Medicare Bill
Won't Include a Co-Payment for Home Care
by Robert Pear, the New
York Times
October 30, 2003
WASHINGTON
— After intense lobbying by Medicare beneficiaries and by former Senator
Bob Dole, Congress has discarded the idea of imposing a co-payment on home health
care services provided to
the elderly and the disabled, lawmakers said on Wednesday.
In addition, House and Senate negotiators said they were
close to an agreement expanding access to low-cost generic drugs, and they have decided to impose new
financial penalties on hospitals that refuse to disclose data on the
quality of care.
The actions came as Congress tried to complete work on a
bill revamping Medicare and offering prescription drug coverage to 40
million beneficiaries, at a cost of $400 billion over 10 years.
Asserting that "Congress is on the verge of
Medicare reform," President Bush said elderly people should put
pressure on Congress to finish the job.
"The time to improve our Medicare system has
come," Mr. Bush said at a White House event on Wednesday. "Now
is the time. I urge
America
's seniors to speak up, to call and write your representatives to urge
them to work out a final bill."
Mr. Bush reiterated his plea for Congress to give private health plans a
larger role in Medicare, saying they
could offer "better coverage at more affordable prices."
The president said he had been assured that employers
would not eliminate drug benefits for retirees if Medicare offered such
coverage.
"Corporations have no intention to what they call
`dump' retirees into a system they don't want to be dumped into," Mr.
Bush said, citing assurances from Richard P. Lavin, a vice president of
Caterpillar Inc.
Many retirees
and labor unions have become alarmed that they will lose health benefits
provided by former employers if Medicare offers similar but more limited
drug benefits. The Congressional Budget Office has estimated that
four million retirees could lose drug coverage offered by former
employers.
The fight over home care was one of many disputes
swirling around the Medicare legislation. The House bill would impose a
co-payment of $40 to $50 for each 60-day period in which a beneficiary
receives home care.
Representative Bill Thomas, Republican of California,
and Senator John B. Breaux, Democrat of Louisiana, supported the payment
as a way to discourage overuse of home care.
Senator Susan Collins of
Maine
and Representative Billy Tauzin of
Louisiana
, both Republicans, led the opposition. "The co-payment would have
forced many of the most frail seniors to turn down care they really need,
and it would have been a particular hardship for people with low
incomes," Ms. Collins said.
Like many Republicans, Ms. Collins said she was
"reserving judgment" on the overall Medicare bill.
Home care agencies and advocates for the elderly
criticized the co-payment as a "sick tax." Mr. Dole, the former
Kansas
senator, conveyed their concerns to lawmakers.
While
abandoning the co-payment, Congressional negotiators have decided to
extract savings from providers of home care by reducing the annual update
in their Medicare payments. The update reflects inflation in the cost of
goods and services.
The conference committee has also decided to revise a
provision of the House bill that would have cut $12 billion from Medicare
payments to hospitals over the next decade. Hospitals could avoid the cuts
if they disclosed information on the quality of care they provided, using
standards specified by the government.
Bush administration officials said such data would help
consumers identify the best and worst hospitals. The officials said they
had been frustrated in efforts to persuade hospitals to release such data
voluntarily.
The emerging agreement on generic drugs would make it
more difficult for manufacturers of brand-name medicines to delay federal
approval of competing generic products. Brand-name manufacturers would be
allowed only a single 30-month stay, while a court tries to resolve patent
disputes. In the absence of a lawsuit by a brand-name company, the maker
of a competing generic drug could ask a court to clarify its right to
market it.
Senator Charles E. Schumer, Democrat of New York, said
this arrangement would benefit consumers by allowing makers of generic
drugs to know in advance whether they can sell copies of a particular drug
without infringing its patents.
The first
manufacturer of generic drugs to get federal approval for a low-cost copy
of a brand-name product would have an exclusive right to market it for 180
days. If the company did not begin marketing in 75 days, it could forfeit
exclusivity.
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