November 10, 2014 | Commentary on Federal Legislative Branch, Health Care, Medicare, Obamacare

Lame duck legislators ought not act on complex health policy issues

A lame-duck Congress typically is driven by a desire to "get things done." But lawmakers should resist ramming last-minute deals on Medicare physician payments and the Children's Health Insurance Program through this Congress. These are complex and highly consequential health policy issues. They deserve prudent deliberation by the people's chosen representatives, i.e., newly elected members of Congress, not "lame ducks."

The term, of course, is Washington parlance for politicians who, having been voted out of office, are no longer electorally accountable to anybody. This leaves them vulnerable to special interest pleadings, especially if they are also self-serving.

All too often, lame-duck sessions - convened between the November elections and the opening of the new Congress in January - wind up fast-tracking controversial bills that would never pass in regular order and making them law.

While end-of-year sessions are often needed to clean up routine budget and appropriations bills, past lame-duck sessions have resulted in members of Congress voting themselves special pay or retirement raises or handing out billions of dollars to favored special interests. Untethered from accountability to their constituents, soon-to-be-unemployed politicians can repudiate popular opinion with impunity, while bypassing the deliberation that the Founders expected of the legislature in a constitutional republic.

A lame-duck session this year would pose two big threats on the health care front.

Medicare doctors are facing a 21 percent pay cut, effective March 15, 2015, because of scheduled - and wholly unrealistic - "updates" to the Sustainable Growth Rate payment formula. These draconian Medicare cuts are clearly unacceptable, even though Congress's own Medicare formula mandates it.

Virtually all lawmakers agree that Medicare's flawed payment system should be repealed and replaced. But that's a hugely consequential undertaking, one that must be done right, in regular order, and in a fiscally responsible fashion. Any lame-duck efforts to enact a permanent fix without offsetting the extra costs via permanent savings elsewhere in the budget should be stopped cold.

The so-called "compromise bill" that House and Senate negotiators agreed to last spring does not meet that test. For one thing, it did nothing to reduce the bureaucratic overregulation that drives Medicare physicians crazy and needlessly ramps up costs. Worse, there was no congressional agreement on how to offset the huge cost that permanent "fix" would impose on taxpayers.

Indeed, the Congressional Budget Office estimated that its initial 10-year cost was $138 billion, and the unfunded "fix" would continue to add massively to the nation's deficit thereafter. Taxpayers should not be burdened with heavier debt because an irresponsible Congress wants to bum-rush Medicare physician payment reform.

The second threat arises from the Children's Health Insurance Program. CHIP was created in 1997 to provide coverage for uninsured children whose families earned too much to qualify for Medicaid. Its continued role, however, is uncertain due to the enactment of the Affordable Care Act. Yet, some are already calling for Congress to provide additional funding for the CHIP program in the lame-duck session. It shouldn't. There is plenty of CHIP money left for FY 2015, so there is no need to act before the end of this year.

Congress must do its due diligence before promising additional taxpayer dollars for CHIP. This certainly requires hearings to review the program's effectiveness, as well as determining how much funding is still available in the program and how the remaining funding is distributed among the states.

Other important issues relating to enrollment and the interaction of the CHIP program with the Affordable Care Act also need to be explored and addressed. These questions should be raised through the normal congressional process of hearings and committee mark-ups. Fast-tracking the bill would be tantamount to asking federal taxpayers to write a check without offering any justification for the request.

James Madison, writing in "The Federalist," insisted that lawmakers should have an "immediate dependence on, and an intimate sympathy with, the people." Members of Congress (even those who are soon to depart) should assure accountability and protect America's taxpayers by sparing the country a lame-duck session and letting the new Congress do its job.

 - Nina Owcharenko is director of the Center for Health Policy Studies at The Heritage Foundation where Robert E. Moffit is a senior fellow.

About the Author

Nina Owcharenko Director, Center for Health Policy Studies and Preston A. Wells, Jr. Fellow
Center for Health Policy Studies

Robert E. Moffit, Ph.D. Senior Fellow
Center for Health Policy Studies

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