MEDICARE: Democrats Mull Reimbursement Restorations

      Senate Democrats met yesterday to develop a consensus proposal for restoring Medicare reimbursement cuts to providers, CongressDaily/A.M. reports. After the meeting, Minority Leader Tom Daschle (D-SD), noting a "sense of urgency" over restoring the cuts, said they are "considering a package of about $20 billion over five years" -- significantly more than the $7.5 billion boost contained in President Clinton's Medicare reform package. Daschle said such a measure would have to be attached to a revenue bill, but as a tax cut and a restructuring of Medicare appear to be dead letters this year, "other targets ... include the tax extenders bill" or a Caribbean trade bill. Democrats have yet to determine how to divide the funding among nursing homes, home health providers, hospital care and medical education. Although Daschle criticized Republicans for not addressing the issue, Senate Finance Committee Chair William Roth (R-DE) is expected to include some restoration of the cuts in a comprehensive Medicare reform plan he will introduce in coming weeks.

Teaching Hospitals Raise Their Voices
      Meanwhile, representatives from Massachusetts teaching hospitals yesterday met with Sen. Edward Kennedy (D-MA) and OMB Director Jack Lew to advance their case for greater reimbursements. In a letter to Roth and Finance Committee ranking member Daniel Patrick Moynihan (D-NY), Kennedy, along with Sens. Bob Kerrey (D- NE), Arlen Specter (R-PA) and Bill Frist (R-TN), wrote that the Balanced Budget Act of 1997 "disproportionately affects teaching hospitals ... creating losses in reimbursement twice those for the average hospital." Also, American Association of Health Plans President Karen Ignagni said Medicare HMOs are looking for about $7 billion in funding restorations (Rovner, 9/15).

'Proceed with Care'
      In an op-ed in the Investor's Business Daily, National Association of Manufacturers President Jerry Jasinowski writes that Medicare reform has "many employers extremely wary" for three reasons: Manufacturers pay half of the payroll tax that funds Medicare Part A, one-third of retirees receive health care from their former employers that Medicare reform may jeopardize, and the "Medicare program has an enormous impact on health care provided to the under-65 population." On the question of a drug benefit, he writes that "layering another ad-hoc benefit on top of a deteriorating Medicare system is like building a swimming pool atop a rickety building. The one thing the Medicare system doesn't need is a new entitlement program premised on a poorly crafted funding system. While modest today, the drug benefit will balloon in cost, inviting tax increases and price controls that could affect the development of life-enhancing medicines." He says Congress should consider the Breaux-Thomas plan, concluding that reform is "a worthy objective as politicians ponder how to safeguard this vital national resource and make it more effective. Yet new spending and new taxes seem hardly the way to go about it" (9/15).

Seeing the Light?
      Rep. Michael Capuano (D-MA) will introduce legislation today that would require Medicare to pay for vision rehabilitation services. The cost of providing such services has yet to be determined, a fact he said "doesn't matter" next to the benefits (States News/Boston Globe, 9/15).