Senate Democrats Criticize Negotiations on Final Medicare Bill
Some Senate Democrats on Tuesday warned that disagreements over several key issues, including the House-passed competition provision, "threate[n] to block a compromise" on the House and Senate Medicare bills (HR 1 and S 1), the Washington Post reports (Dewar, Washington Post, 11/5). They criticized several aspects of the emerging compromise, a move that could indicate that "lawmakers are shifting tactics and focusing less on getting the bill passed than on preparing for a blame game in the event that it collapses," according to The Hill (Bolton/Cusack, The Hill, 11/5). 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 (Rovner, CongressDaily, 11/4). However, he said that it is too early to say if Democrats would try to filibuster a final bill. Daschle added that the discussions seem to be on "a surefire road to failure unless something changes" (Washington Post, 11/5). He said, "It's becoming less and less likely" that a Medicare bill will become law this year. Sen. Edward Kennedy (D-Mass.) said that negotiations are "in free fall" because of disagreements over key provisions (New York Times, 11/5). Kennedy added that Republican negotiators are "catering to House Republicans on key issues as they craft a final bill" and warned that "Republican-leaning" legislation would not pass the Senate, the Washington Times reports (Fagan, Washington Times, 11/5). Although the Medicare legislation is currently "on life support," it can be "resuscitated" if negotiators construct a more bipartisan compromise, Kennedy said.
Republican conferees downplayed Democrats' concerns, according to the Post. Senate Majority Leader Bill Frist (R-Tenn.) said that negotiations are "progressing well" and that he anticipates having a final bill by Nov. 21, when Congress adjourns for the year (Washington Post, 11/5). Sen. Charles Grassley (R-Iowa), a conference committee member, said that for lawmakers to meet the Nov. 21 deadline, conferees would have to reach a significant agreement this week, a schedule that he called "doable" (Rovner, CongressDaily/AM, 11/5). Rep. Bill Thomas (R-Calif.), the conference committee's chair, said, "At some point you may wind up agreeing to disagree" (Rogers, Wall Street Journal, 11/5). Some officials involved in the negotiations "dismissed the [Democrats'] downbeat rhetoric as jockeying for position in a new, more intense round of bargaining" on the competition provision, the AP/Las Vegas Sun reports. Further, some unnamed Republicans said that Frist, House Speaker Dennis Hastert (R-Ill.) and President Bush all plan to become "more deeply involved in the legislation over the next several days," according to the AP/Sun. Frist and Hastert already have met with William Novelli, head of the AARP, in an effort to gain the group's endorsement of a final bill (Espo, AP/Las Vegas Sun, 11/4). In related news, Senate Energy and Commerce Chair Bill Tauzin (R-La.) told Thomas that he would "refuse to sign a Medicare conference report if a deal on energy was not in place," according to a senior GOP aide, CongressDaily/AM reports (Stanton/Wegner, CongressDaily/AM, 11/5).
Lawmakers in particular are concerned about the House-passed competition provision, under which traditional, fee-for-service Medicare would be required to compete directly with private health plans beginning in 2010. Last week, House Majority Leader Tom DeLay (R-Texas) and Thomas said that most House conservatives would support a final bill if it included a competition provision and a provision that would premit the creation of tax-preferred health savings accounts for individuals (The Hill, 11/5). Grassley said that conferees could reach a compromise on the competition provision if they can agree to consider a more limited version of the provision, such as one that would test competition in select markets. But Kennedy said that it would be "almost impossible" to get the Senate to pass a final Medicare bill that contains any variation of the competition provision (Washington Times, 11/5). "This is a nonstarter, and it has been from the beginning," Kennedy said, adding "The Senate will not accept a proposal that's going to undermine the Medicare system, and that's what the conference is headed to" (Kemper, Los Angeles Times, 11/5).
Kennedy also expressed concern about the Republican-backed plan to create tax-preferred health savings accounts for individuals, a provision that he called "a tax gimmick that will primarily help the wealthy and major GOP contributors" who sell the policies (Rovner, CongressDaily/AM, 11/5). Negotiators are considering a measure in the House bill that would permit people enrolled in private health plans to create savings accounts to accrue money tax-free to pay for some medical expenses, including medical treatment, medications and long-term care services or coverage. Under the provision, individuals with health insurance deductibles of at least $1,000 and families with deductibles of at least $2,000 could use the health savings accounts. Conferees recently rejected creating health savings security accounts for individuals with $500 deductibles and families with $1,000 deductibles, the more expensive of the two accounts (California Healthline, 10/31). The measure would expand a limited Medical Savings Accounts experiment that began in 1996 and was available only to 80,000 self-employed individuals and small business employees. According to the Journal, the idea behind the proposal is to "make it less risky for people to buy high-deductible -- and therefore cheaper -- health insurance." The issue is a "favorite" of Hastert, and it has become "hugely important" as the House speaker tries to win conservative support for the Medicare legislation, the Journal reports. But some Democrats have said that the proposed health savings accounts "represent a dangerous precedent from the standpoint of tax policy," according to the Journal. Critics of the proposal are concerned about the idea of tax-deductible deposits into the accounts combined with tax-free withdrawals, the Journal reports (Wall Street Journal, 11/5).
Senate Democrats also criticized other aspects of the Medicare legislation emerging from the committee, according to The Hill. At a lunch meeting on Tuesday, Sen. Jay Rockefeller (D-W.Va.) distributed a paper to colleagues saying that Republicans are "singling out Medicare for arbitrary caps and/or budget rules"; "failing to protect retiree [drug] coverage"; "hurting rural seniors by giving private insurers a big role"; and "not agree[ing] to a federal guarantee in the event that private insurers do provide [drug] coverage," according to The Hill. Sen. Debbie Stabenow (D-Mich.) said that she would not support any bill that does not include incentives to prevent employers from dropping retiree drug coverage if a Medicare drug benefit is enacted (The Hill, 11/5). Daschle criticized a House Republican proposal, backed by the Bush administration, that would require congressional action on ways to reduce Medicare spending if the program's costs increase more quickly than anticipated (Washington Post, 11/5). CongressDaily reports that conferees still have three major and three mid-level issues to decide. The big issues include the cost-containment provision, the House-passed competition provision and whether to allow U.S. residents to purchase lower-cost, prescription drugs from Canada and other nations. The lower-level issues include how to change the current system Medicare uses to reimburse doctors who administer drugs in their offices, whether to implement a competitive bidding system for durable medical equipment and whether to limit physicians' ability to invest in specialty hospitals (Rovner, CongressDaily, 11/4).
Integrating coordinated disease management services into Medicare's traditional fee-for-service program could prove difficult, analysts from the Medicare Payment Advisory Commission and CMS said during a Senate Committee on Aging forum on Tuesday, CongressDaily reports. Both the House- and Senate-passed Medicare bills include provisions that would increase funding for management of chronic diseases under traditional Medicare. The House bill calls for chronic disease treatments to be delivered largely by disease management organizations, while the Senate bill leans toward individual physicians providing such care. MedPac Executive Director Mark Miller said that more than 75% of all Medicare beneficiaries have at least one chronic condition and that nearly 33% have four or more chronic conditions. Together, the two groups account for about 80% of Medicare spending, he added. Stuart Guterman, director of the Office of Research, Development and Information at CMS, said that several demonstration projects testing Medicare disease management programs have had difficulty enrolling beneficiaries, who traditionally have been "reluctant to try new things." Miller said that the key to having a successful Medicare disease management program would be to determine how to encourage beneficiaries to enroll, how to involve individual physicians and how to pay for coordinated services (Rovner, CongressDaily, 11/4).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.