Bush Administration Supports Senate Medicare Bill Provision on Dual-Eligibles
The Bush administration has "quietly told Congress" it supports a provision in the Senate Medicare bill (S 1) that calls for Medicaid, rather than Medicare, to continue to cover drug costs of the more than six million people eligible for both programs if a Medicare drug benefit is enacted, the New York Times reports. Although states are not required to provide prescription drug benefits under Medicaid, all 50 states do so, according to the Times (Pear, New York Times, 9/24). About 6.2 million people are enrolled in both Medicaid and Medicare, and another four million people are considered dually eligible but have not signed up for both programs. Dual-eligibles make up 19% of all Medicaid beneficiaries, and states spend $7 billion per year to provide prescription drug coverage to such people (California Healthline, 8/18). The House Medicare bill (HR 1) would provide drug coverage to all of the estimated 40 million Medicare beneficiaries, and the federal government would gradually assume the drug costs of covering dual-eligibles over 15 years -- a process that the Bush administration labels "buying out the states" and does not support, the Times reports. Dual-eligibles would not receive Medicare drug coverage under the Senate bill, but would continue to receive drug coverage under Medicaid, which can "vary widely from state to state" and has been cut by many states in recent years to reduce costs. An unnamed senior Bush administration official said, "We would rather spend money to cover new people with new benefits, rather than substituting federal dollars for state dollars. To spend federal money on people who have reasonably good drug coverage [under Medicaid] does not seem like the best use of available resources."
The National Governors Association, AARP, Consumers Union and the Catholic Health Association have said they support covering dual-eligibles' drug costs under Medicare, the Times reports. Florida Gov. Jeb Bush (R), one of 50 governors who signed a letter to Congress supporting Medicare drug coverage for dual-eligibles, said, "These seniors are Medicare beneficiaries first and should be afforded equal access to a new prescription drug benefit." Rep. Bill Thomas (R-Calif.), chair of the conference committee charged with reconciling the House and Senate Medicare bills, said that it would be "fair, equitable and logical" to provide drug benefits to dual-eligibles through Medicare, the Times reports. "They should be treated as seniors first, not as low-income first," Thomas said. Rep. John Dingell (D-Mich.) said the Senate bill's provision regarding dual-eligibles could lead to "a two-tiered, second-rate drug benefit for the lowest-income Medicare beneficiaries." Catholic Health Association executives on Monday met with CMS Administrator Tom Scully to push for Medicare to cover dual-eligibles' drug costs. According to CHA President the Rev. Michael Place, Scully said the cost of such a proposal "could well be a stumbling block" to passage of a Medicare prescription drug benefit (New York Times, 9/24).
A Medicare conference committee "subgroup" on Tuesday made some "tentative decisions" about competition among private health plans that would participate in Medicare, CongressDaily/AM reports. The group -- which includes Senate Majority Leader Bill Frist (R-Tenn.); Sens. Max Baucus (D-Mont.), John Breaux (D-La.), Don Nickles (R-Okla.), Orrin Hatch (R-Utah) and Jon Kyl (R-Ariz.); and Reps. Nancy Johnson (R-Conn.) and Billy Tauzin (R-La.) and Thomas -- did not make any final decisions on a provision that would require traditional Medicare to compete with private health plans beginning in 2010. The subgroup is scheduled to meet again Wednesday, CongressDaily/AM reports.
In other Medicare news, the House on Tuesday voted 213-202 to reject a motion by Rep. Charles Stenholm (D-Texas) to instruct Medicare conferees on a package of rural provisions, CongressDaily/AM reports. Stenholm's motion would have encouraged conferees to adopt a Senate provision ensuring that the government would administer a Medicare drug benefit in areas where fewer than two private health plans offered coverage; to approve several Senate provisions regarding rural health that are "more generous" than those in the House bill; and to eliminate a House provision that would cut hospital inflation increases. According to CongressDaily/AM, Republicans said the motion would make a final Medicare bill too expensive. "This budget-busting motion would mean the cost of the entire package would greatly exceed the $400 billion allocated under the budget resolution for Medicare prescription drugs, which would jeopardize our ever getting to a final bill," Rep. John Shimkus (R-Ill.) said (Rovner, CongressDaily/AM, 9/24).
According to the Wall Street Journal, Medicare conference committee members have "made little progress" on "fundamental disputes," such as the extent of private participation in a Medicare drug benefit. Further, President Bush as of yet "hasn't put much muscle toward forging an agreement," the Journal reports. Rep. Jim Cooper (D-Tenn.) said, "The political will is lacking unless the president steps in and devotes an extraordinary amount of political capital." According to Rep. Jo Ann Emerson (R-Mo.), a final bill's chance of passing is no greater than 50%, the Journal reports. However, Republican leaders say they are still working on compromises that will be accepted by both parties. "This isn't a Republican-written bill being jammed [through] and that spirit continues -- not with everybody, but with people who have spent the most time with it," Frist said. Still, most congressional staffers and lobbyists believe that the next three weeks will be crucial, because after that, "partisan wrangling is likely to intensify" with next year's elections on the horizon, the Journal reports (Lueck, Wall Street Journal, 9/24).
Responding to reports that he will leave his CMS post to accept a job in the private sector, Scully on Tuesday said he is not leaving because he is committed to overseeing passage of a final Medicare bill, the Washington Post reports (Kamen, Washington Post, 9/24). The Hill reported Tuesday that in recent weeks, Scully has met with Atlanta-based law firm Alston & Bird and various lobbying firms to "discuss his future" and will likely announce his resignation within the next month. According to an unnamed source, Scully has finalized an agreement with Alston & Bird, but a spokesperson for Scully denied the claim. The spokesperson did say that several lobbying firms have approached Scully about employment opportunities (Cusack, The Hill, 9/23). Scully yesterday said, "I'm not going to go anyplace. ... I am firmly committed to getting this Medicare bill done, which is my No. 1 through 10 priority" (Washington Post, 9/24).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.