Bush Rolls Back Clinton's Medicaid Rules Representative Henry A. Waxman, Democrat of California, said, "The Bush administration has taken every opportunity to side with the H.M.O. industry and against Medicaid patients in these regulations." A Medicaid patient who needs a life-saving treatment on Friday might have to wait until the next Wednesday because the "emergency protections don't apply over the weekend," Mr. Waxman said. About half of the 40 million Medicaid recipients are in managed care. Many are heavy users of medical care. They generally do not have the money to go outside the network of doctors and hospitals selected by their health plans. William A. Pierce, a spokesman for the Department of Health and Human Services, said he was unaware of specific differences between the Clinton and Bush rules. But Congressional aides expressed concern about several differences when they met today with federal Medicaid officials. Under the Clinton rules, H.M.O.'s had to do a comprehensive assessment of Medicaid patients with "special health care needs," including pregnant women, foster children and people over 65. Most of those requirements have been dropped. The Bush rules would allow patients to appeal an overt reduction, suspension, termination or denial of services. The new rules drop a provision that would, in addition, have allowed appeals if an H.M.O. simply "delayed access to services to the point where there is a substantial risk" of harm to the patients' health. http://www.nytimes.com/2001/08/17/politics/17MEDI.html

Social Security Budget Revised Social Security Budget Revised The Bush administration says a change in budget accounting methods will make $4.3 billion in Social Security funds available for general spending or tax cuts. The change, which involves the manner in which payroll-tax revenues are calculated, would technically allow the White House and Congress to spend the money while maintaining their commitment to only use Social Security surplus funds to pay retirees and reduce the national debt. The accounting change comes at a time when officials in Washington are predicting the surplus for the entire federal budget will be much lower than expected because of the slowing economy. http://www.publicagenda.org/headlines/headline.htm

Pentagon Harbors Antimissile Skepticism The head of the Pentagon's missile defense programs said today that he was not fully confident in the "basic functionality" of the antimissile system that successfully intercepted a mock warhead in space last month. http://www.nytimes.com/2001/08/16/national/16MISS.html

Administration Reconfigures the Budget Pie The Bush administration is making an accounting change involving Social Security that will free $4.3 billion for Congress to use, officials said today. The increase could be important as the White House and its Republican allies in Congress try to fend off Democratic assertions that President Bush's tax cuts have drained too much of the surplus to meet government spending priorities. Even with the change, the revised surplus projections for the fiscal year ending Sept. 30 will be much lower than the administration and Congressional Budget Office projected earlier this year. The $275 billion surplus, including Social Security, that was forecast by the budget office in May could fall to roughly $160 billion because of the tax cut and slowing economy. Administration officials, speaking on condition of anonymity, said the accounting change more correctly describes revenue from payroll taxes, those dedicated to Social Security and Medicare. "There's a general consensus that the Social Security surplus should be used for debt reduction," one official said. Democrats described the change as an unprecedented accounting gimmick intended to mask the impact of Mr. Bush's 10-year, $1.35 trillion tax cut on the budget. http://www.nytimes.com/2001/08/16/national/16BUDG.html

States Dismayed by Federal Bills on Patient Rights "The House bill appears to pre- empt all state internal and external review laws," Mr. Fitzgerald said. "If that becomes law, I would have real concern about the ability of people to get an appropriate and adequate review of adverse decisions by H.M.O.'s. In regulating insurance and health care, it's critical to strike an appropriate balance between the rights of states and the role of the federal government." Democrats agree. In an interview, Gov. Gray Davis of California said: "The federal government is diminishing the health care rights of Californians. Congress should adopt minimum standards and allow states to exceed them. But instead, it's rolling back rights that we accorded to patients in a package of 20 separate bills that I signed in 1999." Under a federal bill passed by the Senate on June 29 and the companion bill passed by the House on Aug. 2, insurance companies could charge a filing fee of $25 for the external review of a health plan's decision. "Those fees are really a patients' rights tax, which I find wholly unacceptable," Mr. Davis said. California allows patients to sue health plans for any harm caused by the insurer's negligence, but the state does not limit the amount of damages. By contrast, the bill passed by the United States House of Representatives would set limits in state and federal court: $1.5 million for pain and suffering, plus $1.5 million in punitive damages. President Bush and many Republicans in Congress said the limits were needed to discourage the filing of frivolous lawsuits and to hold down insurance costs. Mr. Bush has said he will sign the version that passed the House, but not the one the Senate passed. Daniel Zingale, the director of the California Department of Managed Health Care, said the potentially unlimited liability of health plans in California had been "an incentive for good corporate behavior" by H.M.O.'s. "We have not had a single lawsuit under the 1999 law," Mr. Zingale said. http://www.nytimes.com/2001/08/13/politics/13PATI.html

A New Threat to the President's Agenda: The Tax Cut Democrats are indeed gasping. They are already warning that Congress will face painful tradeoffs when it returns from its summer recess next month and begins wrangling in earnest with Mr. Bush over next year's spending bills and the array of policy choices within them. But Mr. Bush cannot breathe freely, either. Just two months after he signed it into law, the tax cut that once seemed an unalloyed triumph now threatens to complicate the rest of his agenda and expose him to political peril. From his plans for modernizing the military and developing a national missile defense to his aspirations of becoming the education president and tackling long-term issues like Social Security, Mr. Bush might have trouble paying the tab. At the same time, he has left himself open to accusations from Democrats that the tax cut will plunge the government back into budget deficits of a sort. The buffer left in the surplus following his tax cut appears to be eroding rapidly because of the flagging economy. Both Congress and the White House will update their surplus projections by the end of the month. It is possible the new figures will show the budget in the current fiscal year dipping into money that Democrats and most Republicans had considered off limits � the excess revenues being generated by Medicare. Raiding Medicare, as the Democrats put it, would be a tricky enough charge for the White House to deal with. But it could get worse. Within a year or two, the government may again start spending the Social Security surplus, breaching a bulwark against fiscal irresponsibility agreed to by both parties and the administration. http://www.nytimes.com/2001/08/12/weekinreview/12STEV.html