Copyright 2000 The New York Times Company
The New
York Times
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November 1, 2000, Wednesday, Late Edition -
Final
SECTION: Section A; Page 22; Column
1; National Desk
LENGTH: 894 words
HEADLINE: Clinton Raises Stakes in the Battle Over a
Bigger Medicare Pot
BYLINE: By ROBERT PEAR
DATELINE: WASHINGTON, Oct. 31
BODY:
President Clinton escalated the fight over
Medicare spending today, demanding that Congress shift money to health programs
for poor people, disabled children and legal immigrants.
But Republicans
rebuffed White House pleas to negotiate on the issue and said they felt they had
the upper hand. The two sides are in broad agreement that the Medicare program
should receive more money -- about $30 billion, or 2.3 percent more over five
years. But the fight over how to distribute the money threatens to sink the
plan, jeopardizing the expected increase in payments to health care providers.
A Republican tax bill passed last week by the House would authorize new
Medicare benefits, for preventive care, and would increase Medicare payments to
health care providers, including health maintenance organizations, hospitals,
nursing homes, hospices and home health agencies.
The health care
industry strongly supports the Medicare provisions of the bill. But President
Clinton has threatened to veto it, saying it includes huge tax breaks for the
wealthy and "an unjustifiable spending increase for H.M.O.'s."
Most
Republicans and some Democrats say the increase is needed to prevent wholesale
defections of private health plans from the Medicare program.
Representative Bill Thomas of California, the Republican spokesman on
health care issues, said, "The president sees imperfections in this bill for
political reasons."
Republicans from the House and the Senate have
agreed on the Medicare legislation. Asked if he would negotiate with the
president, Mr. Thomas said: "This measure is done. All the president has to do
is sign it. We don't need another version."
Chris Jennings, the health
policy coordinator at the White House, said tonight, "We've tried to reach out
to the Republicans, but have not had any negotiations."
Representative
Collin C. Peterson of Minnesota, a conservative Democrat, said: "If this bill is
vetoed, I'm not sure you'll get another bill. We'll be a long way into next year
before we get more money out to hospitals, nursing homes and home health
agencies."
Congress cut payments to health care providers in the
Balanced Budget Act of 1997, but the savings have far surpassed what it
expected.
Thomas A. Scully, president of the Federation of American
Hospitals, which represents 1,700 hospitals, said: "There has been an assumption
all year, a 99 percent certainty, that Congress would fix the Balanced Budget
Act. But if Congress goes into a lame duck session, there's no certainty. I'm
very worried that we would lose the momentum for this legislation in a lame duck
session."
The prospect of a delay has alarmed hospitals, which say they
need immediate financial relief.
About 6.2 million elderly and disabled
people -- 16 percent of the 39 million Medicare beneficiaries -- are in
H.M.O.'s. But White House officials say that H.M.O.'s would get 34 percent of
the new Medicare spending.
Mr. Clinton will be president for only 12
more weeks, but he is not acting like a lame duck. He is trying to force
Congress to accept his priorities on a wide range of second-tier issues, even as
he acknowledges that two of his biggest hopes, for Medicare drug benefits and a
federal law defining patients' rights, will probably go unfulfilled.
In
documents circulated today on Capitol Hill, Mr. Clinton set forth his demands.
He insisted that Congress allow Medicaid coverage for pregnant women and
children who are legal immigrants, let working parents buy Medicaid coverage for
children with disabilities and make it easier for children to enroll in
Medicaid, at schools and homeless shelters across the country. (Under the 1996
welfare law, new immigrants generally cannot receive Medicaid until they have
lived in the United States for five years.)
The dispute over Medicare
payments to H.M.O.'s crystallizes several years of frustration. White House
officials say it is simply unacceptable to increase payments to health plans
that have blocked bipartisan efforts to define patients' rights.
For
their part, H.M.O.'s say Mr. Clinton's latest proposals show that he has little
comprehension of how health care markets work: he would lock them into Medicare
for three years at a time, even though their contracts with doctors and
hospitals often last no more than a year.
Diana C. Dennett, executive
vice president of the American Association of Health Plans, a trade group for
H.M.O.'s, said: "No responsible party would get into such an arrangement. Health
plans would be locked into Medicare for three years, with no concept of how much
they would be paid by the government in the second or third year."
Mr.
Jennings, the White House official, said: "We are not rejecting all H.M.O.
payment increases. The president simply wants accountability and a more
equitable distribution of resources to beneficiaries and health care providers."
Republicans say the president should sign the bill because of the new
benefits it would provide Medicare recipients.
The bill
would, for example, expand coverage of mammography, Pap smears
and pelvic examinations for women, broaden coverage of colonoscopies to detect
colon cancer and pay for eye examinations to detect glaucoma, a major cause of
blindness.
The bill also promises to reduce the cost of outpatient
hospital care for Medicare beneficiaries.
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