WASHINGTON – A measure worth $134 million to hospices across the country has made its way into a draft of Congress' economic recovery bill, thanks to an intense and pricey lobbying effort by the industry.
The nation's largest hospices are pushing hard to ensure the provision, which would essentially head off a cut in what the government pays them to care for Medicare patients, survives an increasingly partisan congressional debate and makes it to President Barack Obama's desk.
Their effort is just one example of the behind-the-scenes haggling that's shaping the stimulus plan, as diverse groups jockey to ensure their priorities hitch a ride on a remarkably costly measure that Obama considers must-pass legislation.
The hospices have already cleared some major hurdles in the Democratic-controlled Congress, where the House is poised to approve its version of the economic recovery bill — including the provision the hospices are seeking — with a vote scheduled for Wednesday.
Influential lawmakers led by Maryland Rep. Chris Van Hollen, the party's House campaign chief, made sure the provision was a part of that bill.
"A lot of people who provide end-of-life care told us this was very important," Van Hollen said Tuesday. "If you don't adequately reimburse hospice care providers, they go out of business and then people lose their jobs."
That's the case that hospice advocacy groups have been making to Congress since last spring, when they began fighting a Bush administration-imposed rule they say could cost their industry more than $2 billion over the next five years, and 8,700 jobs in the next year alone.
More recently, they met with Obama's team to press the incoming administration on the issue, said Jonathan Keyserling, an executive at the National Hospice and Palliative Care Organization.
"We've had programs close, we've had programs lay off professionals, we've had them shrink their service areas," Keyserling said. "Our members have a broad outreach to Congress, and it is rare to enter an office where either the staff person or the member themselves have not had a hospice care for a member of their family."
His group's lobbying arm, the Alliance for Care at the End of Life, has blanketed Capitol Hill, spending close to $1 million and employing 10 outside lobbyists last year alone, according to disclosures filed with Congress.
One prominent member of that team was John F. Jonas, a former top aide to Rep. Pete Stark, D-Calif., and the House Ways and Means Committee. When the bill writers inadvertently left the provision out of the stimulus draft last week, it was Stark, the chair of the committee's health panel, who intervened to restore it.
Well-connected Republican lobbyists were enlisted as well, including Candi Wolff, who served as former President George W. Bush's chief liaison to Congress.
Individual hospice companies that stand to benefit handsomely from the change also have spent freely to win its adoption. VITAS Healthcare Corporation, one of the largest hospice providers, spent $330,000 lobbying Congress last year, employing six outside lobbyists to make its case, the disclosures show.
The industry and its champions also have been politically active. VITAS employees gave about $100,000 to political candidates over the last two years, the vast majority of that going to Democrats, according to records compiled by the Center for Responsive Politics, an independent campaign finance research group.
One of the company's founders, Hugh A. Westbrook, who lists himself as the chief executive, donated tens of thousands to Democratic candidates and political action committees over that period, according to forms filed at the Federal Election Commission. The donations included $45,500 to the Democratic Congressional Campaign Committee, which Van Hollen chairs, and $5,000 to the political action committee of South Carolina Rep. James Clyburn, the No. 3 House Democrat.
Westbrook's wife Carole Shields Westbrook also gave $28,500 to the DCCC, the annual maximum for an individual.
Support for the hospice measure isn't confined to Democrats. Twenty-two Republicans signed on to the legislation last year to delay the rule. But even GOP supporters say it doesn't have a place in the economic recovery package.
"That provision on its own is a good one," said Michigan Rep. Dave Camp, the top Republican on the Ways and Means panel. But, he added, "It isn't necessarily a stimulative one. We'd like to see this bill, which is being done so quickly, limited to things that really will grow the economy and create jobs."
The hospice industry and its champions argue the measure is crucial to preserving jobs and care for patients nearing the end of their lives. Keyserling said the cut, which would be phased in over three years, would ultimately eclipse hospices' average profit margin. Hospices were particularly hard-hit by last year's gas price spike, he added, since workers travel to patients' homes to care for them.
The Hospice and Palliative Care Organization, which represents companies caring for 90 percent of hospice patients in the U.S., tried to sue the Bush administration last year to block the rule, but the suit was dismissed by a D.C. district court. The rule went into effect on Oct. 1, but the group appears well on its way to eliminating it; the House stimulus measure would impose a one-year moratorium.
That delay "is a direct result of your Hospice Advocacy — congratulations!" the organization said in a recent memo to its members.
It noted, however, that they still have to lean on senators — who have so far left the delay out of their version of the stimulus package — to back the provision.
"(I)t is way too soon to celebrate," the memo said. "This is just step one in a complicated legislative process."
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