Medicare Conferees Consider Copayment for Home Health Services
Negotiators attempting to reconcile the House and Senate Medicare bills (HR 1 and S 1) say they are "seriously considering" adding a copayment for home health care services, the New York Times reports. Home health care is one of the few Medicare benefits that currently does not require a copay; lawmakers in 1972 eliminated such a copay to encourage more use of care at home rather than in nursing homes or hospitals, where it is more expensive. Several negotiators said on Monday that they are considering implementing a $40 to $45 copayment for each 60-day period in which a beneficiary receives home health care services. The House bill includes such a copay provision, but the Senate bill does not. Conferees also are weighing proposals that would exempt low-income beneficiaries from the new copay and exempt the first 60-day episode of home care from the charge. The House bill also would reduce the annual increase in Medicare payment rates for home health services in each of the next three years, according to the Times. The Times reports that the new copay and the eliminated rate increase would reduce Medicare spending by $7 billion in the next 10 years. Supporters of the proposed copay said it would help "deter unnecessary use of home care," the Times reports. Medicare conference committee chair Rep. Bill Thomas (R-Calif.) said, "Requiring beneficiaries to share the cost of home health services encourages them to use care more prudently." But opponents, including home care agencies and advocates for the elderly, called the copay a "sick tax," the Times reports. A letter to conferees drafted by Sen. Susan Collins (R-Maine) and Russell Feingold (D-Wis.) and signed by 57 senators said that a "home health copayment of $40 to $50 per episode would impose a significant additional burden on those beneficiaries who can least afford it." CMS Administrator Tom Scully said that the Bush administration has not taken a formal position on the proposed copay, but he personally believes that "a good case can be made for charging a modest copayment to people who can afford it." Many observers said it is "likely" that a home health copay will be included in the Medicare bill, the Times reports. Negotiators also are considering a copay for diagnostic tests performed by clinical laboratories; the Senate bill would require beneficiaries to pay 20% of the cost of such tests (Pear, New York Times, 10/13).
Issues that negotiators are still working to resolve include a provision in the House bill that would set up direct competition between traditional Medicare and private plans; the details of a drug benefit; relating benefits or premiums to income; and allowing the purchase of prescription drugs from abroad (Lueck, Wall Street Journal, 10/14). At a Friday news conference organized by the advocacy group Citizen Action of New York, Sen. Hillary Rodham Clinton (D-N.Y.) said that the proposed drug benefit would "actually raise costs for millions of New Yorkers and result in poorer coverage for many of them," the New York Times reports. Clinton said that she will oppose any final bill unless it is "more generous" than those already passed (Perez-Pena, New York Times, 10/11). The AP/Baltimore Sun reports that the issue of incentives to discourage companies from dropping or reducing prescription drug coverage for retirees when a new Medicare drug benefit begins is another "one of [the] many interlocking and expensive items confronting lawmakers" this week. A study by the nonpartisan Employee Benefit Research Institute concluded that it is unclear how many retirees would lose employer-sponsored drug coverage if a Medicare drug benefit took effect. Currently, an estimated 12 million seniors receive their drug coverage through former employers, according to the AP/Sun (AP/Baltimore Sun, 10/12). The Congressional Budget Office has estimated that 32% of Medicare beneficiaries who currently have drug coverage through their former employer would lose that coverage under the House Medicare reform bill, and an estimated 37% would lose employer-sponsored drug benefits under the Senate bill (California Healthline, 9/16). On Thursday, Senate Majority Leader Bill Frist (R-Tenn.) urged conferees to try to find ways to keep companies from cutting retiree drug benefits if Congress passes a Medicare prescription drug benefit (California Healthline, 10/10). Negotiators are discussing subsidies or tax credits for companies that retain retiree drug benefits, as well as loosening Medicare regulations (AP/Baltimore Sun, 10/12).
Accounts of the progress in Medicare negotiations are mixed, and many lawmakers remain unsure when or if they will pass a final bill, the Hartford> Courant reports. The "most optimistic scenario" would have conferees agree on a final bill by Oct. 17, a deadline set by Republican leaders, according to the Courant. Rep. Nancy Johnson (R-Conn.) noted that conferees have so far resolved only about one-third of the issues they will need to address to draft a comprehensive bill and said it is "unlikely" that negotiators will meet the deadline (MacDonald, Hartford Courant, 10/11). A top aide to Thomas said that "momentum is building" (New York Times, 10/14). A spokesperson for Sen. Edward Kennedy (D-Mass.) said that the senator is "hopeful" that a final bill will be passed and that he is "looking for the White House to step in and provide some momentum." White House spokesperson Scott McClellan said that the Bush administration is "working very closely with members of Congress to pass a strong Medicare bill." But House Minority Leader Nancy Pelosi (D-Calif.) said that she does not believe that conferees are on track to finish, adding that the cost of the war with Iraq and its aftermath "diminishes the prospects for affording a prescription drug benefit" (Hartford Courant, 10/11). The Wall Street Journal reports that although "fundamental disagreements over the long-term direction of the Medicare program" remain, the shape of an eventual compromise bill is emerging. Negotiators agree that if a compromise is not crafted by next month, there is little chance that Congress will pass a Medicare reform measure this year (Wall Street Journal, 10/14).
The Washington Post on Tuesday examined many of the "one-vote victories" in the House this year. Such efforts can enable House leaders to "push legislation as much to their liking as they can in a narrowly divided and bitterly partisan House." One narrow victory was the 216-215 vote earlier this year under which House members approved the Medicare bill. Prior to the vote, leaders arranged briefings by senior House members to persuade reluctant first-term members to support the plan. When the bill's backers realized they were "short of victory," House leaders "worked the floor, looking for a convert," and eventually persuaded Rep. Jo Ann Emerson (R-Mo.) to back the plan if leadership "promised to allow a later vote on reimporting U.S.-made prescription drugs from abroad," the Post reports. That compromise allowed the Medicare bill to pass but also allowed the drug reimportation bill to come up for a vote and receive House approval, despite opposition from the House leadership and Bush administration, according to the Post (Eilperin, Washington Post, 10/14).
The St. Petersburg Times on Tuesday looked at the disagreement between President Bush and his brother, Florida Gov. Jeb Bush (R), over whether Medicare should cover prescription drug costs for people dually eligible for Medicare and Medicaid, costs now covered under Medicaid. President Bush has said that the federal government cannot afford to provide drug coverage to dual-eligibles, while Gov. Bush has been lobbying Congress and the administration to support a provision in the House-passed Medicare bill that would allow a Medicare drug benefit to cover dual-eligibles (Fritz, St. Petersburg Times, 10/14).
In a full-page ad in the New York Times on Tuesday, AARP and the Business Roundtable urged lawmakers to reach a compromise on the Medicare bill. The ad calls for a Medicare drug benefit to be comprehensive and to cover all Medicare beneficiaries. The groups urged Congress to "enact a Medicare drug benefit that provides incentives for employers to continue to provide high-quality drug coverage to retirees." The groups also asked lawmakers to allow beneficiaries to stay in traditional Medicare "without financial penalty" (New York Times, 10/14).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.