House And Senate On Course To Pass Medicare Prescription Drug Legislation
By
Washington
The House and the Senate, following separate tracks, are poised to approve a new $400 billion Medicare prescription drug benefit.
Both chambers of Congress were considering bills at press time, and the widespread speculation was that they would complete work on their bills–S. 1 in the Senate and H.R. 2473 in the House–before breaking for a week-long July 4th recess beginning June 30.
The two bills were going through the amendment process at press time, and some minor changes are possible. However, the basic thrust of the bills will likely be preserved.
Under H.R. 2473, beginning in 2006, Medicare beneficiaries would have a new optional prescription drug benefit subject to a $250 deductible.
Above $250, Medicare would pay 80% of all costs up to $2,000. Coverage would then be suspended until a beneficiarys out-of-pocket costs reach $3,700. Above that amount, Medicare would pay all costs.
Beneficiaries could receive coverage through the traditional fee-for-service plan or through a managed care plan.
The Senate bill, S. 1, is largely similar. Under the plan, standard coverage would be available to beneficiaries subject to a $275 deductible.
Between $276 and $4,500 in drug costs, Medicare would pay 50%. Then, coverage would be suspended until a beneficiaries out-of-pocket costs reach $3,700, at which point Medicare would pay 90% of all costs.
Again, coverage would be available both through the traditional fee-for-service plan and managed care plans, although private insurers would offer the coverage and assume some of the risk of loss.
Following passage of the two bills in their respective chambers, a House-Senate Conference Committee would convene to work out the differences and develop a consensus final proposal.
Karen Ignagni, president of the Washington-based American Association of Health Plans, praises the efforts of Congress to create a Medicare drug plan but says more is needed to secure Medicare.
"We applaud Congress for its bipartisan efforts to create a workable plan to give all Medicare beneficiaries access to prescription drug coverage, as well as disease management and preventative services that only the private sector can provide," she says.
She also praises Congress for looking to health plans as the foundation for creating a strong and viable partnership between the government and the private sector.
"For this partnership to succeed, Congress must stabilize the existing Medicare+Choice program by restoring funding to a level that reflects the current cost of health care," Ignagni adds.
