Key Congressional staffers agree that lack of money will be the force that molds lawmaking in the coming year.
At a December health legislation briefing hosted by the Alliance for Health Reform and the Robert Wood Johnson Foundation, Congressional staffers expressed resignation over what they anticipate to be a difficult pay-as-you-go – or "PAYGO" – 110th Congress. Under the PAYGO rules, Congress must pass budget-neutral laws, shifting priorities if need be to cover new projects under current funding streams.
According to Mark Hayes, health policy director for the Senate Finance Committee under former Chairman Charles Grassley (R-Iowa), entitlement spending, such as Medicare and Medicaid, will be the key battleground.
"There will be a lot of discussion over entitlements and where we are going in this country with entitlement spending," Hayes said. "This is the issue we have to face up to. It will be a challenge to make anything happen,
in reality."
Hayes warned that long-term ramifications for sustaining Medicare could include difficult decisions such as restructuring benefits or raising taxes.
While Republicans see restraint as critical on healthcare issues, Democrats have a burgeoning agenda that includes increasing health insurance coverage for impoverished children and making health insurance more affordable for small businesses, staffers said.
"There are a gazillion flowers blooming" among the Democrats regarding potential legislative fixes for the uninsured, said Bridgett Taylor, staffer for the House Energy and Commerce Committee under John Dingell (D-Mich.). But, she acknowledged, "we need money to make things happen."
Both parties agree that 46 million uninsured Americans is a problem that needs fixing, but approaches vary. Deadlocks come over where current spending could be reallocated to cover the costs, staffers said.
"The problem is, you can't stop the machine in order to fix it," Hayes said. "Everything is interconnected."
Medicare Part D will also be solidly on the radar, staffers said. Democrats feel the "doughnut hole" in the program, which excludes beneficiaries who need help paying premiums for prescription drugs but aren't poor enough to qualify, needs to be fixed.
Kate Leone, senior health counsel to Senate Democratic Leader and Majority Leader-Elect Harry Reid (D-Nev.), said Senate Democratic leaders will call for more hearings and open negotiating on Medicare Part D in the coming year.
Some of the Republican concern about overspending in Medicare is designed to create hysteria, Leone said. "This hysteria is misplaced," she said. "We have a crisis in this country, and it's healthcare."