A Republican-set deadline to complete Medicare reform negotiations came and went last week as lawmakers continued their struggle to agree on the $400 billion legislation they've been debating since July. Both the House and Senate bills to overhaul Medicare contain provisions that would be helpful to providers, especially those that serve rural areas.
Some lobbyists speculated last week that Congress will make such provisions law even if it can't pass the larger bill, which would add a prescription drug benefit to Medicare and restructure the program to give seniors the option of enrolling in a private managed-care plan.
Several government officials, including CMS Administrator Tom Scully, said the Medicare reform train, although delayed, is still on track. "I think it will pass," Scully said.
The House-Senate conference committee that has been working to write a bill agreeable to both chambers and parties continued to meet for long hours behind closed doors last week, emerging with only vague comments about the status of their discussions. While committee members announced incremental progress on some items, such as charging higher premiums to higher-income beneficiaries, a broad agreement was not in place by Oct. 17, when several lawmakers had hoped a bill would be ready for a vote (Sept. 29, p. 13).
Late last week the conference committee discussed providers "group by group," said Sen. Max Baucus (D-Mont.), without specifying what, if any, conclusions were reached. Hospital payment increases in coming years and restrictions on specialty hospitals are among the issues conferees are trying to reconcile. With many of the most polarizing issues unresolved, some lobbyists said that provisions favorable to hospitals might survive, even in the event that the larger bill does not.
A full drug benefit is unlikely at this point, but Congress could pass a "smaller bill built around the rural package," said Frederick Graefe, a lobbyist with the law firm Hunton & Williams in Washington.
The rural hospital provisions, similar in both versions of the Medicare reform bill, would earmark some $25 billion over 10 years to permanently equalize the base rate rural and urban hospitals are paid, as well as make other changes favorable to those who deliver healthcare in rural communities.
In passing a smaller, less-sweeping bill, "both parties will join together and say this is the best we can do," Graefe said, adding that the compromise bill might include a drug discount card for the lowest income seniors and provisions that would lift some of the industry's bureaucratic burden.
Some lawmakers on the House-Senate conference committee negotiating the bill, however, would not entertain the possibility of anything less than total success.
"The bill is going to make it," Rep. Nancy Johnson (R-Conn.), a conference committee member, told Modern Healthcare after being asked what would happen to the rural provisions if the larger bill doesn't pass.
Giving the Medicare reform bill an 85% chance of passing, Scully said that it's unlikely Congress will pass a provider package this year if the reform legislation derails.
Speaking to reporters before and after the meetings last week, lawmakers made only general comments and skirted questions about specific policy decisions. "On the whole bill I think there's movement," Sen. Don Nickles (R-Okla.) said.
As for the conference committee not making its deadline, Rep. Billy Tauzin (R-La.) said, "Nobody expected us to make that deadline."
Also last week, HHS announced that seniors' monthly premium for Medicare Part B will increase 13.5% to $66.60 in 2004 from the 2003 premium of $58.70-the third largest percentage increase ever. The deductible for hospital care will be $876 in 2004, up 4.3% from the $840 deductible in 2003. Scully said the "very high" rate of increase for Part B, which covers physician visits and other outpatient services, is an "aberration" partly because premiums were too low in 2003.
By law, Part B premiums must fund 25% of the estimated cost of treating Medicare beneficiaries over age 65.
- With Mark Taylor