ACA UPDATE: Congress Ends with Flurry of Activity, and Unfinished Business

The 109th Congress officially adjourned in the wee hours of the morning on December 9th after a final spurt of legislation.

Appropriations

On appropriations, Congress punted. With nine of the fiscal year 2007 appropriations measures unfinished, Congress passed a stopgap spending measure, or continuing resolution, funding all remaining programs—including those falling under the Departments of Labor, Health and Human Services, and Education—at the lowest of the House-passed, Senate-passed, or previous year funding level until February 15th of 2007.

Incoming Senate and House Appropriation Chairmen, Robert Byrd (D-WV) and David Obey (D-WI), announced in December that they will not seek to pass the remaining nine FY 2007 appropriations bills individually when the new Congress convenes in January. Instead, they will craft what is known as a “joint funding resolution” to fund federal agencies and programs until the end of FY 2007 (i.e., September 30, 2007). In addition, instead of passing a continuing resolution (CR), which provides a set amount of funding (currently set at the lowest of the House-approved, Senate-approved, or FY 2006 level), the joint funding resolution would be a specific document that may provide additional money where necessary to keep agencies and programs operating. An assessment of needs will be conducted at the departmental and agency level and could possibly include individual programs.

Medicare

Congress also passed Medicare legislation in the final hours of the session. Facing a December 31st deadline to forestall a five percent physician pay cut under Medicare, Congress attached Medicare provisions to an unrelated tax and trade measure (H.R. 6111). The bill does not include any provisions allowing additional providers to bill Medicare, or establishing coverage of additional services. Although ACA is disappointed that reimbursement of licensed professional counselors was not included in the bill, Congressional sources have indicated that this was not due to policy objections. Rather, counselor reimbursement and similar improvements in Medicare simply fell by the wayside as legislators scrambled to put together a bill in the last hours of the session.

Passage of the Medicare provisions actually makes it a virtual certainty that Congress will again consider Medicare legislation in 2007. The physician payment issue was addressed only by postponing cuts for one year, and legislators are still interested in establishing pay-for-performance standards for medical care paid for by Medicare. Democrats have also expressed strong interest in altering aspects of Medicare’s prescription drug coverage.

ACA greatly appreciates the efforts of our champions on this issue during the 109th Congress. Senators Craig Thomas (R-WY) and Blanche Lincoln (D-AR), as well as Rep. Barbara Cubin (R-WY) are to be applauded for their leadership in sponsoring the “Seniors Mental Health Access Improvement Act” (S. 784/H.R. 5324), focusing on coverage of licensed professional counselors and marriage and family therapists under Medicare. A total of six bills were introduced in the 109th Congress that would have established Medicare coverage of licensed professional counselors, demonstrating an unprecedented level of awareness and support for our issue. ACA will continue to prioritize this issue, and we are optimistic for our chances of success next year.

Mental Health Parity

Although comprehensive mental health parity was not enacted during the 109th Congress, the tax and trade bill did include a one year renewal of the 1996 Mental Health Parity Act. This law prohibits private sector health plans from setting annual and lifetime dollar limits for coverage of mental health services which are separate from and unequal to dollar limits for general medical services coverage. ACA and other mental health advocacy organizations have long pushed Congress to enact full mental health parity legislation to prohibit other discriminatory insurance practices. Unfortunately, the Republican leadership in the House of Representatives refused to bring the full parity bill (H.R. 1402) to the floor for a vote, despite the bill having more than 218 cosponsors. Speaker-elect Nancy Pelosi has stated her intention to bring a mental health parity bill to the House floor for a vote in the 110th Congress.

Underage Drinking Bill Passed

Another bill passed by Congress before adjournment was H.R. 864, the "Sober Truth on Preventing Underage Drinking (STOP) Act." The bill was sponsored by Representative Lucille Roybal-Allard (D-CA), and authorizes several programs and activities aimed at preventing under-age drinking. Under one of these, the Secretary of Education will administer a new $5 million per year program (subject to appropriations) of grants to prevent and reduce alcohol abuse at institutions of higher education.

The bill also requires the Secretary of Health and Human Services to issue an annual report card rating the performance of each State in enacting, enforcing, and creating laws, regulations, and programs to prevent or reduce underage drinking. The Department of Health and Human Services will also be required to conduct or support research on underage drinking, including the impact alcohol use and abuse has upon adolescent brain development, the scope of the underage drinking problem, and progress in preventing and treating underage drinking.