1998
It did not take long for providers to push for changes, primarily in home care. The first
bill was introduced—with 13 cosponsors—in February 1998. In the House, eight bills on home
health payments were introduced in response to a law passed only months earlier (see Table 2)
<Table 2 About Here>
The National Association of Home Care (NAHC) launched a major media effort to fight
the new prospective payment system proposed in the BBA. To illustrate the “helping” nature of
their industry, many home health groups prepared videos for Congress featuring home health
staff helping seniors to the music, “He ain’t heavy, he’s my brother” (Weissenstein 1998). In
hearings in August, a NAHC official testified that more than 1,000 home health agencies were
forced to close that year. And, he said, some agencies were beginning to avoid patients with
complex needs—requiring more than the new payments would cover (Saphir 1998).
One of the eight bills did become law as part of an omnibus spending bill (PL 105-277).
Home care agencies were given more funding and the scheduled 15 percent payment reduction
(set to go into place in Oct. 1999) was delayed for one year. The give-back totaled $1.4 billion
over five years. The managed care industry also sought “mid-course corrections” but were less
successful. Rep. Pete Stark (D-CA) represented the view of many in Congress when he said that
the health plans were underpaid only because they had been so long overpaid (Congress Daily
1998).
1999
In 1999, providers and their associations continued the drumbeat for money. By this time,
it had a name: “whining for dollars.” (Congress Daily 1999). They were buttressed in their
efforts by the sharper-than-expected reduction in Medicare outlays. Providers argued that at the
Convention