President Bush Urges Lawmakers To Reach Compromise on Final Medicare Bill
In a speech on Wednesday, President Bush urged lawmakers attempting to reconcile the House and Senate Medicare bills (HR 1 and S 1) to "finish the work" required to produce a final bill, although he offered no recommendations on how to resolve lawmakers' differences, the Los Angeles Times reports. "I urge the Congress to act quickly, to act this year, not to push this responsibility to the future," Bush said. According to the Los Angeles Times, administration officials have indicated that while passing a Medicare bill is "important to Bush ... the details of the legislation are not." During the speech, Bush reiterated his support for requiring traditional Medicare to compete with private plans, saying, "We have the opportunity, we have the obligation to give seniors more choices and better benefits" (Kemper, Los Angeles Times, 10/30). According to the Washington Post, Bush did not "explicitly take sides" in negotiators' dispute over requiring traditional, fee-for-service Medicare to compete directly with private health plans. However, he said the word "choice" nine times during the 14-minute speech, which the Post reports is "an allusion to the larger role for the private sector that the GOP favors for Medicare." Bush also emphasized the importance of ensuring that private employers do not drop drug coverage for retirees if Congress enacts the proposed Medicare drug benefit (Goldstein, Washington Post, 10/30). Bush said he wants to sign a Medicare bill into law before the end of the year (Fagan, Washington Times, 10/30). Reuters/USA Today reports that Bush coupled his appeal to negotiators to reach a compromise with a request that seniors lobby their lawmakers to enact a prescription drug benefit (Entous, Reuters/USA Today, 10/30). In a closed-door meeting with Medicare beneficiaries and representatives of interest groups on Wednesday, Bush said he "didn't want to penalize those who stay with a traditional Medicare plan," according to James Parkel, president of the AARP (Hamburger/Lueck, Wall Street Journal, 10/30).
Senate Majority Leader Bill Frist (R-Tenn.) said Bush's speech was "helpful," according to the Los Angeles Times. He added that the president's talk shows that Medicare legislation "is a major priority for the president of the United States that the Congress must deliver on in the next several weeks." Ron Pollack, executive director of Families USA, said, "[Bush] knows (passage of a prescription drug bill) is essential for him and for Republicans in Congress. But there needs to be a little banging of heads here, and that's not happening." John Rother, director of policy and strategy for AARP, said, "It seems pretty clear that (Bush) doesn't want to get too engaged. But to the extent that these disputes are between House Republicans and Senate Republicans, he's the obvious referee." The Los Angeles Times reports that many lawmakers said Bush's remarks "would do nothing to move the [negotiating] process forward." Senate Minority Leader Tom Daschle (D-S.D.) said, "The president restated today what we've all been saying for years: that seniors want and need a Medicare prescription drug benefit" (Los Angeles Times, 10/30). Daschle also expressed frustration that Bush had not weighed in on how to resolve the differences between Senate Democrats and House conservatives that have slowed the negotiations (Hamburger/Lueck, Wall Street Journal, 10/30). He said, "The president must do more than simply say, 'complete your work'" (Goldstein, Washington Post, 10/30). But White House Press Secretary Scott McClellan said that the "president has been personally involved in this issue for a long time" (Hamburger/Lueck, Wall Street Journal, 10/30). According to administration officials and Republican lawmakers, Bush's top health aides have attended the negotiations nearly every day. Sen. Edward Kennedy (D-Mass.) said in a statement that Bush should "disavow [House Republicans' demands] and support a fair compromise" (Washington Times, 10/30). Sen. Max Baucus (D-Mont.) told CNN immediately after Bush's speech that there would be a bill only if Bush "doesn't try to put an ideological agenda on top of the drug benefit." He said that the chances for a deal on the bill are 50-50 (Koffler/Rovner, CongressDaily, 10/29).
Conferees on Tuesday and Wednesday reached tentative agreements on a number of issues, including omitting two provisions from the House-passed bill that would have imposed copayments on home health and laboratory services (Goldstein, Washington Post, 10/30). The House bill calls for a copay of $40 to $50 for each 60-day period in which a beneficiary receives home care. The New York Times reports that negotiators dropped the copay proposal after "intense lobbying by Medicare beneficiaries and by former Sen. Bob Dole (R-Kan.)" (Pear, New York Times, 10/30). Conferees also are nearing a compromise on a provision that would cut $12 billion from Medicare payments to hospitals over 10 years but would allow hospitals to avoid the cuts by submitting government-specified quality of care data. In addition, conferees report being "close to an agreement" on expanding access to low-cost generic drugs, the New York Times reports (New York Times, 10/30). FDA regulations concerning market entry of generic drugs that took effect Aug. 18 allow brand-name pharmaceutical companies to receive only one 30-month delay in cases in which brand-name companies claim patent infringement by generic pharmaceutical companies; previously, they had been permitted multiple delays. The agreement conferees are considering would adopt a provision in the Senate Medicare bill that would build on the FDA generic drug regulation. It goes further, however, by, for example, eliminating a 180-day period of market exclusivity -- given to the first generic drug to come to market -- for any generic drug company that enters into anticompetitive deals or fails to come to market in a timely manner (California Healthline, 10/29).
