Congressional Democrats last week drew a line in the sand on Medicare reform, complaining that they've been left out of the legislative process and threatening to vote against any bill that would "privatize" Medicare.
Throughout last week the Washington rumor mill churned out conflicting information about the progress being made by House and Senate negotiators who are working to reconcile the two chambers' bills, each of which would add a drug benefit to Medicare and give seniors the option of selecting a private managed-care plan.
Despite an attempt to keep a lid on the negotiations, members of the conference committee leaked an outline of their nascent legislation that still left out many important details, including the size of the payment increase hospitals would receive in the next two years.
Under the outline, seniors could buy prescription drug coverage for a monthly premium of $35 and a $275 annual deductible. Beneficiaries would have a 25% copayment from $275 to $2,200. Coverage would cease at $2,200 in total drug expenses until a beneficiary's out-of-pocket spending reached $3,600. Beneficiaries then would pay a modest copayment, perhaps $5 per prescription.
Seniors earning less than 135% of the poverty level with no more than $6,000 in personal assets would have a copayment throughout of up to $5. Seniors earning 135% to 150% of the poverty level with assets of no more than $10,000 would receive a smaller break on copayments (See Washington View, p. 17).
At deadline, specifics on how the final legislation would treat healthcare providers were still under the committee's policy microscope. Sen. Charles Grassley (R-Iowa), vice chairman of the committee, said hospital payment rates and restrictions on specialty hospitals were discussed but no hard-and-fast agreements were reached (See related story above).
Some Democrats, meanwhile, revisited arguments that a privately run component of Medicare would only harm the program and its beneficiaries. If the final Medicare bill includes a House provision known as "premium support," which would put Medicare in direct competition with private health plans starting in 2010, "I don't believe the votes are there in the Senate to pass it and I will help lead the effort to oppose the bill," Sen. Debbie Stabenow (D-Mich.) said in an interview with Modern Healthcare.
Stabenow was one of 41 senators, including Minority Leader Tom Daschle, to sign an Oct. 21 letter to President Bush saying that any plan that would increase seniors' premiums or "coerce" them to join HMOs is unacceptable.
Only one Republican, Sen. Olympia Snowe of Maine, signed the letter. A spokeswoman for the House Ways and Means Committee called the letter "an obstructionist tactic."
The protests, nevertheless, continued. "A premium support plan that isn't just a demonstration would be a serious problem for me," Snowe said last week. The Senate bill would conduct demonstration projects to test premium support but wait for the results before broadly implementing the plan.
Conferees also are considering creating Medicare Advantage, a program to replace and supplement the current Medicare+Choice program with a PPO-type benefit that seniors could select instead of traditional Medicare coverage.
According to CMS Administrator Tom Scully, health plans that win a competitive bidding process to participate might gain 20% to 30% in reimbursements by 2006, the first year that reform would take effect.
"We have got to give health plans incentives to get back into these rural markets and to serve all beneficiaries," Scully said last week.