GOP Objections May Delay Floor Action on $350B Medicare Reform Package

Although House Republican leaders "insist" a floor vote will occur this week on a GOP-backed $350 billion Medicare reform package that includes a prescription drug benefit, objections from some House Republicans could "imperil passage" of the bill, the Washington Times reports (Fagan, Washington Times, 6/26). At least four separate groups of Republicans have threatened to vote against the package unless they can amend the bill. With few Democrats expected to support the package, leadership aides yesterday acknowledged they might be short of the 218 votes needed to pass the GOP plan. As a result, the leadership is holding a Republican conference meeting today instead of putting the bill on the floor (Rovner, CongressDaily/AM, 6/26). "We're aware of their concerns; we're trying to work with that," John Feehery, a spokesperson for House Speaker Dennis Hastert (R-Ill.), said. He added that a floor vote still will be held before the July 4 recess (Washington Times, 6/26).

As it stands, there are two versions of the bill, one approved by the House Energy and Commerce Committee and one approved by the House Ways and Means Committee. Under both versions, Medicare beneficiaries would be allowed to purchase drug coverage directly from private insurance companies. Seniors would pay a $250 annual deductible and a $35 monthly premium. Low-income seniors would be exempt from the premiums and deductible. The government would cover 80% of seniors' annual prescription drug costs up to $1,000, 50% up to $2,000 and no costs between $2,000 and $3,700 or $3,800, caps approved by the Energy and Commerce and Ways and Means committees, respectively. After that amount, a catastrophic benefit would begin. The Energy and Commerce measure also includes a provision allowing drug plans to negotiate discounts with pharmaceutical companies greater than the price breaks Medicaid programs receive. The Ways and Means version includes a provision requiring Medicare beneficiaries to pay a $40 copayment for home health services, a provision that was dropped from the Energy and Commerce version (California Healthline, 6/25). Reps. Gil Gutknecht (R-Minn.), Jo Ann Emerson (R-Mo.) and Jack Kingston (R-Ga.), John Peterson (R-Pa.) and Marge Roukema (R-N.J.) are pushing to amend the Republican bill to address their concerns, which include:

• Costs: Gutknecht has drafted an amendment that would allow U.S. residents to buy and reimport FDA-approved drugs sold in foreign countries at lower costs. Emerson wants to add an amendment that would make it difficult for pharmaceutical companies to delay market entry of generic drugs.
  
• Hospital payments: Peterson said he would "absolutely" vote against the bill unless Medicare payments to rural hospitals are increased by 5%. In addition, Roukema is lobbying to reclassify certain hospitals in New Jersey as part of the New York metropolitan area. Such a classification would result in increased Medicare payments for those facilities (CongressDaily/AM, 6/26).

Meanwhile, the House Rules Committee could merge the versions of the bill passed by the Ways and Means and Energy and Commerce committees, according to an aide (Congressional Quarterly, 6/25). The two committees have yet to file their reports with the Rules Committee, but are expected to do so late Wednesday or early Thursday (Darryl Drevna, California Healthline, 6/26).