CongressDaily reports that conferees remain "at loggerheads" over whether to allow physicians to invest in specialty hospitals and how to overhaul the system under which Medicare reimburses physicians for drugs administered in their offices. According to CongressDaily, GOP leaders have asked negotiators to "clear away" all such issues as soon as possible so they can concentrate their discussions on the "four most polarizing issues on the bill": competition between Medicare and private health plans, ways to contain costs in the program over time, reimportation of U.S.-made drugs from Canada and other countries and tax-preferred health savings accounts. On Wednesday, conferees were expected to begin voting on issues on which they had been unable to reach a consensus (Rovner, CongressDaily, 10/29).
To encourage Medicare negotiators to keep in the final bill a measure that would permit U.S. residents to purchase medications from Canada and other nations, a bipartisan group of senators led by Sens. Byron Dorgan (D-N.D.), Debbie Stabenow (D-Mich.) and John McCain (R-Ariz.) has introduced a new reimportation bill, Knight Ridder/Tribune/Baltimore Sun reports. The bill would allow pharmacists and wholesalers to purchase or reimport U.S.-made drugs from Canada and 24 other industrialized nations and is similar to a bill passed in the House. Unlike language included in the Senate Medicare bill, the new bill would not require the approval of HHS Secretary Tommy Thompson. The FDA, the Bush administration and the pharmaceutical industry have voiced opposition to allowing the reimportation of U.S.-made drugs from abroad, citing safety concerns. Stabenow said that such concerns could be addressed with FDA regulations, adding that a "well-regulated reimportation system is better than having consumers ... do without expensive medications or buy them on the Internet from unlicensed providers," according to Knight Ridder/Tribune/Baltimore Sun. Dorgan said the new Senate bill is intended to pressure conferees to include language allowing reimportation in the final bill (Knight Ridder/Tribune/Baltimore Sun, 10/30).
Some groups have begun voicing their opposition to the compromise that is taking shape in conference, CongressDaily/AM reports. On Wednesday, a coalition of liberal labor and consumer groups hosted a conference call for reporters after Bush's speech, "blasting the bill ... and the president's lack of action to try to make it more palatable to Democrats," according to CongressDaily/AM. Roger Hickey, co-director of the Institute for America's Future and Gerald Shea of the AFL-CIO, both said that Bush's lack of action to help create a compromise is hampering progress. Ted Marmor, a professor in the School of Management at Yale University, said that the $400 billion over 10 years limit on the legislation means that "the bill can't possibly fulfill its goal" of providing affordable drug coverage to beneficiaries. He added, "Stalemate is better than a step in the wrong direction." Meanwhile, the National Taxpayers Union, with 38 groups from 23 states, sent a letter to members of Congress stating, "Taxpayers will be trampled in the rush to create a new entitlement program." The letter calls the legislation moving through Congress "disastrous" and "politically inexcusable" (Rovner/Heil, CongressDaily/AM, 10/30).
Washington Post: The Post on Thursday examined how the contentious relationship between Sen. Charles Grassley (R-Iowa) and Rep. Bill Thomas (R-Calif.), chair of the Medicare conference committee, is affecting the Medicare and energy bills. GOP officials say the tensions between the two lawmakers and their staffs are "complicating efforts to resolve differences between the House and Senate" on the bills, the Post reports (Morgan/Eilperin, Washington Post, 10/30).
- Wall Street Journal: The Journal on Thursday examined the disagreement among Medicare negotiators over the House-passed competition proposal. The Journal calls the provision "a major stumbling block" in the effort to add a drug benefit to Medicare, noting that Republicans favor the proposal while Democrats oppose it. "If there is a compromise this year, it is bound to bring more private health plans into Medicare," the Journal concludes (Wessel, Wall Street Journal, 10/30).
- CNNfn's "Market Call": The program on Wednesday interviewed Thompson about the "sticking points" in the Medicare negotiations. "Right now everybody is trying to get this package to fit within the parameters of $400 billion over 10 years ... that's the goal, I believe, of all the conferees. It certainly is of the president and myself, and I think we can accomplish that," Thompson said (Hock/Schaffler, "Market Call," CNNfn, 10/29).
- "Nightly Business Report": The program on Wednesday reported on Bush's Wednesday speech on Medicare. The segment includes comments from Bush; Hickey; and Michael Tanner, health studies director at the Cato Institute (Woods, "Nightly Business Report," 10/29). The transcript of the segment is available online.