Democrats Increase Criticism of Medicare Legislation
Democrats on Saturday "ramped up" their criticism of the Medicare legislation (HR 1) Congress passed last month, saying that the bill would do little to control rising prescription drug prices and is the first step toward privatization of the program, the AP/Las Vegas Sun reports. The Senate passed the bill Tuesday on a 55-44 vote, just three days after the House approved the legislation 220-215 in a three-hour roll call (Gersema, AP/Las Vegas Sun, 11/30). Senate Minority Leader Tom Daschle (D-S.D.) has introduced a bill that would repeal several of the provisions in the Medicare legislation and allow reimportation of cheaper, U.S.-made prescription drugs from Canada and Western Europe (Espo, AP/Las Vegas Sun, 11/30). In the Democrats' weekly radio address, Rep. John Tanner (D-Tenn.) said that many members of his party remain concerned about several provisions in the legislation, including one that calls on Congress to intervene if general tax revenue makes up more than 45% of Medicare spending. He also criticized what he said are "huge new subsidies for HMOs" and the bill's "fail[ure] to deliver a meaningful guaranteed drug benefit in Medicare" (Gersema, AP/Las Vegas Sun, 11/30).
Analysts and some conservative lawmakers are growing increasingly concerned that the passage of the Medicare legislation will result in higher spending and a larger federal deficit, the New York Times reports. The deficit is expected to reach about $500 billion in the fiscal year that started Oct. 1, largely because of the costs of anti-terrorism measures, the aftermath of the war with Iraq and recently passed tax cuts. The Medicare legislation, which will cost about $400 billion over 10 years, will "further weig[h] down the budget," according to the New York Times (Stevenson/Andrews, New York Times, 11/29). Several experts say that the estimated cost is a "false indication of the legislation's true impact" and that expenses will rise further as the baby boom generation retires (Westphal, Raleigh News & Observer, 11/30). As a result, Bush is "coming under intensifying pressure from conservatives in the Republican ranks who want him to do more to choke off what they see as an orgy of spending since he took office," the New York Times reports (New York Times, 11/29). "This bill, put quite simply, is the largest intergenerational tax increase in the history of the country, and it should not be sugarcoated," Sen. Judd Gregg (R-N.H.) said (Raleigh News & Observer, 11/30). Nine Republican senators and 25 House Republicans voted against the Medicare bill, largely because of cost, according to the Washington Times (Lakely, Washington Times, 11/28). But Bush administration officials said they still expect to be able to reduce the deficit through curbs on spending and increase revenue as the economy improves (Raleigh News & Observer, 11/30).
The provision in the Medicare bill allowing the creation of tax-preferred health savings accounts "could have a profound effect on employer-based medical insurance plans," according to experts, the Washington Post reports (Crenshaw, Washington Post, 11/27). The bill would allow the creation of health savings accounts for individuals with health plan deductibles of $1,000 per year and couples with deductibles of $2,000 per year (California Healthline, 11/18). The accounts could begin as soon as January, according to the Chicago Tribune (Meyer, Chicago Tribune, 11/27). In the final days before the Medicare bill passed, the health savings account provision was supporters' "most powerful argument," the Los Angeles Times reports (Kemper, Los Angeles Times, 11/27). Some experts say that the accounts could help slow rising health care costs because workers would be paying some of their medical costs themselves, according to the San Jose Mercury News (Schwanhausser, San Jose Mercury News, 11/27). During a speech at a Las Vegas hospital on Tuesday, Bush called the accounts "an important part" of Medicare reform, because such accounts "trust the consumers, provide incentives for people to make wise choices and help to maintain the doctor-patient relationship," according to the Post. But critics say the new accounts will appeal mostly to people who are healthy and young, drawing them away from traditional plans (Crenshaw, Washington Post, 11/27). USA Today reports that the provision might influence some employers that offer health coverage to raise deductibles to $1,000 so workers can qualify for the savings accounts, thus raising out-of-pocket costs for employees even further. Critics also say the plans could result in employers dropping insurance coverage altogether and offering only savings accounts (Appleby, USA Today, 12/1).
A proposal by Rep. Dana Rohrabacher (R-Calif.) that would require hospitals to turn over undocumented immigrant patients to immigration officials before being reimbursed for care is coming under fire from a number of sources, the Fort Worth Star-Telegram reports (Brooks, Fort Worth Star-Telegram, 11/30). Rohrabacher agreed to vote for the Medicare bill in exchange for a promise by House leadership for a vote on the provision. It would require hospitals to "report to authorities within hours of treatment that health care is being provided to illegal immigrants," the Washington Times reports. The Medicare bill includes $1 billion to reimburse hospitals for treating indigent undocumented immigrants. Rohrabacher's office said it expects a vote on the provision in 2004 (Dinan, Washington Times, 11/27). Hospitals originally praised Rohrabacher's move, but now some are concerned that such a provision would increase paperwork and lead to more discrimination lawsuits and more public health problems (Fort Worth Star-Telegram, 11/30). Laurie Lange, vice president of public affairs for the Arizona Hospital and Healthcare Association, said that "hospitals don't want to get mixed up with immigration issues," according to the Washington Times (Washington Times, 11/30).
