Congressional Republicans will propose that Medicare beneficiaries be allowed to enroll in medical savings accounts when they begin to fill in the details of the budget agreement in early June, a leading GOP legislator said last week.
That would set up a budget showdown with the Clinton administration. Two administration officials said they strongly oppose MSAs, even in a limited test form.
Both the House and Senate finished work last week on their own balanced-budget frameworks. The House passed its plan by a vote of 333-99, while the Senate measure was approved 78-22.
The Senate vote came after a 65-45 vote shot down a proposed amendment that would have financed health insurance premium subsidies for children by raising tobacco taxes.
Each plan retained the previously agreed upon $115 billion in savings in budgeted Medicare spending. Of that total, $105 billion will come from projected payments to providers and managed-care plans (May 5, p. 2).
Differences in the House and Senate budget frameworks must still be reconciled when Congress returns from its Memorial Day recess next week. Various congressional committees will begin the task of filling in the details of the budget outlines, including how the Medicare savings will be achieved.
Rep. William Thomas (R-Calif.), chairman of the House Ways and Means health subcommittee, said last week his panel intends to include many of the Medicare structural reforms that were in the 1995 Republican budget eventually vetoed by President Clinton.
MSAs, which allow beneficiaries to couple a catastrophic insurance policy with a tax-free account from which they would pay incidental health costs, were among the most controversial provisions in the Republicans' 1995 balanced-budget plan.
Since then, MSAs have been opened to non-Medicare insurance beneficiaries on a limited basis under last year's health insurance reform bill. Thomas said White House opposition would not stop Republicans from trying to open them to Medicare beneficiaries this time around.