Even as President Bush signed Medicare reform into law last week, Democrats launched another round of legislative volleys to eliminate major provisions they said would harm seniors. If they are successful-and that's a big if-Medicare reform could end up looking somewhat different than it appears now.
The Democratic bills primarily target the law's prescription drug benefits. The Medicare package also provides millions of additional dollars for hospitals and doctors, which have not been challenged. The $395 billion law for the first time begins covering prescription drugs for seniors, starting in 2006. Seniors will be able to buy discount drug cards to help lower their drug costs, starting next spring. A demonstration project putting Medicare into competition with private payers in six metropolitan areas will begin in 2010.
HHS last week released its first regulations in connection with the new law, on the drug discount card. Scheduled to appear in the Dec. 15 Federal Register, the proposed regulations specify that seniors will save 10% to 15% on their total drug costs, and that low-income beneficiaries will be eligible for an additional subsidy of $600 per year. Private companies will administer the card under a contract with Medicare. The regulations go into effect 30 days after they are published.
Rep. Chet Edwards (D-Texas) and Sen. Edward Kennedy (D-Mass.) introduced separate bills last week aimed at repealing parts of the new Medicare law. Edwards' bill takes aim at the inability of Medicare to negotiate prices with drug companies.
Appearing at a rally last week at the Senate Hart Building with other Democrats and hundreds of seniors, Edwards said, "With this bill signed into law today, for the drug companies, it gives new meaning to the song `Tis the Season to be Jolly.' "
Kennedy's bill also seeks to allow negotiations between the government and drug companies and to repeal the demonstration project that begins in 2010 on the grounds that it is just a step toward forcing seniors into private HMOs for Medicare coverage. Kennedy's bill would allow for importation of drugs from Canada, and it seeks to repeal a provision that limits how much Medicare spends in the future, which was added at the behest of Republicans to control the spending growth of Medicare. Upon signing the bill, President Bush said it offers Americans "better choices and more control over their healthcare," but the legislation also has deeply divided seniors and outraged Democrats.
Even before the president had signed the bill, Senate Minority Leader Tom Daschle (D-S.D.) introduced his own bill to allow Medicare to negotiate with drug manufacturers for lower prices for beneficiaries (Dec. 1, p. 8).
Nonetheless, Democrats may find repealing the Medicare legislation next to impossible, said Jorge Lopez, a partner specializing in healthcare law at the firm Akin Gump Strauss Hauer & Feld.
"Politically, the Democrats won't have the horses to change things next year," he said. "Given how difficult it was to get this through ... I just don't see (the law) changing dramatically until we see how it actually works."
Whether it works or not, HHS Secretary Tommy Thompson won't be sticking around to find out. Last week, he reiterated statements he's made previously that he would not return to his job after the 2004 presidential elections. Thompson, who had hinted at his decision last spring, spoke to reporters while on a trip in Africa, according to published reports.