|
|
|
|
||
|
||
|
|
||
| SEARCH | SUBSCRIBE | ||
|
 |
Senate Wins Support on a Medicare Issue
By
Robert Pear, The New York Times September
24, 2003 The Bush administration has quietly told Congress that it should not provide Medicare drug benefits to six million poor elderly and disabled people because they are already eligible for similar help through state Medicaid programs. Administration officials said they were siding with the Senate, against the House and all 50 governors, on one of the most divisive issues in the Medicare legislation. A major issue of principle and large amounts of money are at stake. The principle, rooted in the history of Medicare, is that all benefits are generally available to all beneficiaries, regardless of their income. Under the House version of the legislation, the new drug benefit would be available to all 40 million Medicare beneficiaries, including 6.2 million who are also eligible for Medicaid, the insurance program for low-income people. By contrast, the Senate bill denies Medicare drug benefits to people eligible for both programs. They would have to rely on Medicaid for assistance with their drug costs. Although states are not required to provide drug benefits under Medicaid, all have chosen to do so. Medicaid has historically provided extensive drug benefits, but they vary widely from state to state, and in recent years states have reduced the coverage in an effort to hold down soaring costs. A senior administration official said he had told Congress that the administration preferred the Senate approach. "We would rather spend money to cover new people with new benefits, rather than substituting federal dollars for state dollars," he said. "To spend federal money on people who have reasonably good drug coverage does not seem like the best use of the available resources." Medicare is financed entirely by the federal government; Medicaid is financed jointly by the federal government and the states. The National Governors Association, AARP, Consumers Union and the Catholic Health Association all say Medicare should pick up most drug costs for low-income people that is now borne by states. "These seniors are Medicare beneficiaries first and should be afforded equal access to a new prescription drug benefit," said Gov. Jeb Bush of Florida, echoing views expressed in a letter to Congress from all 50 governors. States say that through Medicaid, they spend $7 billion a year on prescription drugs for people covered by both Medicaid and Medicare. Under the House bill, the federal government would gradually assume these costs over 15 years. "We spend $43 billion over the next decade picking up these low-income seniors," said a principal author of the House legislation, Representative Bill Thomas, Republican of California. Administration officials call that process "buying out the states," and say it is a bad idea. The Senate agrees, and, as a result, its bill can provide more generous subsidies to those low-income elderly people who do not qualify for Medicaid. Administration officials said they had not publicized their views because they did not want to anger House Republicans like Mr. Thomas, the chairman of a conference committee trying to reconcile the Medicare bills. Mr. Thomas said it was fair, equitable and logical to give elderly poor people access to drug benefits through Medicare. "They should be treated as seniors first, not as low-income first," he said. Democrats agree. Senator John D. Rockefeller IV, Democrat of West Virginia, said the new drug benefit should be universal, like other Medicare benefits. Representative John D. Dingell, Democrat of Michigan, said the approach favored by the Senate's Republican majority and the Bush administration could lead to "a two-tiered, second-rate drug benefit for the lowest-income Medicare beneficiaries." Executives of Catholic hospitals met on Monday with Thomas A. Scully, administrator of the federal Centers for Medicare and Medicaid Services. They said Medicare should be the main source of drug coverage for people eligible for both programs. The Rev. Michael D. Place, president of the Catholic Health Association, said Mr. Scully had replied that because of the costs, Medicare coverage of prescription drugs for this group "could well be a stumbling block" to the passage of legislation. Asked about the meeting, Mr. Scully declined to comment. "We're trying to stay neutral in public," he said, "though we're privately telling people our preferences."
Copyright
© 2002 Global Action on Aging |
