After hours of bitter and partisan debate, the House approved, 221-208, a bill (H.R. 4954) to provide a Medicare prescription drug benefit. The vote came in the early morning hours on June 28, after debate on the measure was delayed until 9 p.m. the evening before.
During debate on the rule, a group of roughly 30 Democratic women came to the floor to protest the measure. One after another, they called the legislation a “sham” and said it would “harm senior women.” Bill sponsor Rep. Nancy Johnson (R-CT) adamantly responded that the measure is “the greatest leap forward for women’s health,” adding that “for the first time, we provide coverage for women.” Rep. Shelley Moore Capito (R-WV) agreed, saying that the benefit is “extremely beneficial to the senior women of America.”
Democrats also protested their inability to offer a substitute amendment under the closed rule. “Why don’t you stand up and be men and women and debate it?” asked Rep. Anna Eshoo (D-CA). “I’ll tell you why. You’re afraid to debate it.”
Rep. John Linder (R-GA) countered that “in the 40 years the Democrats were in the majority, they never offered a benefit. The Republicans are.”
Rep. John Shimkus (R-IL) said, “It’s not a perfect bill. It’s a thing we can pass on the floor tonight.”
The bill considered on the House floor combined provisions approved last week by the House Ways and Means and Energy and Commerce Committees (see The Source, 6/21/02). Overall, the legislation would provide an estimated $310 billion Medicare prescription drug benefit over ten years. The House-passed FY2003 budget resolution (H. Con. Res. 353) set aside $350 million over ten years. Beginning in 2005, the bill would establish a voluntary Medicare prescription drug benefit; however, the coverage would be provided by private insurers, with federal subsidies of up to 67 percent of the cost to encourage plans to participate.
Medicare beneficiaries would pay an estimated $250 deductible and an estimated $35 monthly premium. Once beneficiaries met the deductible, they would be required to pay 20 percent of their prescription costs up to $1,000. Between $1,001 and $2,000, the costs would be split 50-50, and between $2,001 and $3,700, seniors would be responsible for all of their prescription drug costs. The Ways and Means Committee-approved bill would have set a catastrophic limit of $3,800, while the Energy and Commerce Committee-approved bill set the limit at $3,700.
The bill would provide subsidies to low-income seniors, covering all costs, including the premium, for those seniors with incomes up to 150 percent of the poverty level. H.R. 4954 would gradually phase-out the full subsidy between 150 and 175 percent of the poverty level. Low-income seniors who qualify for the subsidies would be required to pay a $2 co-payment for generic drugs and a $5 co-payment for brand-name drugs.
Under the measure, prescription medications, biological products, insulin, and prescription smoking cessation drugs would be covered, and a formulary would be used to determine which specific drugs would be covered by the plan.
H.R. 4954 also would make changes to the Medicare program involving reimbursements provided for services by hospitals, home health agencies, skilled nursing facilities, and physicians. The increased payments to Medicare providers are estimated to cost $34.5 billion over ten years.
Medicare+Choice (M+C) plans would see their payment rates increase under the measure, costing an estimated $500 million over ten years, and a new competitive bidding program for M+C plans would be created.
