Legislative Newsletter Update 19 October 2009 


Legislative News is AUSA Government Affairs Directorate's 
weekly electronic newsletter, and is published 
every Monday when Congress is in session. 


In this issue

  • Vote Scheduled Today on Medicare/TRICARE Cuts
  • Advance Funding for VA Legislation Passes Congress
  • Improvements for Wounded Warriors Cited in GAO Report


      Vote Scheduled Today on Medicare/TRICARE Cuts

      The Senate is poised to vote on legislation that would block a scheduled 21 percent reduction in Medicare payments to doctors in 2010 and change the statutory formula to prevent such cuts over the next 10 years.  The bill, S. 1776, The Medicare Physician Fairness Act, was introduced by Sen. Debbie Stabenow, D-Mich.

      Medicare rules require an annual review and updating of physician fee schedules with the process weighing a number of medical cost factors.  In order to achieve budget neutrality and stay within annual targeted sustainable growth rate, physician fee schedules will either decrease if Medicare spending exceeds the targeted growth figure or increase if Medicare expenses are less than the targeted growth.  In an era of rapidly rising medical costs, the annual review would have resulted in a decrease in the physician fee schedules during the last few years had Congress not taken action each year to postpone the reductions.  Because payment rates in the TRICARE program are tied to Medicare rates, this affects many military beneficiaries.

      The cost of blocking the cuts is usually offset under the Congressional Budget Office’s scoring rules; however, this time it would not be offset.  The bill would reset the budget “baseline” used in the formula at a cost of $245 billion over 10 years. 

      Not all are on board with the Stabenow bill because the cost would not be offset.  Budget Committee Chairman Kent Conrad, D-N.D., is one of those.  “You can’t just alter the baseline and say, all of a sudden, you don’t have to pay for things,” he said. 

      What we do know is that every year, AUSA spends a considerable amount of time pushing Congress to change the statutory formula that imposes these cuts.  Declining participation of providers in Medicare and TRICARE due to low reimbursements is a serious healthcare problem facing Medicare-eligibles and military beneficiaries of all ages.  Finding doctors who accept TRICARE is already an enormous problem for the military community - particularly for Guard and Reserve families, retirees, and survivors who live in areas with a small military population.  Payment cuts will make the situation even worse.

      AUSA will closely monitor today's vote and will report on any developments.  

      Advance Funding for VA Legislation Passes Congress

      The Senate passed the Veterans’ Health Care Budget Reform and Transparency Act of 2009 by unanimous consent last week.  The House approved its bill on Oct. 8 by a vote of 409-1.  The final bill will now go to President Obama for his signature.

      Reform of the method in which the VA health care system is funded has been a top legislative priority of AUSA’s for many years.  For years, the agency’s health care system has been plagued by consistently late and, at times, inadequate budgets.  Final appropriations for the VA have not been enacted before the start of the fiscal year in 19 of the past 22 years.

      The legislation would secure funding for veterans’ health care one-year in advance of the regular appropriations process.  It would also ensure transparency in the funding process by requiring public reports and GAO audits on VA’s funding forecasting.  

      Advance funding would apply to medical services and support and facility programs, but not to other portions of the VA budget.  Funds for benefits such as disability compensation and the GI Bill are not subject to disruptions because they do not come from annual appropriations.

      AUSA is grateful for the overwhelming bipartisan support of this long-overdue legislation.

      Improvements for Wounded Warriors Cited in GAO Report

      Chairman of the Social Security Subcommittee of the House Ways and Means Committee Rep. John Tanner, D-Tenn., joined with colleagues in thanking federal agencies for improving service to wounded warriors who are eligible for Social Security disability benefits.  These improvements were cited in a new report released by the Government Accountability Office (GAO).

      Service members who have been seriously wounded may be eligible for Social Security disability insurance or Supplemental Security Income disability benefits from the Social Security Administration, in addition to possible disability benefits from the VA and Defense Department.  In 2007, advocates began reporting that wounded warriors - service members wounded since 2001 in Iraq or Afghanistan - often did not know about Social Security’s disability benefits or were encountering barriers when they attempted to apply.

      In response, the Subcommittee asked GAO to conduct a study to determine what challenges wounded warriors face in accessing Social Security’s disability benefits and what the Social Security Administration, Defense Department and VA have done to address these problems.

      GAO's report, released October 15, found that the three agencies have worked together since 2007 to significantly expand outreach to wounded warriors to inform them about disability benefits.  GAO also found that Social Security has successfully taken measures to expedite these disability claims.

      However, not all service delivery problems have been fixed. GAO found that some wounded warriors still face delays in receiving benefits because the Defense Department does not transfer their medical records to Social Security quickly enough.  In addition, GAO recommended outreach be expanded to already-discharged veterans to make sure that they are aware of the disability benefits.  The report identified several groups in particular need of outreach, including those suffering from traumatic brain injury or post-traumatic stress disorder.

      Chairman Tanner and Ranking Member Sam Johnson, R-Texas joined colleagues from other House subcommittees to urge Defense Secretary Robert Gates, Veterans' Affairs Secretary Eric Shinseki and Social Security Administration Commissioner Michael Astrue to promptly carry out GAO's further recommendations.

      "We commend you on the success of your efforts to improve service delivery for wounded warriors who may be eligible for Social Security or SSI disability benefits, and look forward to working with you to ensure that they are fully informed about these benefits," they wrote in letters to the agencies.