron Wyden (D-OR) regarding legislation that he and Sen. Olympia Snowe (R-ME) have introduced that would make several changes to the MMA, Secretary Thompson concurred, “We have to look at cost-containment…I’d be more than happy to work with you to further the cost-containment.”
Sen. Patty Murray (D-WA) discussed her concern over the Department of Justice’s recent request for the medical records of women who have undergone “partial-birth abortions” in conjunction with their defense of the Partial Birth Abortion Ban (P.L. 108-105). There are currently three cases pending in federal courts challenging the constitutionality of the ban. Attorney General John Ashcroft has requested the medical records, saying that the government’s attorneys need them to determine if the procedures were medically necessary.
Noting that HHS has authority over the Health Insurance Portability and Accountability Act (HIPAA), the nation’s health privacy law, Sen. Murray questioned whether the department was aware of this request and asked, “Are women who seek abortions and reproductive health care denied privacy under the law?”
Secretary Thompson replied that he was not aware of the request for records and assured Sen. Murray that the department would look into it. Referring to his prosecutorial experience, Sen. Jeff Sessions (R-AL) stated that “anything can be subpoenaed,” adding, “Congress did vote to ban partial-birth abortions…so I think if you’ve got an investigation into whether a physician is performing illegal procedures,” then the subpoenas are warranted.
Sen. Sessions also questioned the Secretary about the impact of unsafe health care practices in the spread of HIV/AIDS in Africa. He expressed his disappointment with a recent HHS examination of the issue, which determined that “the reusing of needles is not a major part of the problem.” He asked that further studies be conducted to determine the exact extent of the problem.
Secretary Thompson agreed. “I think it is a higher percentage…I think we do need further studies, and I think we need an accurate number.”
