Medicare Compliance & Reimbursement

Hill Republicans see an opportunity to move quickly on Medicare prescription drugs and other program changes, and they want to seize it.

At the American Association of Health Plans’ National Policy Forum, House Ways and Means Majority Staff Director John McManus and Energy and Commerce Committee majority staffer Patrick Morrissey both said Feb. 25 that their committees would act in time to have a bill on the floor by Memorial Day as Speaker Dennis Hastert (RIL) wants.

On the Senate side, the Finance Committee is pushing to meet Majority Leader Bill Frist’s (R-TN) plan to have a bill on the floor by July 4.

Chair Charles Grassley’s (R-IA) consultations are currently limited to committee Republicans and the administration, Finance majority aide Colin Roskey said. But once a “comfort level” is reached among all GOP members — “probably in a few weeks, maybe in a month and a half or so — Grassley will go public with hearings. At that point, Grassley will also begin “reaching out aggressively to Senate Democrats,”

Roskey said. At a Feb. 27 hearing, Grassley expressed hope that, unlike last year, the panel could markup a “bipartisan, consensus bill ... because as we all know, for anything to get done around here, it will need to be bipartisan and will need 60 votes.”

However, there are still big differences with Democrats, and in one important respect those differences may have gotten larger. “Last year, there was a widespread consensus — Democrat, Republican, House, Senate, White House — that all Medi care beneficiaries should have a drug benefit,” said

Jon Blum from Finance’s minority side. But “we’re now seeing a shift in the dialogue,” with the administration suggesting limiting a benefit to beneficiaries willing to enter private plans. Seniors who stay behind in traditional Medicare would get no benefit or a more meager one. Blum called this “a step backward” that would “make a consensus in the Senate much more difficult.”

The administration Mar. 4 proposed providing a drug benefit to seniors who stay in feefor- service Medicare. According to the New York Times, FFS beneficiaries would get, at no extra premium, catastrophic coverage plus a discount card for use on purchases below the cap. Bush announced his plan in a speech to the American Medical Association.

But that benefit would still be significantly less than coverage available in private plans, and is unlikely to satisfy even moderate Democrats like Finance ranking member Max Baucus (MT), who has been open to a greater role for private plans in Medicare but “does not believe that we should have carrots or sticks to encourage beneficiaries to leave” FFS, said Blum. Baucus said Feb. 27 that he would not support “any proposal that would create an unlevel playing field between private plans and the current fee-for-service program” and called for making the “same drug benefit” available to all.

Remarks by Roskey, meanwhile, indicated that Grassley is taking a gentler, wait-and-see attitude on some proposed Medicare revisions, other than the drug benefit, based on administration promises that new Medicare+Choice options like preferred provider organizations will eventually locate in rural areas.

This year, Hill Republicans want to emphasize benefit integration to make disease management easier, said Roskey. “We mean notions like preferred provider organizations ... having some measure of coordinated, but not necessarily tightly managed care.” These mechanisms can work in rural areas, but withdrawals of M+C health maintenance organization, while not necessarily HMOs’ fault, have made discussing integrated care “that much more difficult,” he said.

“It has been a difficult thing for many members who have had M+C plans in their state and do not know to really tackle the notion of some other sort of private delivery mechanism. … How can the system work tomorrow if it didn’t work yesterday?”