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House
and Senate Weigh Co-Payment for Care at Home
By
Robert Pear, the New York Times
House and Senate negotiators working on
Medicare legislation say they are seriously considering imposing a
co-payment on home health care, one of the few Medicare benefits for which
patients do not have to pay such charges. Congress eliminated the co-payment in
1972 in an effort to encourage the use of home care as an alternative to
nursing homes and hospitals, which are generally more expensive. Just four days remain before a Friday
deadline suggested by Republican leaders of Congress for completing work
on the legislation, which would revamp Medicare and add prescription drug
benefits, at an estimated cost of $400 billion over 10 years. Several negotiators said on Monday that
they were seriously considering a co-payment of $40 to $45 for each 60-day
period in which a beneficiary receives home care. That is about 1.5
percent of the average cost of such care. For each 60 day period, Medicare
typically pays $2,700 to $3,000. Members of a Congressional conference
committee are trying to reconcile separate bills passed by the House and
the Senate, a big challenge with big political implications for President
Bush and lawmakers of both parties. The House bill includes a co-payment
for home care, but the Senate bill has no comparable provision. Representative Bill Thomas, Republican
of California, the chief architect of the House bill, described the
co-payment as a way to deter unnecessary use of home care. "Requiring beneficiaries to share
the cost of home health services encourages them to use care more
prudently," said Mr. Thomas, the chairman of the conference
committee. But home care agencies and advocates for
the elderly criticized the co-payment as a "sick tax." Most supporters of the co-payment are
Republicans. But opposition comes from both parties. "A home health co-payment of $40 to
$50 per episode would impose a significant additional burden on those
beneficiaries who can least afford it," said a letter to the
conference committee, drafted by Senators Susan Collins, Republican of
Maine, and Russell D. Feingold, Democrat of Wisconsin. Fifty-seven
senators, including 24 Republicans, have signed the letter. Medicare spending on home care soared in
the early 1990's. But it fell to $10 billion in 2002 from $17.5 billion in
1997 as the government adopted a more restrictive method of payment and
cracked down on fraud. The Congressional Budget Office predicts that
annual spending will triple in the coming decade, to $32.9 billion in
2013. Thomas A. Scully, administrator of the
federal Centers for Medicare and Medicaid Services, said the Bush
administration had not taken a formal position on the co-payment. He said
he personally believed that "a good case can be made for charging a
modest co-payment to people who can afford it." A Republican working on the Medicare
bill said, "A co-payment seems inevitable." Any effort to block
the co-payment at this stage would probably touch off a big fight, he
said. Another Republican, Representative John
E. Peterson of Mr. Peterson said he came away from the
meeting with the impression that "there's likely to be a
co-payment" on home health care. Mr. Peterson is not a member of the
conference committee, but is closely following its work. Home care workers provide a wide range
of services to the homebound elderly and disabled: nursing care for
patients with surgical wounds, physical therapy for those with hip
fractures, speech therapy for stroke patients and monitoring of patients
with unstable vital signs. The Republican leaders of Congress,
Speaker J. Dennis Hastert of Several lawmakers said it would be
difficult to meet that goal. But Congressional aides have been meeting
continually for several months, and John E. McManus, a top aide to Mr.
Thomas, said: "The end is nigh. We are making tremendous progress,
and the momentum is building." Though the prospect of new drug benefits
has excited the greatest public interest, the Medicare bill would affect
many other aspects of the program. The conference committee is weighing a
proposal to exempt low-income beneficiaries from the new co-payment.
Several negotiators have also proposed an exemption for the first 60-day
episode of home care. Kathy S. Thompson, vice president of the
Visiting Nurse Associations of America, a trade group for nonprofit home
health organizations, said the co-payment was one of many surprises buried
in the voluminous bill. "Most beneficiaries receiving home
care are elderly women in poor health, living alone on fixed
incomes," Ms. Thompson said. "Even if individuals with incomes
under $12,000 a year are exempt, the co-payment would create a real
hardship for those with incomes of $12,000 to $15,000." Mary Vasinda, president of Around the
Clock Home Care in Representative Billy Tauzin, Republican
of Louisiana, tried to eliminate the co-payment from the House bill in
June. The Committee on Energy and Commerce, of which he is chairman, voted
41 to 5 to delete it. But the charge was included in the bill passed by
the House. Mr. Peterson said Mr. Tauzin was now
"working hard to minimize the co-payment." But Mr. Peterson
added, "I don't know anybody in the conference committee who's
fighting to keep it out completely." The House bill would also reduce the
annual update in Medicare payment rates for home health services in each
of the next three years. The Congressional Budget Office estimates that
that change, combined with the new co-payment, would save Medicare a total
of $7 billion, or 3.4 percent of projected home health spending, in the
next 10 years. William A. Dombi, vice president of the
National Association for Home Care, said that many Medicare beneficiaries
receiving home care already paid co-payments and deductibles for doctors'
services, hospital care and medical equipment like wheelchairs and
walkers. Lobbyists and lawmakers are also
debating a proposal to establish a co-payment for diagnostic tests
performed by clinical laboratories. The Senate bill would require Medicare
beneficiaries to pay 20 percent of the cost of such tests. The
Congressional Budget Office estimates that those co-payments would total
$18.6 billion over the next decade. Alan B. Mertz, president of the American
Clinical Laboratory Association, said, "We have made some headway in
convincing Congress that the laboratory co-payment is unworkable." In many cases, Mr. Mertz said, the cost of trying to collect the co-payments would exceed the amount collected. For the 100 most common tests, he said, the co-payment would average less than $2.50 a test. Copyright
© 2002 Global Action on Aging |
