Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, February 3, 1991 TAG: 9102030045
SECTION: NATIONAL/INTERNATIONAL PAGE: A3 EDITION: METRO
SOURCE: The New York Times
DATELINE: WASHINGTON LENGTH: Medium
The proposals, part of the president's budget for 1992, are sure to reignite debate over Medicare, which finances health care for 33 million elderly and disabled Americans. Some lawmakers are already suggesting the proposals will break a budget deal sealed in October.
"As far as I'm concerned, further Medicare cuts would be a deal-breaker," said Sen. Lloyd Bentsen, D-Texas. As chairman of the Finance Committee, Bentsen has more influence over Medicare legislation than any other senator.
Congressional leaders of both parties say they want to preserve the framework for federal spending and taxes forged by the White House and Congress last year. But it may be blown apart by the costs of the recession, war in the Persian Gulf and federal insurance for depositors in banks and bankrupt savings-and-loan associations.
"Were it not for the twin problems of recession and the war," said Sen. Jim Sasser, D-Tenn., chairman of the Senate Budget Committee, `this would be a smooth budget year and we could have taken an uncomplicated, uncontroversial approach. But if the war goes on for more than two or three months, we may have a very turbulent budget year."
Within the constraints of the budget agreement last fall, Bush will also propose low-cost steps to combat infant mortality, a modest expansion of some child nutrition programs, major reductions in federal aid to college students from middle-income families and a substantial increase in spending for highways and space programs.
Administration officials acknowledge the proposed cutbacks in payments to hospitals and doctors were not required by or envisioned in last year's budget agreement. But they say it is essential to slow the growth of Medicare costs, which rose nearly 14 percent last year, to $107 billion.
Last year's budget agreement covered five years, and many lawmakers say they assumed they would not have to make another major effort at deficit reduction before the 1992 elections.
It is not clear what Bush wants to do with the money he would save by trimming Medicare payments to hospitals, doctors, laboratories and suppliers of medical equipment to the elderly and disabled.
The biggest savings, $1.4 billion next year and $9.6 billion over five years, would result from his proposal to cut payments to teaching hospitals. Such hospitals now receive an allowance for the extra costs they incur in training doctors and treating people who are more severely ill than the average patient. Most teaching hospitals are in inner cities and serve large numbers of poor people.
Paul C. Rettig, executive vice president of the American Hospital Association, said the proposed cuts, if approved, would almost certainly contribute to "a deterioration in the quality of care and access to care" at hospitals.
After an agonized struggle over the budget last year, Congress appears unlikely to accept the president's Medicare proposals, some of which were previously considered and rejected by Congress. But many lawmakers operate on the premise that doctors are overpaid, so it is conceivable Congress could agree to trim Medicare payments to certain medical specialists.
by CNB