House Speaker Hastert Urges Passage of Final Medicare Bill

As talks to reconcile House and Senate Medicare bills (HR 1 and S 1) appear "stalled" over "deep ideological disagreements," House Speaker Dennis Hastert (R-Ill.) on Thursday tried to "revive negotiations," the New York Times reports. Hastert urged negotiators to work quickly to produce a bill that would pass both chambers, saying, "My personal opinion is if we don't get this thing done now, we don't get it done. It will be almost impossible for us to get anything major done after we adjourn in the fall." If Congress does not approve a reconciled Medicare bill this year, Democratic senators could "exploi[t]" the issue in the 2004 election cycle, Hastert said, according to the Times. In an effort to pass legislation, the Times reports that House Republicans have abandoned a goal of bipartisan support in the Senate and are now aiming to produce a bill that would attain a simple 51-vote majority in the Senate. However, one unnamed Republican aide said that a party-line vote strategy would probably be unsuccessful because some Senate Republicans are expected to vote against the bill. House Republican Whip Roy Blunt (Mo.) said that the House would not likely pass a bill supported by 60 senators -- the number needed to break a filibuster -- but he added, "I don't believe the Senate would filibuster this issue, as important as it is." Blunt said, "I think our goal should be to get a bill that gets a majority in the Senate."

On Thursday, Senate Democrats kept up a "drumbeat of criticism" on the Medicare legislation, particularly criticizing a measure that would require private health insurers to compete with traditional, fee-for-service Medicare by 2010 and one that would relate beneficiaries' incomes to premiums under Medicare Part B, which covers outpatient services, the Times reports. Sen. Jack Reed (D-R.I.) called the emerging legislation "the greatest bait-and-switch scheme the Republic has ever seen." However, House Majority Leader Rep. Tom DeLay (R-Texas) said lawmakers are "on the right course" because Democrats are "starting to wail," according to the Times. DeLay said Democratic lawmakers are "destructive and obstructive," while "the Republicans are getting things done" (Pear, New York Times, 11/7).

Hastert and Sen. Charles Grassley (R-Iowa) on Thursday disagreed on including a provision regarding health savings accounts in a final Medicare bill, CongressDaily reports (Wegner/Heil, CongressDaily, 11/6). A measure in the House bill would permit people enrolled in private health plans to create savings accounts to accrue money tax-free to pay for some medical expenses, including medical treatment, medications and long-term care services or coverage. Under the provision, individuals with health insurance deductibles of at least $1,000 and families with deductibles of at least $2,000 could use the health savings accounts. Conferees previously rejected creating health savings security accounts for individuals with $500 deductibles and families with $1,000 deductibles, the more expensive of the two accounts. The issue has become important in winning conservative support for the Medicare legislation, but some Democrats oppose the proposed health savings accounts (California Healthline, 11/5). Hastert said the accounts represent "one of the most important pieces" of the drug bill. However, Grassley said that of the significant debate points -- which include cost containment measures, income relating and health savings accounts -- lawmakers are least likely to reach a compromise on the health savings accounts. In other matters, Grassley said that conferees are likely to include language from the Senate Medicare bill that would allow U.S. residents to purchase lower-cost prescription drugs from Canada (CongressDaily, 11/5). The Senate-passed legislation would allow the purchase of drugs only from Canada and only if the FDA certifies the practice. A similar provision included in the House bill would give U.S. residents permission to purchase drugs from Canada and two dozen other industrialized nations but would not require approval (California Healthline, 11/6). Grassley said negotiators "can't go back to the House and Senate" without a reimportation measure in a final bill (CongressDaily, 11/6). Talks on whether to discourage doctors from investing in specialty hospitals, whether to require competitive bidding for durable medical equipment and whether the government will administer Medicare drug coverage in areas where too few private plans participate are expected to continue on Friday, CongressDaily/AM reports. Negotiators likely will take up "major decisions," such as reimportation, cost containment measures and the competition provision, on Monday, according to CongressDaily/AM.

CongressDaily/AM reports that the "slow pace" of the Medicare talks might jeopardize the scheduled Nov. 21 congressional adjournment. Conference committee members said it is not likely they will have a final proposal ready by Monday, as requested by Rep. Bill Thomas (R-Calif.), the conference committee's chair. Although it might not take a full eight days to write a bill and get it scored by the Congressional Budget Office, CongressDaily/AM reports that lawmakers who are not conference committee members will need additional time to review the legislation (Rovner/Heil, CongressDaily/AM, 11/7). House Republicans have asked leadership to allow them three days to examine a final bill before a floor vote (California Healthline, 10/29). In addition, several unnamed sources have said that the emerging bill likely would exceed the $400 billion over 10 years spending limit set by the Bush administration, which would "require another round of negotiations and changes," according to CongressDaily/AM(CongressDaily/AM, 11/7).

Medicare cost-containment measures that lawmakers are considering "are ill-designed and could force radical changes that would disproportionately hurt those with low and moderate incomes," according to a report released by the Center on Budget and Policy Priorities, CongressDaily/AM reports. Conferees are considering proposals to cap the federal government's general revenue Medicare spending at 45% of the total budget. A measure that would reduce provider reimbursements would cause providers to stop treating Medicare beneficiaries and other proposals that would increase beneficiaries' share of costs could leave the "near-poor unable to afford ... basic medical care," the report states. The report also states, "It makes no ... sense to say that reliance on general revenue financing makes Medicare Part B or the new drug benefit insolvent" (Rovner, CongressDaily/AM, 11/7). The report is available online.

Negotiating a Medicare prescription drug benefit has been difficult this year, as the "risk of alienating a key voting bloc with a bill that falls well short of expectations is large," the Christian Science Monitor reports. Medicare beneficiaries' concerns include the "complexity" of the proposed drug benefit, increased health costs and the possibility that former employers would stop offering retiree drug benefits if a Medicare drug benefit is enacted, according to the Monitor. David Certner, director of federal affairs for the AARP, said that whether the benefit is "good or bad, it's going to be a lot more choices and decisions than people had to make before. They are going to be a lot more confused." Larry Sabato, a political scientist at the University of Virginia, said, "Not only is a backlash possible, it's likely. Seniors want what America probably can't afford. They are only going to be satisfied with a very generous prescription drug bill that would break the bank" (Russell Chaddock, Christian Science Monitor, 11/7). Sen. John Breaux (D-La.) said that unless Medicare negotiators reach a compromise, the end result will be "a basket full of excuses to give to seniors ... And they can't take excuses to the drug store to get their prescriptions" (Kemper, Los Angeles Times, 11/7).