What You Are Writing About

Top concerns from Idahoans for week ending May 2, 2008

Hospice Care Programs

Social Work Reinvestment Act (S. 2858)

Internet Gambling

Medicare Advantage

Gasoline Prices

Each year, I hear from thousands of Idahoans who write, e-mail, fax and call my offices to let me know how they feel about issues facing our country today. On average, I receive approximately 2,000 letters and e-mails a week. In recent years, an increasing number of that correspondence has come via electronic means. Even with such a volume of correspondence, I try to respond to each Idahoan as promptly as possible. In an effort to be even more responsive and to fully utilize the technology available through the Internet, this web page features the top five issues of concern from Idahoans and my response on each from the previous week. You may also wish to review information in the Issues Section or details from my Legislative Record, which lists bills I have sponsored and co-sponsored.

Hospice Care Programs

Hospice care provides an invaluable service to individuals with chronic illnesses and their families.  Through symptom and pain management, hospice helps patients maintain dignity and quality of life.  A large majority of hospice patients remain in a personal residence, providing a familiar setting in a patient’s final days.  An interdisciplinary team works with family members to ensure the patient’s comfort.

 

I recently joined with several of my Senate colleagues on a letter to Health and Human Services Secretary Michael Leavitt opposing the Administration’s plan to cut hospice reimbursement under Medicare by $2.29 billion over five years in the Fiscal Year 2009 Budget.  This letter requests that the Administration reconsider this proposal and maintain the current budget neutrality factor for the hospice wage index.

 

Senator James Inhofe (R-Oklahoma) introduced S. 2727, the Preserving Access to Hospice (PATH), on March 6, 2008.  This bill would provide a one-year moratorium on the enforcement of the hospice cap amount.  It would also require the Medicare Payment Advisory Commission to analyze and report on the quality of hospice care as a substitute benefit for Medicare’s other acute care alternatives, the reason for the low average length of stay in hospice care under Medicare, and the option of requiring a national coverage eligibility determination for such care.  S. 2727 was referred to the Senate Committee on Finance, where it awaits further consideration.  Please rest assured that as measures dealing with this topic are considered before Congress, I will work to ensure fair compensation to providers and quality care for patients.    

 

 

Medicare pays for most acute inpatient and outpatient hospital services, skilled nursing facility services, and home health care under a prospective payment system (PPS) established for the particular service.  Under PPS, a predetermined rate is paid for each unit of service such as a hospital discharge or payment classification group.  Generally, Medicare provides for annual updates of the payment amounts to reflect inflation and other factors.  One method of updating these payments is through a “market basket” update.  The market basket index is a provider-specific rate that measures the change in the price of goods and services purchased by the provider. 

 

I have long advocated for long-term, sustainable changes to the Medicare payment system.  Indeed, the long-term outlook necessitates significant changes not only to the Medicare payment system, but to the program as a whole.  Without legislative changes, Medicare spending will steadily increase, reaching $500 billion in 2011, with an average annual growth rate of 8.1 percent.  Unfortunately, this unsustainable growth continues into the foreseeable future.  Of course, the most important objective in considering changes to the Medicare system is to support care that improves patient outcomes while restraining spending.

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Social Work Reinvestment Act (S. 2858)

Senator Barbara Mikulski (D-Maryland) introduced S. 2858, the Dorothy I. Height and Whitney M. Young, Jr. Social Work Reinvestment Act, on April 15, 2008.  This bill would establish the Social Work Reinvestment Commission to provide independent counsel to Congress and the Secretary of Health and Human Services on policy issues associated with recruitment, retention, research, and reinvestment in the profession of social work.  It would provide grants geared toward social work education, research, and training.  Such grants would also fund community-based programs as well as scholarships for future social workers, would promote social work through media campaigns, and would recognize March as Social Work Awareness Month.  S. 2858 was referred to the Senate Committee on Health, Education, Labor, and Pensions, where it awaits further consideration. 

 

Social workers tirelessly labor to provide critical care to some of the most vulnerable members of our communities through their advocacy and guidance.  They serve on the frontlines against social turmoil and are often the only constant resource for those most in need.  Social workers often serve as the critical link between illness and strife and access to wellness.

 

During my service in Congress, I have consistently advocated for additional support for those who dedicate their time, efforts, and resources to helping those in need.  Please rest assured that I will continue to work in Congress toward this end.

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Internet Gambling

President Bush signed the Internet Gambling Prohibition and Enforcement Act into law on October 13, 2006 as part of the SAFE Port Act.  This law prohibits placing bets over the Internet using credit cards, electronic fund transfers, checks, drafts, or similar financial transactions.  In effect, this legislation bans all Internet gambling with the exception of horse racing and state lotteries. 

