Conferees Miss Medicare Deadline But Report Some Progress in Negotiations
Negotiators attempting to reconcile the House and Senate Medicare bills (HR 1 and S 1) missed their self-imposed Oct. 17 deadline for agreement on a final bill, but they reported progress on a number of issues, the New York Times reports. Medicare conferees said that although they have not made "many final decisions," they have "stepped up negotiations in the last few days" and hope to finish work on the bill by Nov. 7, according to the New York Times. The chances of reaching an agreement have increased since early September, when lobbyists and health care policy experts estimated the chances at about 50-50, negotiators said (Pear, New York Times, 10/18). Senate Majority Leader Bill Frist (R-Tenn.) said the Oct. 17 deadline served as a "good glidepath" and helped advance the talks, adding that conferees are "making progress" (Barfield Berry/Hoy, Long Island Newsday, 10/18). Sen. Max Baucus (D-Mont.) said, "We are getting closer and closer to agreement" on a number of issues, but "nothing definite has been decided" (New York Times, 10/18). Sen. Charles Grassley (R-Iowa) said that conferees have reached tentative agreements on certain issues, but "in the final analysis, nothing has been agreed to." He added, "By this time next week, almost all this has got to be agreed to" (Long Island Newsday, 10/18). In a joint statement Friday, Sens. Olympia Snowe (R-Maine) and Edward Kennedy (D-Mass.), who led a bipartisan group of senators monitoring the talks, said, "It is deeply disappointing that the Medicare conference has made so little progress" (New York Times, 10/18). Conferees on Friday responded that Rep. Bill Thomas (R-Calif.), the conference committee's chair, is allowing negotiators to discuss all issues in the bills before asking them to make decisions on any specific provisions. Such a strategy "hold[s] discussion together" but has not led to any "firm agreements," they added, CongressDaily reports (Heil, CongressDaily, 10/17). There is a 95% chance that President Bush will sign into law a new Medicare prescription drug benefit next month, CMS Administrator Tom Scully predicted on Friday (Lochhead, San Francisco Chronicle, 10/18). Before he left for his trip to Asia, Bush said he "will not sign an unacceptable bill," despite earlier reports that he would sign any Medicare bill passed by Congress, the Chicago Sun-Times reports (Novak, Chicago Sun-Times, 10/19).
Conferees have reported agreements on a number of issues, including the details of a prescription drug discount card and preventive care coverage (Baltimore Sun, 10/19). Negotiators also have agreed to cover under Medicare prescription drug costs for beneficiaries dually eligible for both Medicare and Medicaid (Wheeler, Gannett/Detroit News, 10/19). Conferees also agreed in principle on relating premiums for Medicare Part B, which covers outpatient services, to beneficiaries' incomes, although details of any such plan have yet to be determined, the New York Times reports (New York Times, 10/18). In addition, they are considering increasing payments to rural Medicare providers, a provision included in both the Senate and House bills that has support from "key lawmakers in both parties," as well as from Bush, the Washington Post reports. The plan calls for a payment boost of at least $25 billion for doctors, hospitals and other providers (Goldstein, Washington Post, 10/20). On Friday, negotiators discussed a proposal under which Medicare would cover an initial physical examination for any new beneficiary, regardless of whether the person has any symptoms of illness. Conferees also said they are working on a plan that would help keep the cost of the new prescription drug benefit to less than $400 billion over 10 years. Sen. John Breaux (D-La.) said negotiators are developing a plan that would require Congress to intervene if general tax revenues accounted for more than a certain percentage, perhaps 40%, of Medicare spending, a provision supported by Republicans and opposed by Democrats. Conferees also said they are "narrow[ing] their differences" on issues such as reimporting U.S.-made prescription drugs from abroad, the New York Times reports. Rep. Michael Bilirakis (R-Fla.) and Grassley said the final bill will likely contain a provision addressing reimportation (New York Times, 10/18). Conferees have begun to tackle key issues such as the details of the prescription drug benefit and a provision that calls for private health plans to compete directly with traditional, fee-for-service Medicare beginning in 2010 (Long Island Newsday, 10/18).
