State Associations Continue Momentum on H.R. 3790  -

Stop “Competitive” Bidding

Although H.R. 3790 has already surpassed the initial goal of 216 cosponsors, state associations continue the momentum to garner maximum support of H.R. 3790. On May 12, Mississippi Association of Medical Equipment Suppliers (MAMES) president and VGM member Danyelle Carroll of Mobility Medical learned that Congressman Gregg Harper (R-Miss.) signed onto the bill to stop competitive bidding, bringing the state of Mississippi to 100 percent cosponsorship.

“Persistence pays off!” said Carroll of the recent good news. In March, Carroll and MAMES Legislative Chair Wayne Carroll met with Congressman Harper during the AAHomecare Legislative Conference. Since their initial meeting, Carroll indicates that Wayne had been relentless with maintaining contact with Harper’s office. “He spoke with the congressman’s staff nearly every day,” states Carroll.

The following is a recent correspondence from Danyelle to Congressman Harper’s staff:

Gene Taylor, Travis Childers, and Bennie Thompson have all signed onto HR3790 that would eliminate National Competitive Bidding for Medical Equipment Companies. I am sure Gregg doesn’t want to be the only one from MS that won’t sign on. He told us he would sign the bill, but that he wouldn’t do it right away. We have enough votes in the house but still it would be ever so helpful if he showed his support as we are desperately trying to get Senate companion legislation moving forward now. All the support we can get! PLEASE HELP.

30+ employees at our Flowood location are all voters in Gregg’s district. They want to keep their jobs. I want to keep giving them jobs. We help people each and every day and we would love for you to come visit us…if you would come to our location and visit us sometime you could see how we do help in a huge way and see this first hand….

Meanwhile, efforts from members of the Wisconsin Association of Medical Equipment Services (WAMES) have lead to Wisconsin representatives to sign on as well. Yesterday, WAMES executive director Ann Barrett learned that Congresswoman Gwen Moore (D-Wisc.) and Energy and Commerce member Tammy Baldwin (D-Wisc.) have also added their signatures to H.R. 3790. Their support follows continuous contact between WAMES members and the congresswomen’s staff.

According to Barrett, Jean McAdams was very instrumental in getting Congresswoman Baldwin’s support. “She has a good relationship with her staff, and expresses concerns of the WAMES members on a regular basis.” McAdams of Community HME is the president of WAMES and a VGM member. According to McAdams, contacting Congresswoman Baldwin’s staff and forwarding the information provided by VGM and WAMES is probably what geared her support. McAdams stated that her efforts did not stand alone and the efforts of many WAMES members helped acquire Congresswoman Baldwin’s support.

Barrett also indicated that past WAMES president and founding member John Teevan had been communicating with Congresswoman Moore’s staff, and was influential in getting her signed on.

Number of H.R. 3790 Cosponsors Continues to Climb

With Reps. Greg Walden (R-Ore.); Chet Edwards (D-Tex.); Tammy Baldwin (D-Wisc.); Eleanor Holmes Norton (D-D.C.); Bob Filner (D-Calif.); and Gregg Harper (R-Miss.) officially signed on to H.R. 3790, the bill is now up to 237 cosponsors.

From Congress Daily

Medicare Physician Fix Latest Sticking Point for ‘Extenders’

By Peter Cohn

Funding for Medicare physician payments has emerged as a sticking point in House-Senate negotiations on a massive package of tax break extensions and aid to states and the unemployed that Democrats want to bring to the House floor next week.

Under the statutory pay/go law enacted in February, there is room for $88.5 billion without offsets for reimbursements to physicians that take Medicare patients to prevent steep cuts scheduled for June 1. That would take care of the problem for up to five years. Blue Dogs, who pushed for the new budget rules, now say that exemption from pay/go may be too generous. "I don't like a big number being unpaid-for," said Rep. John Tanner, D-Tenn.

A permanent extension of higher Medicare payments passed the House with fairly broad support last year on a 243-183 vote. Such a move would be impossible under the new pay/go law, but House Energy and Commerce Chairman Henry Waxman said the fix should be generous, given last year's vote and the drama that played out with healthcare reform.

Tanner, who voted for the permanent bill, said he didn't like it when Republicans approved short-term fixes. "It's too bad we didn't fix it permanently back when we could have," Tanner said. The fiscal red ink continues to get worse, and an expensive and un-offset physician payment bill could face a tougher slog in the Senate as moderates in that chamber are chafing at being asked to vote for a sizeable "doc fix."

While not an apples-to-apples comparison, only 47 senators voted for a permanent fix last year when it came up for a vote, far short of the 60 needed to cut off a filibuster. "It seems like there's discussion on both sides of the Capitol on how to figure that one out," said Rep. Earl Pomeroy, D-N.D.

The matter could have implications for how extensions of the Bush-era tax cuts for the middle class are handled, and any hope of a permanent solution for the expired estate tax might be all but shot. The statutory pay/go law only allows room for a lower estate tax for two years without offsets.

"It confronts the reality of pay-as-you-go government," Pomeroy said. He was the lead author and prime mover late last year of legislation to make the estate tax permanent at its 2009 parameters. That would have set the rate at 45 percent with an exemption level at $3.5 million per spouse.

That measure passed the House on a 225-200 vote -- losing an odd assortment of 26 Democrats, including progressives who felt it was a giveaway to the wealthy and conservatives who objected to its unpaid-for cost of $233.6 billion. Tanner and Pomeroy, both Blue Dogs, were among the Ways and Means members who appealed to House leaders for a permanent fix rather than a one-year extension that Ways and Means leaders were considering.

It never came up in the Senate, where Democrats like Pomeroy's home-state colleague, Budget Chairman Kent Conrad, thought it was too expensive, and he pushed for the two-year limit under pay/go to allow time for a bipartisan deficit commission to come up with a longer-term solution. Conrad's FY11 budget plan reiterates the two-year limit, with anything beyond that requiring offsets.

Pomeroy said he's resigned to that position now. "I would like to see us take the '09 levels, extend them for the next two years, and then this will have to be approached from the context of longer-term tax reform," he said. "We're not going to do it by just adding to the deficit out past two years."

Tanner said he'd still like to make the estate tax permanent, but acknowledged the pay/go hurdle.

Still, Senate Finance Chairman Max Baucus and ranking member Chuck Grassley, along with Senate Agriculture Chairwoman Blanche Lincoln and Senate Minority Whip Kyl, continue to negotiate a solution.

Whatever they come up with is likely to be too generous for Conrad and House Democrats, setting aside the pay/go issue.

And then there is the $2 trillion question of extending and making permanent the middle-income tax cuts enacted in 2001 and 2003. While that would not require offsets under pay/go, some aides are already speculating that if Congress can't pass a roughly $90 billion un-offset Medicare fix, the pressure will build to limit extensions of the Bush tax cuts as well.