Medicare Conferees May Abandon Reimportation Language
Negotiators attempting to reconcile the House and Senate Medicare bills (HR 1 and S 1) might not include language that would permit people in the United States to purchase cheaper prescription drugs from Canada and other foreign nations, the Washington Post reports. Both the House and the Senate have passed legislation that would allow the reimportation of U.S.-made drugs from abroad; the House-passed legislation includes language that would give U.S. residents permission to purchase drugs from Canada and two dozen other industrialized nations where drug prices are government-controlled. The Senate-passed legislation would allow the purchase of drugs only from Canada and only if the FDA certifies the practice. Some Senate negotiators are pushing for conferees to adopt the Senate's more restrictive approach, but Rep. Bill Thomas (R-Calif.), the chair of the conference committee, has "balked" at that proposal, according to the Post. Rep. Billy Tauzin (R-La.), who opposes reimportation, has given conferees an outline questioning whether the final bill should omit language on the issue. According to the Post, key House Republicans are recommending abandoning reimportation language in the final bill and allowing federal health officials to conduct a study of the issue.
However, the possibility that conferees will eliminate reimportation language from the final Medicare bill "raises questions about whether a final Medicare agreement can pass the House," the Post reports. In June, the House Medicare bill passed by one vote -- only after House Speaker Dennis Hastert (R-Ill.) promised Rep. Jo Ann Emerson (R-Mo.) that he would schedule a vote on reimportation and she switched her vote to favor the legislation (Goldstein/Dewar, Washington Post, 11/6). CongressDaily/AM reports that conferees still might try to include a "watered-down" provision on reimportation (Heil/Rovner, CongressDaily/AM, 11/6). In an interview on Wednesday, Emerson said, "Coming up with an entirely new position short of either (the House or Senate approach) does not, in my opinion, reflect the will of the House by any stretch of the imagination" (Washington Post, 11/6). Other members of the House who support reimportation say they are withholding judgment until they see the final package, but some have said they will vote against the bill if it contains "the wrong reimportation policy," according to CongressDaily/AM (Heil/Rovner, CongressDaily/AM, 11/6).
As conferees work to reach a compromise on the reimportation issue, the differences between Senate Democrats and House Republicans continue to complicate negotiations on other issues, CongressDaily/AM reports. Some of the most contentious issues negotiators are still debating include the House-passed competition provision that would require traditional, fee-for-service Medicare to compete with private health plans beginning in 2010; tax-preferred health savings accounts; and a measure that would contain the cost of the legislation (Rovner, CongressDaily/AM, 11/6). According to the Wall Street Journal, the competition issue and ongoing disagreements over cost-containment go "to the heart of an ideological struggle" between Democrats and Republicans. Further, the Medicare debate is "awakening deeply felt beliefs about the role of government and what has been a social contract with senior citizens," the Journal reports. Thomas said, "You just have to be more creative and figure a way around what appears to be an impasse. We've always been able to do that. This one is especially challenging." Many Republicans say that introducing more competition into Medicare would save money over the long-term by lowering premiums. But some Democrats say that competition will set Medicare up for failure by making it "sit passively by as patients were picked off by private plans in lucrative markets," the Journal reports (Rogers, Wall Street Journal, 11/6). To support their claims, the Democratic staff on the House Budget Committee on Thursday will release a report detailing potential disparities in premiums throughout the country under the proposed competitive system. According to a staff analysis, premiums for the fee-for-service program could range from $675 to $2,400 annually in counties across the United States if the competition provision is enacted (Rovner, CongressDaily/AM, 11/6).
Some Senate Democrats have warned that disagreements over several key issues, including the House-passed competition provision, could block a compromise. According to Senate Minority Leader Tom Daschle (D-S.D.), an "overwhelming majority" of Senate Democrats have expressed serious concerns about the direction of the negotiations, and Sen. Edward Kennedy (D-Mass.) said that negotiations are "in free fall," as Republican negotiators "cate[r] to House Republicans on key issues as they craft a final bill" (California Healthline, 11/5). Senate Democrats also have complained about being largely left out of negotiations (Rovner, CongressDaily/AM, 11/6). Daschle said, "This has become not a fight to add prescription drug benefits to Medicare, but a fight to save Medicare itself" (Rovner/Wegner, CongressDaily, 11/5). Sen. John Breaux (D-La.), a conference committee member, said that the Medicare legislation "is not dead. It's not on life support. We can make it work" (Washington Post, 11/6). He added, however, that a "GOP-only bill cannot pass the Senate" (Rovner/Wegner, CongressDaily, 11/5). In the House, there are three groups that could "derail" the bill -- those who support reimportation, those who support controls on Medicare costs and those who support allowing only a prescription drug discount card, not a drug benefit, CongressDaily/AM reports (Heil/Rovner, CongressDaily/AM, 11/6). The Hill reports that a possible approach Republicans could take would create legislation that would pass "mostly along party lines" (Cusack, The Hill, 11/6). Democrats are concerned that Republicans' strategy is to "move far to the right to win a majority in the House, then dare the Senate to kill an unacceptable bill and blame them for being obstructionists," CongressDaily/AM reports (Rovner, CongressDaily/AM, 11/6).
On Wednesday, a number of reports surfaced that conferees will miss their self-imposed Friday deadline and "are close to declaring that they cannot reach agreement," the Hartford Courant reports. Republican leaders set the Friday deadline in the expectation that it will take two weeks to move any Medicare legislation through the House and Senate. "We ain't going to be around here after Nov. 21, so it's either get it done this week or no bill," Sen. Charles Grassley (R-Iowa) told "CQToday." But Sen. Trent Lott (R-Miss.) said, "I'm very leery of (the negotiators') ability to come to an agreement that can pass the Senate, and I'm leery of what would be in that agreement" (MacDonald, Hartford Courant, 11/6). However, Sen. Tom DeLay (R-Texas) predicted that conferees were nearing a compromise, saying, "The obstructionist Democrats in the Senate ... are starting to wail; we must be getting close" (Pierce, Washington Times, 11/6). An unnamed congressional source said that Hastert and Senate Majority Leader Bill Frist (R-Tenn.) have directed staffers working on the bill to finish by Tuesday; the preliminary plan calls for a vote on a conference report the week of Nov. 17 (The Hill, 11/6).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.