Republicans Might Rework Medicare Conference Committee Schedule
Senate Finance Committee Chair Charles Grassley (R-Iowa) yesterday said that Republican members of the conference committee charged with reconciling the House and Senate Medicare bills (HR 1 and S 1) will likely rework the committee's schedule, after his recent disagreement with House Ways and Means Committee Chair Bill Thomas (R-Calif.) stalled negotiations, CongressDaily/AM reports (Rovner, CongressDaily/AM, 9/4). Grassley last week withdrew his staff from negotiations because he said he wants negotiators to begin talks on provisions in both Medicare bills that would allocate at least $25 billion to increase payments to rural Medicare providers. Grassley said that aides to Thomas, who as head of the conference committee sets the conference committee's agenda, told Senate staffers they are not permitted to discuss such payments. Grassley has indicated that he believes Thomas is stalling on such provisions as a way to gain leverage in the Medicare negotiations (California Healthline, 9/3). According to CongressDaily/AM, Grassley noted that the negotiations are proceeding based on a conferee-approved schedule, under which their staff members would work on "noncontroversial provider issues" during the August recess and conferees would hold meetings on other provider issues in September. However, he said that Republicans might alter the schedule during a meeting today because of the "limited work" that staff members completed, according to CongressDaily/AM.
Senate Minority Leader Tom Daschle (D-S.D.) said yesterday, "I applaud Sen. Grassley for standing up for what's been an inequity for decades." Sen. John Breaux (D-La.), a conference committee member, said that the disagreement between Grassley and Thomas is a "normal part of the process." He said that President Bush should set a deadline for the conferees to complete their negotiations. "Sometime in October is reasonable," Breaux said. Grassley has said that Bush should set an Oct. 13 deadline (CongressDaily/AM, 9/4). Breaux said the conference committee "needs a push," the Baton Rouge Advocate reports. Breaux added, "The president has to come in and say, 'Get it done.' Otherwise, we'll have a bill that won't pass." White House officials yesterday responded to Breaux, indicating that Bush has been urging negotiators to keep working, including meeting with a bipartisan group of conferees yesterday. "This is an issue that the president has encouraged the members of Congress to work (on) in a bipartisan way," Taylor Gross, a White House spokesperson, said (Shields, Baton Rouge Advocate, 9/4).
The New York Times today examines how Congress has passed up several successful drug purchasing models -- including the Department of Veterans Affairs drug purchasing plan -- in proposing a Medicare drug benefit. According to the Times, "by most measures" the VA drug purchasing plan has made drugs affordable for a large group of veterans "without wrecking the federal budget." A study by the National Academy of Sciences found that the VA's drug purchasing plan "meaningfully reduced drug expenditures without demonstrable adverse effects on quality." Under the VA plan, VA doctors and pharmacists analyze research to develop a list of preferred drugs for various conditions. The VA then obtains discounts for those treatments through bulk purchasing, using generic drugs when possible and employing competitive bidding. Michael Valentino, a manager of the VA's drug benefit program, said that Medicare could use a similar program by leveraging its purchasing power. Congress never "seriously considered" the VA's approach, according to the Times. Congress also did not choose other alternatives, including a plan that would issue vouchers to allow low-income beneficiaries to purchase private drug coverage and drug assistance. Instead, the House and Senate bills would subsidize drug coverage provided by private health plans, which would bargain with drug companies -- most likely through pharmacy benefit managers -- for discounts and rebates to be passed on to beneficiaries. Both bills stipulate that CMS officials cannot "interfere in any way" with those negotiations, the Times reports. The Times reports that CMS Administrator Tom Scully "concedes that such [private] drug coverage 'does not exist in nature' and would probably not work in practice."
According to the Times, Congress has "consciously decided" to lessen Medicare's purchasing power by not creating a preferred drug list or a price list, ideas that the drug industry opposes. Rep. Michael Bilirakis (R-Fla.) said that if Medicare used its purchasing power, it would amount to "a form of price controls." He added, "That's not America. Many of my constituents would feel that price controls are a great thing. But ultimately some of us have to be responsible." Jeffrey Trewhitt, spokesperson for the Pharmaceutical Research and Manufacturers of America, said, "Price controls cause artificially low prices." But Bruce Vladeck, who headed CMS, then HCFA, under the Clinton administration, said, "The obvious is that if you control prices, you pay less. There are some problems with it, and not all price controls work as well as others. But the pharmaceutical industry does not have enough political juice to prevent any reasonable price controls." Princeton University health care economist Uwe Reinhardt added, "On one hand, there is the taxpayer and, in fact, patients who would benefit from having costs controlled. But on the other hand, those people do not finance the campaigns of these legislators" (Pear/Bogdanich, New York Times, 9/4).
Although a majority of seniors want Congress to approve legislation that would add a drug benefit to Medicare, many are concerned that they still would pay a large portion of their medication costs even after the benefit takes effect, according to a new survey by the Kaiser Family Foundation and the Harvard School of Public Health, the Associated Press reports. Researchers surveyed 2,043 people, including 376 seniors, between Aug. 6 and Aug. 12, finding that 76% of seniors said they are worried and 52% are "very worried" that they will pay too much for prescription drugs even if Congress approves a Medicare drug benefit and that their drug expenses will still be too high (Dalrymple, Associated Press, 9/4). In addition, the survey found that just 37% of respondents said Congress should pass either the House or Senate Medicare bill, after being told such a bill would cost the federal government $400 billion over 10 years and would require seniors to pay more than half of their drug costs out-of-pocket. Further, 57% said they believe Congress should abandon the current proposals and "work to pass [legislation] that provides more help to seniors, even if might take years to get done and cost the government more" (Rovner/Wegner, CongressDaily, 9/3). The survey also found that 68% of seniors do not know enough about the House and Senate bills to say whether they contain differences. "I think seniors are confused more than anything else right now," Drew Altman, Kaiser Family Foundation president and CEO, said (Associated Press, 9/4). Robert Blendon, a Harvard School of Public Health professor of health policy and political analysis who helped conduct the survey, added, "Congress is between a rock and a hard place. Seniors will be critical of Congress if it does not pass a prescription drug bill, but unhappy if it passes either of the current bills." The survey also says that 43% of seniors believe congressional Democrats are handling Medicare reform better, compared with 24% who believe the President is doing a better job. Limiting the question to Congress, 37% of seniors said Democrats are doing a better job, compared with 21% of those who believe Republicans are doing a better job and 18% who say neither party is doing a good job. According to the survey, 68% of the public and 65% of seniors support legislation that would permit the reimportation of U.S.-made prescription drugs from Canada; those percentages dropped to 63% and 57%, respectively, when respondents were given arguments for and against reimportation (KFF release, 9/3). The survey is available online.
Two senior groups plan to launch lobbying efforts today to offer advice to lawmakers on a Medicare drug benefit, Cox/Atlanta Journal-Constitution reports. AARP will tell lawmakers that the House and Senate Medicare bills contain gaps in drug coverage and that the conference committee should repair the bills and pass a compromise this year (Mollison, Cox/Atlanta Journal-Constitution, 9/4). AARP is scheduled to host a Friday rally on Capitol Hill and deliver 100,000 petitions to lawmakers. In addition, thousands of AARP members plan to call lawmakers on Friday to discuss the proposed legislation (California Healthline, 9/2). AARP also will host a rally Friday for its West Coast members in Laguna Beach, Calif. The 2.7 million-member Alliance for Retired Americans also will ask lawmakers to "kill both bills," Cox/Journal-Constitution reports. More than 1,000 ARA members plan to rally today on Capitol Hill (Cox/Atlanta Journal-Constitution, 9/4).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.