Republican Leaders Consider Deadline To Move Negotiations on Final Medicare Bill
Negotiators charged with reconciling the House and Senate Medicare bills (HR 1 and S 1) are "so plagued by policy differences and personality clashes" that some GOP leaders are considering setting a deadline for a final bill to speed up the bargaining process, the AP/Fort Lauderdale Sun-Sentinel reports. After more than two months of formal negotiations, conference committee members have reached general agreements on several items, including a drug discount card program for Medicare beneficiaries. However, many "critical details" have yet to be resolved, such as whether to make participation in a new electronic prescription program mandatory, and negotiators have not yet addressed some of the more "fundamental differences" between the House and Senate bills, according to the AP/Sun-Sentinel. House Majority Whip Roy Blunt (R-Mo.) said, "We're considering setting a deadline." Senate Majority Leader Bill Frist (R-Tenn.) said GOP leaders have not decided whether to set a deadline, but he added, "I could see certain benchmarks being set." Frist and other GOP leaders have begun meeting with Sens. Max Baucus (D-Mont.) and John Breaux (D-La.) to discuss possible ground rules for a House provision that would require competition between traditional Medicare and private health plans beginning in 2010. They discussed a proposal that would combine competitive bidding and a fee schedule based on traditional Medicare payments to set payments to private companies that establish managed care plans. Anonymous sources have said that Frist, Baucus and Breaux are attempting to reach a compromise in which payments are high enough to encourage private companies to participate in Medicare but low enough to rein in the program's cost, the AP/Sun-Sentinel reports. Frist said he is committed to passing a "comprehensive [Medicare] bill, not scaled-back" this year. White House spokesperson Scott McClellan on Friday said President Bush is also seeking a comprehensive bill by the end of this year.
Because of the "slow pace" of negotiations and complaints from some Medicare beneficiaries, many lawmakers have begun discussing potential alternatives to a final Medicare bill, the AP/Sun-Sentinel reports (Espo, AP/Fort Lauderdale Sun-Sentinel, 9/21). For example, lawmakers are considering passing a Medicare drug card program that would offer discounts of 10% to 25% instead of a drug benefit, the Wall Street Journal reports. Seniors would pay perhaps $30 per year for the cards, which would be offered by health plans or pharmacy benefit managers. CMS officials and congressional aides have begun working on the details of such a program to allow the cards to be "issued quickly" no matter what action Congress takes, according to the Journal. If Congress passes a Medicare bill with a drug benefit, the discount cards would act as a temporary measure until the benefit takes effect in 2006; if a final bill stalls, the discount cards could provide "scaled-back benefits," including catastrophic coverage, the Journal reports. Under a current agreement, beneficiaries with annual incomes below about $12,123 could receive a $600 subsidy per year for their prescription drug costs and would pay a 5% or 10% copayment for each prescription. CMS Administrator Tom Scully said that if the discount card program is approved, his agency would have it ready by April. However, consumer advocates and PBMs have begun "butting heads" over possible provisions of the discount card program, the Journal reports. Consumer advocates said a provision that would require beneficiaries to pick only one discount card and keep that card for at least one year regardless of price could make the program unattractive to beneficiaries. "While prices can fluctuate, seniors can't walk with their feet to another card program," Tricia Neuman, a Kaiser Family Foundation vice president and director of its Medicare Policy Project, said. Meanwhile, PBM officials say "important details," such as whether Medicare would reimburse the companies for their costs to administer the discount card program or whether they would be required to pass some or all of the discounts they negotiate with drugmakers on to beneficiaries, are still being discussed, the Journal reports. "You can't evaluate [the discount card program] as a commercial option right now," Dan Mendelson, a lobbyist for PBMs, said. Barrett Toan, CEO of PBM ExpressScripts, said, "We expect to participate, although a final decision will have to await an evaluation of the bill" (Lueck, Wall Street Journal, 9/18).
A group of 13 conservative House Republicans on Thursday issued several demands for provisions they said must be included in a final Medicare bill, the New York Times reports (Pear, New York Times, 9/18). According to a draft of a letter sent last week to House Speaker Dennis Hastert (R-Ill.), the group, led by Reps. Trent Franks (R-Ariz.), Sue Myrick (R-N.C.), Joseph Pitts (R-Pa.) and Patrick Toomey (R-Pa.), a final Medicare bill cannot include price controls on prescription drugs; must include a provision that would require traditional fee-for-service Medicare to compete with private health insurers beginning in 2010; must include a "generous expansion of health savings accounts"; and must include provisions to ensure that the cost of the bill would not exceed $400 billion over 10 years. "If the final bill does not meet each of these criteria, we believe that it would be contrary to the interests of current and future generations of taxpayers to vote for the bill," the letter says (California Healthline, 9/17). Many Democrats have said such a competition provision would preclude them from voting for a final bill, the Times reports (New York Times, 9/18).
The Pharmaceutical Research and Manufacturers of America on Friday ran a quarter-page advertisement in the Washington Post supporting passage of a prescription drug benefit under Medicare. At the top, the ad states, "Let's pass a prescription drug plan that offers Medicare beneficiaries a choice." The ad also says, "Thanks to research, today there are prescription medicines that help people live longer, healthier lives. Now is the time for Congress to improve patients' access to those medicines with a Medicare prescription drug benefit. America's seniors and people with disabilities are waiting for Congress to pass a prescription drug plan this year. A plan that provides real choices and access to the best medicines. Let's work together to give them the coverage and choices they deserve" (Ad text, Washington Post, 9/19).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.