House Defeats Democrats’ Proposal on Instructing Medicare Conferees
The House on Wednesday voted 220-189 along party lines against a measure that would have called for negotiators attempting to reconcile the House and Senate Medicare bills (HR 1 and S 1) to reject the House-passed competition provision and adopt a government-run "fallback" drug plan, CongressDaily reports. No Republicans voted in favor of the motion (Rovner, CongressDaily, 9/11). The competition provision calls for private health plans to compete directly with fee-for-service Medicare beginning in 2010 (California Healthline, 9/9). Under the fallback provision in the Senate bill, the federal government would provide drug benefits in areas that do not have coverage options from at least two private plans (California Healthline, 9/8). According to CongressDaily, the vote "drove home" how difficult it will be to pass a final bill in the House and Senate. With the vote, the House is now "firmly on record" as supporting the competition provision and opposing the fallback provision; however, Senate Democrats and some Republicans have said they would not vote for a final bill that contains the competition measure or omits the fallback measure, CongressDaily reports (CongressDaily, 9/11). Conference committee members are scheduled to meet this week to discuss provisions in both bills that address provider payments. Christin Tinsworth, a spokesperson for conference committee Chair Rep. Bill Thomas (R-Calif.), said conferees will likely meet early to midweek. According to the CQ Today Midday Update, aides to committee members in a Sept. 9 meeting circulated an outline of 24 "provider issues" that negotiators must address, including payments to "low-volume" hospitals, which are typically in rural areas (CQ Today Midday Update, 9/12).
A coalition of about two dozen health, labor and consumer groups has written a letter to conferees urging them to eliminate a provision from the final Medicare bill that would expand access to health savings accounts, CongressDaily reports (CongressDaily, 9/11). The provision would allow the creation of savings accounts that people enrolled in private health plans could use to accrue money tax-free to pay for some medical expenses, including medical treatment, medications and long-term care services or coverage (California Healthline, 8/14). The coalition, which includes the AFL-CIO, the Center on Budget and Policy Priorities, Consumers Union and United Cerebral Palsy, said in the letter that HSAs "are likely to significantly weaken the employer-based health insurance system through which the vast majority of Americans obtain their health coverage." The letter also said that making HSAs more accessible would encourage employers to adopt "less-comprehensive, high-deductible insurance, where employees bear a significantly greater proportion of health care costs." In addition, the letter said that low-income workers or employees who are in poor health -- "who are least able to take advantage of the tax benefits of these accounts but who most need health care -- could therefore lose access to necessary medical services" (CongressDaily, 9/11).
The New York Times on Saturday examined health care usage by Medicare beneficiaries in Boca Raton, Fla., who "have more office visits, see more specialists and have more diagnostic tests than almost anywhere else in the country." According to the Times, Boca Raton has become a "case study" of what happens when people "are given free rein to have all the medical care they could imagine" -- doctor appointments have become a "social activity" for beneficiaries, many of whom have between eight and 12 specialists and visit "one or more of them most days of the week," and "every visit, every procedure is covered by Medicare." The Times states that Boca Raton has become a "cautionary tale" because it illustrates "why it is so hard to control costs" in the Medicare program (Kolata, New York Times, 9/13).
The New York Times yesterday examined the "bleak" financial choices lawmakers may be forced to make given the nation's current economic condition and President Bush's recent request for $87 billion to fund military operations in the Middle East. The Congressional Budget Office last month warned that if the administration enacts all its planned tax cuts, lawmakers pass a prescription drug benefit under Medicare and the nation continues to spend at its current level, the federal deficit could reach $6.2 trillion by 2013. The anticipated deficit, coupled with Bush's request for $87 billion to fund military operations, means lawmakers may have to decide between reconstructing Iraq or rebuilding America's hospitals, for example, or between paying for American soldiers to remain in the Middle East or funding a Medicare prescription drug benefit. The "painful effects" of the budget deficit have started to emerge, the Times reports, noting that spending "battles" over popular nonmilitary programs, such as veterans hospitals, have already begun. In addition, while federal deficits "can be useful" to stimulate the economy, if they "persist for years" they can boost interest rates and "impose huge costs" on Medicare just as the baby boomer generation will begin to receive benefits (Firestone, New York Times, 9/14).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.