If Lawmakers, Bush Administration Agree on Medicare ‘Givebacks’ It Will Be at the ‘Last Minute,’ CQ’s Carey Says

Any agreement on a Medicare provider 'giveback' bill likely will come at the "last minute," Congressional Quarterly reporter Mary Agnes Carey says in this week's "Congressional Quarterly Audio Report." While the House has passed a Medicare giveback package, which was included in the same bill as a prescription drug benefit for seniors, such legislation remains delayed in the Senate. Work on fiscal year 2003 appropriations and on a possible war with Iraq has delayed the bill, Carey says. Also, lawmakers disagree on how much funding should be included in the package and what types of providers the bill should address. Carey notes that the White House prefers a $15 billion to $20 billion package, while Senate Finance Committee Chair Max Baucus (D-Mont.) and ranking member Charles Grassley (R-Iowa) have drafted a $43 billion package (Carey, "Congressional Quarterly Audio Report," 10/7). The 10-year Baucus-Grassley package includes smaller-than-planned cuts for hospitals and increases in payments for rural physicians, hospitals and home health agencies. Medicare+Choice plans would receive a boost in payments of 4% in 2003 and 3% in 2004. The bill also would reverse the expiration of $1.7 billion in temporary Medicare funding for nursing homes that expired Oct. 1. In addition, the package would expand a pilot program that uses competitive bidding for durable medical equipment nationwide. The plan also includes a provision that would allow Medicare to cover immunosuppressive drugs for organ transplants and would renew a five-year program that helps low-income seniors pay their Medicare premiums. The plan includes a two-year delay of payment caps for physical and occupational therapy and would expand coverage of cholesterol and lipid level tests. The package also includes additional funding for state Medicaid and CHIP programs (Kaiser Daily Health Policy Report, 10/4). Any final agreement between lawmakers and the White House is likely to be smaller than what the Finance Committee leadership or the House had planned, Carey predicts.

Other Action
Carey also addresses Senate-passed generic drug legislation, which the House Energy and Commerce Health Subcommittee will consider this week ("Congressional Quarterly Audio Report," 10/7). The bill would allow brand-name drug companies to receive only one 30-month patent extension per product, closing loopholes in the 1984 Hatch-Waxman Act that pharmaceutical companies have used to delay generic competition. The legislation also would prevent brand-name drug companies from paying generic manufacturers to keep their products off the market and would allow generic drug companies to legally challenge frivolous patents, including superficial changes in a treatment's color or physical design intended only to stifle competition (Kaiser Daily Health Policy Report, 10/2). Despite pressure from House Democrats to move on the bill, Energy and Commerce Chair Billy Tauzin (R-La.) said he wants to investigate other methods of bringing generics to the market, instead of amending the patent process. As a result, Carey said the Senate bill "is unlikely to pass in the House." Carey adds that with "much work to be done," it is unclear when Congress will adjourn for the year ("Congressional Quarterly Audio Report," 10/7).

Carey's report is available online.

In addition, a HealthCast of the Energy and Commerce hearing on generic drug access will be available online.