Senate Democrats on Friday warned that they will "not hesitate" to filibuster the Medicare bill that emerges from conference committee if it does not address their concerns or if it "caters to Republicans," the Washington Times reports (Fagan, Washington Times, 10/19). In July, Kennedy and 36 other Democratic senators wrote a letter to Bush outlining their concerns with the proposed legislation (Hearst/Baltimore Sun, 10/19). In the letter, Democrats said they want to provide a larger prescription drug benefit -- instead of spending money on health savings accounts for individuals -- and have the federal government administer coverage in regions where too few private plans opt to participate. On Friday, Senate Minority Leader Tom Daschle (D-S.D.) said, "We're saying, look, these concerns still hold; these problems are still serious ones that have to be addressed, and if they're not, don't look to us for support for this bill." Democrats said they strongly oppose the competition provision and plans to relate Part B premiums to beneficiaries' incomes, the Washington Times reports. A spokesperson for Kennedy, who has said he will reserve judgment on the bill until he sees the final version, said the senator would join Daschle in blocking a "bad" bill that "undermines or privatizes Medicare," according to the Washington Times (Washington Times, 10/19). Democrats also have raised concerns about their participation in conference committee negotiations, the Washington Post reports. In a "blunt warning" to Frist last week, Daschle said that Democrats "may invoke rules under which they can block formation of future conference committees unless Republicans assure Democrats of broader participation in negotiations" on the Medicare and energy bills, the Post reports. Baucus and Breaux are the only two Senate Democrats who have participated in the Medicare negotiations to date. Republican members of the conference committee said that they have consulted regularly with Democrats and kept them apprised of developments (Dewar, Washington Post, 10/19).
AP/Las Vegas Sun: The AP/Sun on Sunday examined the "furious lobbying campaign" by drugstores and supermarkets to influence lawmakers as they debate Medicare reform. Retail drug stores fear being shut out of the market if the pharmacy benefit managers administer the drug benefit under Medicare and sell drugs by mail order. They also are pushing Congress to enact a provision that would prohibit PBMs from participating in government health programs and from directing business to companies in which they have a financial interest (Sherman, AP/Las Vegas Sun, 10/19).
New York Times: The Times on Sunday looked at Bush's slipping popularity, which analysts attribute in part to older U.S. residents' concerns about Medicare and the cost of prescription drugs. With health care costs rising, many retirees are growing increasingly concerned about the gaps in coverage and high copayments in the proposed Medicare legislation, as well as the possibility that they could lose coverage provided by their former employers (Toner, New York Times, 10/19).
Washington Post: On Sunday, Stan Hinden, a retirement consultant, examined how some of the key provisions in the House and Senate bills would affect beneficiaries with prescription drug coverage through a former employer. If employers decide to drop retiree drug coverage when a prescription drug benefit is created, an estimated four million people will have to move to the Medicare drug plan, which would be "less generous and more complicated than most employer plans," Hinden writes. He concludes, "One of the oldest rules of medicine is 'First, do no harm.' That would be a good rule for members of Congress to keep in mind" when deciding on a final Medicare bill (Hinden, Washington Post, 10/19).
- NPR's "All Things Considered" on Friday reported on the "vastly different" plans for a proposed prescription drug benefit. The segment includes comments from Baucus, Daschle and Kennedy; Edward Howard, executive vice president of the Alliance for Health Reform; and House Energy and Commerce Chair Billy Tauzin (R-La.) (Rovner, "All Things Considered," NPR, 10/17). The full segment is available online in RealPlayer.
- PBS' "Nightly Business Report" on Friday also reported on prescription drug benefit negotiations. The segment includes comments from David Certner, federal affairs director for the AARP; Daschle and Joanne Woodward, policy analyst for Goldman Sachs (Woods, "Nightly Business Report," PBS, 10/17). The full transcript is available online.