Conferees Take On Remaining Medicare Issues

November 3, 2003
Little by little, a Medicare reform bill is being pieced together by the Senate-House committee that's been struggling since last summer to add a prescription drug benefit to Medicare while balancing the demands of industry and interest groups.

Among the sticking points members think they're ironed out in the last week are concerns about rural health care, co-payments for home health care and employers dumping current retirees' benefits.

• Rural Care Protected Conferees reportedly are allocating $12 billion to entice private health plans to enroll elderly patients in rural areas. There has been concern that preferred provider organizations (PPOs) won't offer care in rural areas. Since Republicans think PPOs should become the main form of care for Medicare recipients, the conferees are adding the incentive to ensure that rural areas aren't left behind.

The $12 billion was not in either the House or Senate version of the bill and is strictly a conference committee invention. The Secretary of HHS would have the authority to decide when and where the incentives would be paid.

• No Co-Payment for Home Care Intense lobbying by Medicare beneficiaries and former Sen. Bob Dole put an end to the notion of charging a bimonthly fee of $40 to $50 for home care. Rep. Bill Thomas (R-Calif.) and Sen. John Breaux (D-La.) had supported the payment as a way to discourage overuse of home care. Home care agencies called it a "sick tax" and retained Mr. Dole to take their concerns to the Hill.

Sen. Susan Collins (R-Maine) and Rep. Billy Tauzin (R-La.) led the opposition, saying the charge would be a particular hardship on people with low incomes. "(It) would have forced many of the most frail seniors to turn down care they really need," Collins said.

• Home Care Fee Increases Reduced Home health care escaped the co-pay but to extract some savings from care providers, Congress is reducing the annual Medicare update paid to home health agencies. The update is intended to cover inflation in the cost of goods and services.

• Current Retirees' Health Benefits
The labor-supported Alliance for Retired Americans purchased television ads in key media markets, urging viewers "not to let Congress turn Medicare over to private insurers as now being proposed."

"Millions of retirees could lose their existing employer-provided coverage," warns Alliance President George J. Kourpias, who charged that under the legislation, "Seniors will end up with thousands of dollars in out-of-pocket costs."

President Bush, meanwhile, said the elderly should put pressure on Congress to finish the group. "I urge America's seniors to speak up," he said. Bush said he has been assured that employers will not eliminate drug benefits for retirees if Medicare begins picking up some prescription costs. He cited assurances from a vice president of Caterpillar, who said his firm would not "dump" retirees into a system they don't want.