STS consultant Deborah Steelman, president of the policy consulting firm Steelman Health Strategies and a member of last year’s Bipartisan Commission on the Future of Medicare, will join a panel from the STS Professional Affairs Committee in looking at the options for changes in health care policy in the next Congress. The Professional Affairs Symposium will be held during the STS Annual Meeting, at 6:45 a.m., Tuesday, January 30, 2001.
With both the Senate and the House of Representative so closely divided between parties, proposals for major reforms are likely to give way to merely incremental reforms in which bipartisan agreement may be possible.
Senator Bill Frist (R-TN), who will deliver the first Thomas Ferguson Lecture at 1:30 p.m. January 29, is co-sponsor with Senator John Breaux (D-LA) of a proposal which would add a prescription drug plan to a modified version of a Medicare reform plan. Although it received the support of a majority of the Bipartisan Commission, it failed to obtain the one additional vote needed to become a recommendation of the Commission.
The Breaux - Frist proposal would create a new Medicare option under which patients would have a choice of either the standard Medicare program or of alternate plans for which the government would provide a defined premium based on the costs of the standard program. Prescription drug coverage would be offered by both the current Medicare program and the alternate programs as an enhanced option, with partial coverage of the drug costs by the government on a sliding scale depending on income. All participating programs would have to offer a minimum program, but would be allowed to offer additional services if the Medicare beneficiaries chose to pay whatever additional costs came with these services. “Modernization” of the traditional program, probably including options for joint hospital/physician contracting, would also be mandated.
Governor Bush endorsed this plan. Democrats have opposed the “defined benefit” proposal as simply expanding the Medicare HMO program and as opening the way to future Medicare cuts. Instead, they would prefer to “modernize” Medicare by adding prescription drug coverage to the standard program.
Also on the Congressional agenda will be further iterations of HMO reform bills that would require independent external review of decisions to withhold care, strong requirements that HMOs must observe the decisions of such external review panels, and ready access for patients to specialist care outside any closed panel. House Speaker Dennis Hastert has continued to encourage efforts to develop a compromise bill that includes these provisions but bridges the controversies over the right of patients to sue HMOs and over the scope of coverage of a bill. With the slight shift in power in the Senate toward Democrats, the Republican Senate leadership, which has blocked any bill with even a limited right to sue HMOs, may have to give way to a compromise bill.
Meanwhile, three organizations with divergent points of view in the health policy arena—the Health Insurance Association of America, Families USA, and the American Hospital Association—joined together in a program that would expand health coverage for a substantial portion of the 43 million individuals in the United States who lack health insurance.
Under this proposal, Medicaid would be
expanded to include all people younger than 65 years of age whose
annual incomes are below 133% of the federal poverty level ($18,820
for a family of three). Individual states would be given the option
to provide coverage, with enhanced federal matching funds, for
adults up to 200 percent of the federal poverty level. Employers
would be offered a tax credit if they covered the workers’
part of health insurance premium costs for low-income workers.