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Panel
Backs Senior Drug Card
By Vicki Kemper,
Los Angeles Times
September
10, 2003
A sharply divided
House-Senate conference committee tentatively agreed Tuesday to offer
seniors a Medicare-endorsed drug discount card but raised new doubts about
prospects for a comprehensive Medicare prescription drug benefit.
The card, which would become available no later than six months after
enactment of a Medicare overhaul bill, is designed to give beneficiaries
some relief from medication expenses until a Medicare drug benefit could
take effect. That would be no sooner than Jan. 1, 2006.
But some Democrats suggested that a final bill would
not pass the Senate if it contained certain House-passed provisions — or
if Republicans, who hold a majority in both chambers of Congress, squeezed
Democrats out of negotiations.
"If I feel that's happening, I'm going to have to reconsider my
position on this legislation," said Sen. Max Baucus (D-Mont.), who
helped draft the Senate-passed bill. "I'd rather have a good bill.
But no bill is better than a bad bill."
House Republicans countered that, in the words of Rep. Nancy L. Johnson of
Connecticut, Congress did "not have the luxury of not passing a
bill."
There were signs of bipartisan cooperation.
Conservative Sen. Don Nickles (R-Okla.), who voted against the Senate
bill, and liberal Rep. John D. Dingell (D-Mich.), who voted against the
House bill, worked out a co-payment plan for low-income seniors using a
drug discount card.
The panel approved that and other aspects of the temporary drug discount
card, as well as a few other largely technical, noncontroversial issues.
Congressional aides estimated that the discount card would save Medicare
beneficiaries 15% to 25% for each prescription.
Drug manufacturers, pharmaceutical benefit managers, retail pharmacies and
others could submit their discount cards to the government for a
"Medicare stamp of approval." To win that approval, discount
card programs would have to meet certain government standards, including
guaranteed access to participating pharmacies. Card providers could charge
seniors an annual fee of up to $30.
Seniors could choose a single Medicare-endorsed card, although they could
continue to use other discount cards as well. Card providers would pass on
to seniors some or all of the discount they received from drug
manufacturers.
Beneficiaries with incomes of less than $12,123 for an individual or
$16,362 for a couple (135% of the poverty level) would qualify for a
federal subsidy on the drug card of up to $600 a year.
The government would also pay the enrollment fee for low-income
beneficiaries, but they would be responsible for a modest co-payment on
each drug.
Those with incomes below the poverty level — $8,980 for an individual or
$12,120 for a couple — would pay 5% of a drug's discounted cost. Seniors
with slightly higher incomes would pay 10% of each drug's cost.
Committee members also agreed to increase Medicare payments to so-called
critical-access hospitals, about 800 facilities largely in rural areas,
and to expand Medicare coverage to include certain screening tests for
heart disease and diabetes.
Beyond such matters, the third meeting of the full, 17-member conference
committee was laced with partisan accusations and recriminations. "I
know that the really tough issues are still ahead of us," said Sen.
Charles E. Grassley (R-Iowa), vice chairman of the committee.
Sen. John D. "Jay" Rockefeller IV (D-W. Va.) listed four issues
that he said could change the fundamental nature of Medicare, which offers
equal benefits to all 40 million seniors and disabled people in the U.S.:
market competition, treatment of the poorest seniors, a
"fallback" plan to have Medicare administer the drug benefit in
underserved areas and higher payments for doctors, hospitals and nursing
homes in rural areas.
Rockefeller, who voted against the Senate bill, supported the House
position on only one of the four, concerning treatment of the poorest
seniors.
Noting the Senate rule that requires 60 votes to cut off debate, Baucus
said a final overhaul bill designed to win a simple majority of 51 votes
would be doomed. "The only way to pass legislation here is to find a
solution that moves more toward the Senate version," he said.
"We have strong feelings on the House side too," said Rep. W. J.
"Billy" Tauzin (R-La.). "We have to find a way to
accommodate each other The last thing we ought to be doing is challenging
each other."
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