WASHINGTON -- The House Energy and Commerce Committee overwhelmingly approved legislation yesterday that would delay for nine months the Jan. 1, 1992, effective date of new Medicaid financing rules that states have warned could cripple their budgets and harm their credit ratings.
The panel's 35-to-8 vote for the bill came amid indications that the Health Care Financing Administrion, which proposed the rules in September, was backing away from its opposition to a delay and may soon announce a blanket postponement of the effective date.
The legislation, which now must be voted on by the full House, was introduced by Rep. Henry Waxman, D-Calif., the chairman of the panel's subcommittee on health and the environment.
Rep. Waxman offered the bill after failing several weeks ago to persuade the health agency's head, Gail R. Wilensky, to withdraw the rules, which Rep. Waxman charged go well beyond congressional intent.
About a dozen Republicans broke ranks with the Bush administration and voted for Rep. Waxman's bill, saying they felt the delay was necessary to protect their states' finances.
Several of those Republicans also said meetings were going on behind the scenes with the health administration to forge a compromise on the regulations and to delay their effective date. Those Republicans said they believed the health administration was on the verge of agreeing to a postponement of the regulations, and they urged the administration to put that delay into effect without waiting for the passage of the legislation.
Rep. Claude Harris, R-Ala., criticized what he called "callous budgeteers" in the Office of Management and Budget and the health administration for previously having insisted on a Jan. 1, 1992, effective date for the regulations.
"These people need to take off their green eyeshades and talk to some of my constituents, who have to choose between buying food and buying medicine," Rep. Harris said.
"It's time for HCFA to come to the table" said Rep. Jack Fields, R-Tex. "We are hopeful something can be worked out" with the health administration. But he added that "some of us are a little jaded" about the way the agency handled the situation, because it said it would agree to a compromise on or a postponement of the regulations only if the Republicans agreed to vote no on Rep. Waxman's bill.
The regulations, designed to implement the 1990 Medicaid law, would require the federal government to stop matching the portion of states' Medicaid funds garnered through donations. They also would restrict the ability of states to count revenues from certain taxes on hospitals toward the Medicaid match.
The heatlh agency offered its own proposal to delay the rules last week but only on a case-by-case basis. The agency said it would grant any state a six-month postponement only if it agreed to certain conditions. Health-care lobbyists charged that the conditions are so stringent they would be difficult, if not impossible, to meet.
States have been arguing that the regulations will create serious problems because they will become effective in the middle of most states' fiscal years. States already amount of Medicaid money this fiscal year from the federal government, and if some of that money is not forthcoming, it will exacerbate many states' already precarious budget situations.
For its part, the health agency has said using donations to count toward the match is inappropriate because it allows a state to receive more federal aid without kicking in its own funds. State taxes also can be unfair because may states makes higher Medicaid payments to hospitals to pay such taxes, in effect reimbursing them for those levies, the administration has said.