AMNews: Aug. 19, 2002. Senate debate shifts to pay fix ... American Medical News

Senate debate shifts to pay fix

A panel plans to consider reversal of Medicare physician reimbursement cuts next month, but reaching agreement on a prescription drug benefit could be trickier.

By Markian Hawryluk, AMNews staff. Aug. 19, 2002. Additional information

Washington -- Efforts to reform Medicare suffered a severe blow when the Senate failed to pass an outpatient prescription drug bill, but so far the damage hasn't hurt the drive to fix Medicare physician payment.

Senators left for their August recess after two weeks of fruitless debate over a prescription drug benefit. However, Senate Finance Committee Chair Max Baucus (D, Mont.) has indicated he would like his panel to vote on a Medicare practitioner payment bill as early as possible after the Senate returns in September.

Although details of the payment package were not available at press time, the overall spending level of the measure is expected to be close to the $30 billion over 10 years approved by the House in June. The House measure included $21.3 billion over five years to replace the deep cuts in physician reimbursement predicted for the next three years with payment updates of about 2%.

Meanwhile, the body of evidence showing that physician payment cuts are causing an access problem for Medicare services is growing. An annual survey by the American Academy of Family Physicians found that 21.7% of its members can no longer take new Medicare patients, up from 17% in 2001.

"My practice has been forced to quit taking new Medicare patients because the costs associated with treating them are increasing, while our reimbursement continues to go down," said Deborah G. Haynes, MD, a family physician from Wichita, Kan. "It's sad, because these are the patients who need us most."

The ultimate fate of the physician payment fix could still be linked to the Medicare prescription drug debate, which is likely to come up again in the Senate this year. Senators might be unwilling to pass Medicare payment increases without also adding drug coverage.

Almost one-quarter of seniors skip doses or don't fill prescriptions due to cost.

Lawmakers in the Senate have been unable to agree on even the most basic structure of a prescription drug benefit. Republicans have been unwilling to back benefits that would cost more than $400 billion, while Democrats have been reluctant to allow private insurance companies to administer the benefit.

The Senate failed to pass four proposals brought as amendments to a generic drug bill, which was eventually approved without them. Senate Majority Leader Tom Daschle (D, S.D.) tried to push through a $594 billion bill introduced by Sen. Bob Graham (D, Fla.) that would have provided a more generous drug benefit than the House plan. Republicans countered with a $370 billion plan that was similar to the House measure.

When both measures failed, Senators considered but rejected a Republican amendment that would have provided some coverage for low-income seniors and capped expenses at $3,500 for others.

Senate Democrats then tried to broker a last-ditch compromise bill that would have established coverage for beneficiaries with low incomes or high drug costs.

Perhaps indicative of worries that they would face a political fallout in November elections if they failed to pass a drug benefit, Democratic senators abandoned long-held party tenets that Medicare benefits should be universal and not income-tested.

The compromise measure won the support of AARP. The group said it hoped that a stronger benefit could be worked out when House and Senate versions of the drug benefit were merged.

One-fifth of AAFP members are not accepting new Medicare patients.

"While AARP supports a comprehensive drug benefit that would help all beneficiaries, we are determined not to see this end in a stalemate," AARP board member Erik Olsen said.

House Republicans, however, blasted Senate Democrats, saying the proposal would help fewer individuals at a greater cost.

Rep. Nancy Johnson (R, Conn.) said the Senate measure did exactly what Democrats had criticized House Republicans for doing.

"Democrats have attacked the House-passed bill and similar bipartisan legislation in the Senate because of a gap in coverage for those with modest drug costs," Johnson said. "Now they eliminate all coverage for those with modest costs and expect to be taken seriously?"

The final Democratic amendment was rejected on a 50-49 vote, with four Republicans backing the bill but five Democrats opposing it.

The vote sent lawmakers home for the recess without a drug benefit to tout to voters. But many observers, including Health and Human Services Secretary Tommy Thompson, said they are still optimistic that a compromise could be hammered out before the elections.

"While it is disappointing that the Senate was unable to pass Medicare prescription drug legislation before its August recess, we strongly encourage senators to come together to get the job done upon their return after Labor Day," Thompson said.

Widespread need

Although limited assistance with drug costs is available to beneficiaries through a number of state-run programs, it is often not enough for low-income seniors.

In a Kaiser Family Foundation survey of seniors in eight states, nearly one-quarter of respondents reported skipping doses of medicine or not filling prescriptions because of costs.

Almost one-quarter of seniors spend $100 or more a month on prescriptions.

The survey found 37% of seniors enrolled in Medicare HMOs, 31% of those with medigap, 28% of those enrolled in state pharmacy assistance programs, and 24% of those with Medicaid coverage skipped doses because of costs. Nearly one-quarter of seniors spent $100 or more per month on prescription drugs in 2001.

"With one in four seniors skipping medications, lack of drug coverage is more than a financial burden -- it's a health risk for seniors," said Drew Altman, PhD, president and CEO of the Kaiser Family Foundation.

Whether lawmakers ultimately pass a Medicare physician payment fix or a drug benefit could depend on timing.

Although Congress is scheduled to complete its work by Oct. 4, most pundits expect lawmakers to work well past that deadline.

None of the 13 appropriations bills was finalized before the recess. There is a good possibility Congress may have to resort to a session extending after the November elections.

ADDITIONAL INFORMATION:

Bitter pill

Cost concerns keep many senior citizens from maintaining pharmaceutical therapy regimens, a recently released survey of seniors in eight states showed.

Did not fill a prescription because it was too expensive:
Total: 14%
Without drug coverage: 25%
With drug coverage: 11%

Skipped doses to make prescription last longer:
Total: 16%
Without drug coverage: 27%
With drug coverage: 13%

Source: Kaiser Family Foundation and the Commonwealth Fund

Weblink

Kaiser Family Foundation survey, "Seniors and Prescription Drugs: An Eight-State Survey" (http://www.kff.org/content/2002/6049/)

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