Health Experts Question House Republican Medicare Rx Drug Benefit Plan

The House Republican plan to provide a prescription drug benefit to Medicare beneficiaries through private health insurers has received a "skeptical reaction from many health policy experts," the New York Times reports (Pear, New York Times, 6/16). The latest drafts of the House GOP plan, which would cost $350 billion over 10 years, would require Medicare beneficiaries to pay a $250 deductible and a $35 premium. The plan would require seniors to cover 20% of their annual prescription drug costs up to $1,000, 50% up to $2,000 and 100% between $2,000 and $4,500, when a catastrophic benefit would begin (California Healthline, 6/14). Under the plan, Medicare would pay subsidies to private health insurers to provide prescription drug coverage for beneficiaries. However, the Times reports that most private health insurers do not offer "drug-only" coverage, and many doubt that they could provide the coverage at an affordable price. Republicans have said that health insurers and pharmacy benefit managers that participate in the plan would submit bids to the government "specifying the premiums they proposed to charge" for prescription drug coverage. The companies would manage the coverage and "share the risk of financial loss if subscribers' drug costs exceeded expectations." According to some health policy experts, however, the House Republican plan would face the same problems that have "plagued" the Medicare+Choice program. Many health plans have withdrawn from the program since 1998, dropping coverage for 2.2 million beneficiaries, as a result of "inadequate" reimbursements from Medicare (New York Times, 6/16).

Sens. Bob Graham (D-Fla.) and Zell Miller (D-Ga.) on Saturday also criticized the House GOP plan in the Democratic response to President Bush's weekly radio address. According to Graham and Miller, the "confusing and complicated" plan has a "gap in coverage" and an "untested delivery system run by private insurance companies" (Price, Washington Times, 6/16). They added that the Senate "soon" may vote on a rival Democratic plan (Miller, AP/South Florida Sun-Sentinel, 6/15). Under the Democratic plan, sponsored by Graham and Miller, Medicare beneficiaries would pay a $25 monthly premium with no deductible, a $10 copayment for generic drugs and a $40 copayment for brand-name drugs, and Medicare would cover their annual prescription drug costs that exceed $4,000. The plan also calls for reduced premiums and copayments for low-income beneficiaries (California Healthline, 6/13).