 

Representative Robert Wexler (D-Florida) introduced the Skill Game Protection Act (H.R. 2610) on June 7, 2007.  This legislation would permit gambling in online poker and other selected games to the extent that competition existed only between and among participants, not the game operators.  In addition, operators would be required to restrict Internet gambling sites to participants eighteen years of age or older.  H.R. 2610 has been referred to the House Subcommittee on Crime, Terrorism, and Homeland Security, where it awaits further action.  Similar legislation has not been introduced in the Senate. 

 

I understand concerns over losing a venue through which you were previously able to play poker.  Although this legislation affects the ability to play poker on the Internet, it does not prohibit anyone from enjoying poker in other unregulated venues.  Other forms of gambling will only be affected through legislation that is designed to directly affect their regulation. 

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Medicare Advantage

The Medicare Advantage (MA) program offers comprehensive health care to Medicare beneficiaries in a preferred provider organization structure.  In most MA plans, generally there are extra benefits and low monthly premiums compared to the original Medicare plan.  MA plans are an attractive option for those beneficiaries desiring comprehensive coverage coupled with affordability.  In an attempt to pass a Medicare bill prior to the end of 2007, some MA critics within the Senate advocated cuts to MA in favor of funding other measures.  The President, as well as many members of the Senate, opposed funding cuts to MA. 

 

Because Congress was unable to pass permanent Medicare legislation before the end of the legislative session, the Senate passed S. 2499, the Medicare, Medicaid, and SCHIP Extension Act of 2007 on December 18, 2007.  This bill, which was signed into law by the President on December 29, 2007, temporarily extends funding to these programs until permanent legislation regarding each program can be considered and passed in 2008.  This package contained some MA funding cuts, primarily to the MA stabilization fund.  However, the cuts for the stabilization fund are expected to have little immediate impact on health plans or beneficiary access to care.   

    

Consumers should be free to select the health care plan that best fits their medical and financial needs.  I understand the valued freedom of choice and access to quality care that MA provides its beneficiaries.  As a member of the Senate Finance Committee, I will keep MA’s many benefits in mind when considering the permanent Medicare bill in the upcoming months.  Providing quality health care for all citizens must remain a priority for this Congress.  Please know that I will continue to work with my Senate colleagues to improve our system of health care.

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Gasoline Prices

I share the desire to see lower gas prices in Idaho and the U.S., and many in Congress also share this sentiment.  Members of Congress have held hearings to investigate the reasons for high gas prices, and the House of Representatives passed two bills to address the high price of gasoline.  One bill would make price gouging a federal offense, and the other would brand certain Organization of the Petroleum Exporting Countries’ (OPEC) actions illegal. 

 

Attempts by Congress to control oil companies and prices should be examined closely.  The oil industry is a free market industry and responds to supply and demand forces.  Through April 2007, the amount of finished gasoline produced in the U.S. was the highest it has ever been, and industry capacity expansions have added the equivalent of 10 new refineries over the past decade.  The industry is expected to bring the equivalent of an additional eight new refineries into operation in the U.S. by 2011.  Matching this increased supply, however, is very high demand for gasoline throughout the world and an ever increasing demand from India and China.  Maintenance at European refineries, strikes, refinery problems in Nigeria and Venezuela, and in the U.S. as a result of Hurricane Katrina, and a host of other issues that cause fluctuations in the price of oil have added to the already tight supply of oil. 

 

Quite simply, gas prices are high because the world’s supply cannot keep up with the world’s demand.  Oil companies have made record profits because their product is in demand.  Rising prices are a regulator on the economy and the consumption of goods.  Prices convey information.  When prices rise, consumers know that the supply of certain products is limited.  In response, ultimately, consumer behavior will change.  If government interferes by placing restrictions on the price of gasoline, keeping it artificially low, consumer behavior does not change, resulting in an even greater shortage.  Consumers faced this scenario during the 1970s when Congress placed restrictions on the price of gasoline, resulting in oil shortages, rationing, and long lines at the pump.   You may be interested to know that the profit margin for oil companies remains on par or only slightly above other major industries.  Oil companies typically experience a 5 percent profit margin, much of which is reinvested in exploration, development, and expansion of refineries.  

 

I understand your concern over high gas prices every time I fill up my tank.  While it is my hope that gas prices will soon fall to manageable levels, it is also important to continue exploring alternative sources of energy.  You may be interested to know that, as a member of the Senate Finance Committee, I have been working to promote federal policies that encourage the identification of new sources of energy and conservation practices.  Also, I have worked to provide incentives for renewable fuel sources, including biofuels, such as cellulosic ethanol and biodiesel, as well as policies encouraging the advancement of alternative vehicles such as hydrogen fuel cell cars, plug-in hybrids, and flexible-fueled vehicles.  In addition, the Senate passed, and I voted for, the Energy Independence and Security Act.  This legislation, which was signed into law by President Bush on December 19, 2007, will strengthen fuel efficiency standards.  Higher fuel efficiency standards mean less money that Americans have to spend on gas at the pump.  Please rest assured that I will continue to work with my colleagues in Congress to promote alternative and renewable sources of energy.

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