Issues in the Medicare bill of greatest concern to doctors continue to take a back seat to details of the prescription drug benefit and the role of private health plans in conference negotiations in Congress.
Senate Minority Leader Tom Daschle (D-S.D.) says he has not seen any language from the conference relating to a proposed physician reimbursement cut of 4.2% or to a proposal that would close the loophole allowing physicians to invest in specialty hospitals.
"Obviously, that would pose some real serious issues, as well," Daschle says. "And we're trying to find ways with which to reach consensus on them. But until we see the language, it would be very hard to comment."
Daschle made his remarks at a news conference this morning of Democratic Senators warning House-Senate conferees that certain provisions must be included in the bill to achieve bipartisan support. Physician concerns were not included among the issues highlighted in a letter, signed by 41 senators, that was sent to President Bush today.
Speaking with Daschle at the event were Sens. Edward Kennedy (D-Mass.), Debbie Stabenow (D-Mich.), Jon Corzine (D-N.J.) and Byron Dorgan (D-N.D.).
Reports in newspapers this morning that some agreement has been made among core negotiators "are overly optimistic," Daschle says. "There is no agreement."
"It is not my intention today to say we're going to filibuster anything," Daschle says, but the conference must address certain issues more consequentially. Among other measures, the letter says the final conference report on the Medicare reform bill must:
- Create a drug benefit that is universal, whereby the government would provide a "fallback" Medicare prescription drug plan in any region where private plans do not.
- Provide employers with incentives to prevent them from dropping retiree drug coverage. Democrats cite a Congressional Budget Office estimate that 37%, or 4 million seniors with employer-sponsored drug benefits, could lose that coverage.
- "Preserve a level playing field between conventional Medicare and HMOs and other private plans." Democrats are concerned about a House proposal that would require direct competition on price between Medicare and private health plans in 2010, a restructuring called "premium support" that Democrats say could raise premiums for some beneficiaries.
- Give priority to low-income Medicare beneficiaries. The letter advocates an element of the Senate-passed bill that provides low premiums, low co-pays and a relaxed or eliminated assets test for about 40% of Medicare recipients.
- Encourage new ways to contain drug costs, such as making generics more available and allowing re-importation.
- Avoid imposing caps or arbitrary limits on Medicare spending, which could endanger Medicare as an entitlement.
"We're reaching the final hours," Kennedy says. "We call on the president to intervene and to exercise judgment in this conference to indicate that they want a bipartisan bill. It's still possible, but we're further away from that possibility today than any time since the conference first began."