House Could Approve Republican Medicare Package This Week, CQ’s Carey Says

With the Ways and Means and Energy and Commerce committees last week each having approved the House Republican Medicare bill, which in part would offer seniors drug coverage, floor debate is set to begin this week and the bill is expected to pass, Congressional Quarterly reporter Mary Agnes Carey says in this week's "Congressional Quarterly Audio Report" (Carey, "Congressional Quarterly Audio Report," 6/24). Under the $350 billion, 10-year House GOP plan, Medicare beneficiaries would purchase drug coverage directly from private insurance companies. They would pay a $250 annual deductible and a $34 monthly premium. Low-income seniors would be exempt from the premiums and deductible. The government would cover 80% of seniors' annual prescription drug costs up to $1,000, 50% up to $2,000 and no costs between $2,000 and $3,800, after which a catastrophic benefit would begin (Kaiser Daily Health Policy Report, 6/21). The bill also would increase payments to some Medicare providers and institute some cost-savings measures, such as a competitive bidding system for medical supplies. Carey predicts the vote on the bill will be close, as it was two years ago when House Republicans passed a drug-only Medicare package. She adds that House Republican leaders will not bring the bill to the floor unless they have enough votes; if the bill fails to come up this week, "it will likely be a sign that there aren't enough votes at this point to pass it." It will be tough for any Republican to vote against the bill, Carey says, but she notes that some Republicans are concerned about the "financial burden" of adding drug coverage to Medicare and others object to including Medicare reform provisions in the package. During debate, Democrats are likely to criticize Republicans' drug benefit proposal because seniors would be responsible for all drug costs between $2,001 and either $3,700 or $3,800, the caps in the Energy and Commerce and Ways and Means committee bills, respectively ("Congressional Quarterly Audio Report," 6/24). House Democrats' Medicare bill, which would cost between $750 billion and $900 billion over 10 years, would cover 80% of seniors' annual drug costs up to $2,000 and 100% above that figure. Seniors would pay a $100 annual deductible and a $25 monthly premium. The Energy and Commerce Committee rejected the bill last week (Kaiser Daily Health Policy Report, 6/21). Even if the House approves the Republicans' plan, it is unlikely to come up for a vote in the Senate, where leaders prefer a different plan by Sens. Bob Graham (D-Fla.), Zell Miller (D-Ga.) and Edward Kennedy (D-Mass.) ("Congressional Quarterly Audio Report," 6/24). Under that bill, which would cost between $400 billion and $500 billion over 10 years, Medicare beneficiaries would pay a $25 monthly premium with no deductible, a $10 copayment for generic drugs and a $40 copayment for brand-name drugs, and Medicare would cover their annual prescription drug costs that exceed $4,000. The plan also calls for reduced premiums and copayments for low-income beneficiaries (Kaiser Daily Health Policy Report, 6/18).

Patients' Rights
Even though the Supreme Court last week decided to uphold state laws affording managed care plan beneficiaries the right to seek independent review for denials of care, Carey says the decision will likely not have much affect on the patients' rights debate. She adds that had the court struck down the laws, "it might have put pressure on Congress to enact a uniform federal standard." And even though lawmakers had been negotiating with the White House on such legislation, it seems that for now they are "not anywhere closer to a deal" ("Congressional Quarterly Audio Report," 6/24).

Carey's full report is available online.