The New York Times on Saturday examined some of the "little-known" provisions in the Medicare legislation that would benefit specific health providers. For instance, to secure the vote of Rep. Harold Ford (D-Tenn.), lawmakers added a provision that would benefit an unnamed hospital in his state. Further, the bill also would increase payments to doctors in Alaska providing brachytherapy, a cancer treatment manufactured by the Buford, Ga.-based Theragenics. The provision was proposed by Sen. Saxby Chambliss (R-Ga.) and Rep. Nathan Deal (R-Ga.). In addition, many of the 358 groups supporting the Medicare legislation "stand to benefit" from it and some of them participated in a lobbying campaign for the bill, according to the New York Times. Timothy Westmoreland, a professor at Georgetown University Law Center, said, "Big bills become larded with whatever bait it takes to get a majority vote. A lot of the Medicare bill is spent on things that have nothing to do with a prescription drug benefit" (Pear/Janofsky, New York Times, 11/27).
As Republicans tout the success of their efforts to expand Medicare and Democrats criticize the legislation for being a "giveaway to drug and insurance companies," Medicare likely will be a "flashpoint" in the upcoming presidential election, the Los Angeles Times reports. President Bush is expected to praise the bill as "proof that he has delivered a 'compassionate conservative' agenda" and succeeded in his effort to modernize the program, according to the Los Angeles Times (Brownstein, Los Angeles Times, 11/30). After the bill passed on Tuesday, Bush said, "Some said Medicare reform can never be done. For the sake of our seniors, we got something done" (Espo, AP/Las Vegas Sun, 11/30). Bush also is expected to use the legislation's passage to pursue even greater changes in Social Security that would give workers the option of diverting part of their payroll taxes into individual investment accounts that they can invest in the stock market, according to the Los Angeles Times. On the campaign trail, many Democrats will continue to say that the Medicare bill provides inadequate benefits for many seniors and that it will undermine Medicare's traditional benefits. They also will characterize the bill as a "giveaway" to HMOs, which would receive incentives to participate, and to pharmaceutical companies, which would not be required to negotiate with the federal government for lower drug prices, according to the Los Angeles Times (Brownstein, Los Angeles Times, 11/30). "This is an election-year gimmick charged to the taxpayers," former Vermont Gov. and presidential candidate Howard Dean (D) said (Jackson/Hillman, Dallas Morning News, 11/27).
The Medicare issue will likely be "only one factor" in the 2004 election, and "possibly not the major factor, in determining how seniors vote," analysts say, the Los Angeles Times reports. Because the prescription drug benefit would not take effect until 2006, Democrats and Republicans will have to shape public opinion on the legislation through arguments, instead of practical experience. Moreover, recent elections have shown that seniors' votes are shaped not only by issues like Social Security and Medicare, but also by issues such as international policy and homeland security (Brownstein, Los Angeles Times, 11/30). A recent poll showed that voters ages 65 and older would choose a generic Democratic president over Bush, but Bush was favored over the specific Democratic candidates (Dallas Morning News, 11/27).
Several newspapers recently examined the political "back-scratching" and "arm-twisting" that resulted in the Medicare bill's passage. Lawmakers were able to break the logjam over the House-passed competition provision, cost-control mechanisms, tax-preferred health savings accounts and employer incentives by crafting political solutions that in some cases were just a "fig leaf," USA Today reports (Welch, USA Today, 11/28). The Washington Post reports that after six years of "political fighting over Medicare's future," lawmakers were able to take definitive action in 2003 because "top GOP leaders of the House and Senate intervened and imposed their will." In a phone call to Medicare conference committee chair Rep. Bill Thomas (R-Calif.) on Nov. 12, House Majority Leader Tom DeLay (R-Texas) and House Speaker Dennis Hastert (R-Ill.) said that "the price of failure on the proposed Medicare revision would be too high," according to the Post. In the end, the Republican leaders' "dual strategy" of limiting input from the Bush administration and courting outside groups and Senate Democrats ensured passage of the bill (Goldstein, Washington Post, 11/30). The Los Angeles Times on Friday examined Senate Majority Leader Bill Frist's (R-Tenn.) role in the passage of the Medicare bill. According to Sen. John Breaux (D-La.), Frist "played a critical role" in securing the bill's passage. "It could well never have happened had he not stood up and said, 'Look, we're going to settle this at the leadership level," Breaux said (Anderson, Los Angeles Times, 11/28).
Sen. Edward Kennedy (D-Mass.), who has been vocal in his criticism of the Medicare bill, said that after the "unfair dealing" involved in the bill's passage, he will shift tactics in how he advocates legislation. He said he will "demand commitments up front that Democrats be included in conference committees and that major changes [to legislation] be avoided," the Boston Globe reports. He also said he wants to "pre-conference" bills to avoid scenarios in which bills passed by the Senate are rewritten by conservative House members in conference committees, according to the Globe. But conservatives say that despite Kennedy's concerns, the Medicare legislation contains much of what he supports, including the new drug benefit and the largest expansion of the program since its creation in 1965 (Milligan, Boston Globe, 11/27).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.