Congress' mission to pass Medicare reform moved closer to its goal last week, but for seniors and healthcare providers alike there are still some miles left to go.
As lawmakers work to provide Medicare drug coverage that would represent the program's biggest expansion since it was created, hospitals and physicians stand to benefit from the legislation, too. How much they ultimately get, however, depends on which provider-friendly provisions from the House and Senate bills survive a conference committee that will reconcile the two chambers' plans.
Unlike previous attempts to pass what always is a controversial proposal, leaders in Congress and the Bush administration were optimistic this year will be a success story, even as the legislation's goal of putting Medicare in competition with private-sector managed-care plans continued to stir controversy.
"When people really find out what we're doing, they aren't going to be pleased with us," said Rep. Charles Rangel (D-N.Y.).
"We couldn't be more pleased with the progress being made," said HHS Secretary Tommy Thompson. Although "extremely complex and very contentious" issues remain to be ironed out, Thompson said, the Bush administration expects the Senate to vote overwhelmingly in favor of the bill.
"We're undertaking an ambitious agenda that I'm absolutely confident we'll be successful with," added Senate Majority Leader Bill Frist (R-Tenn.), as senators debated the $400 billion Medicare modernization bill.
Under that bill, which cleared the Senate Finance Committee earlier this month, overall hospital payment rates would not be touched, but rural providers would receive some $25 billion in new federal assistance (June 16, p. 8).
With the House bill, which the Ways and Means Committee approved 25-15 last week, hospital and physician pay rates would be rejiggered, and rural providers would get considerable new help (See chart).
Any assistance to one group, however, means less for another. "I would never begrudge rural hospitals any payment relief. I would just note that urban hospitals need the relief as badly as the rurals," said Ellen Kugler, executive director of the Sterling, Va.-based National Association of Urban Hospitals. "It's a shame there's no recognition of that at all in this legislation."
Like many provider lobbying groups, the NAUH staff spent much of last week on Capitol Hill making the case for amendments to the House and Senate bills that would assist its 52 members, which serve densely populated urban areas.
Under the congressional proposals discussed last week, seniors would have the choice of joining private managed-care plans that would administer their Medicare benefits, including prescription drug coverage, starting in 2006. With the possibility that premiums, deductibles and copayments will be higher under such a system, Kugler said, urban hospitals will see their bad debt increase when low-income patients can't afford to absorb the new costs.
In the Senate last week, however, most attention paid to providers focused on those serving rural populations. "Without rural healthcare, we can't have rural life," Sen. Ron Wyden (D-Ore.) said in debate on the Senate floor. "That is why provisions in this legislation to provide better reimbursement for rural healthcare are a strong step forward."
Those provisions enjoy the support of Senate Finance Committee Chairman Charles Grassley (R-Iowa) and ranking Democrat Max Baucus of Montana, which bodes well for their chances in the conference committee that will be convened once the full Senate and House have each passed legislation.
Despite widespread agreement that Congress will send a bill to President Bush by the end of the summer, several major rifts still exist, especially with regard to the availability of private health plans to seniors throughout the country.
Even congressional aides who drafted the legislation admitted the proposed Medicare program is likely to require major changes-and additional funds-over the next 10 to 20 years.
Some critics predicted that if Congress passes the proposals it mulled last week, problems would surface early and often.
"This is not good legislating," said Tom Miller, director of health policy studies for the liber- tarian Cato Institute in Washington. Lawmakers "will have to come to terms with this in an ugly way two years down the road," Miller said.
Talking with reporters last week, Frist acknowledged the difficulties of drafting major Medicare reform legislation. "It's really challenging in terms of making this sustainable long term," he said.
Criticism of the House and Senate proposals came from all directions last week, even in the halls of Congress.
Shortly after House Ways and Means Chairman Bill Thomas (R-Calif.) began his committee's hearing on the reform bill last week, a group of seniors wearing T-shirts labeled "Seniors' Truth Squad" stood up and chanted in unison: "We're blowing the whistle. Don't privatize Medicare." As the seniors were escorted out by security, Thomas told them that the House plan does no such thing. One senior shouted back, "Read the bill. ... Ray Charles can see this."
By a vote of 29-20, the House Energy and Commerce Committee last week also passed a Medicare reform bill, much of which closely resembled the Ways and Means plan. The House Rules Committee will combine the two bills for debate by the full House.
Those proceedings could start as early as this week. The Senate, too, will continue its deliberations and is expected to approve a bill before adjourning for the July 4 recess.