Friday, Nov. 21, 2003 | 9:45 a.m.
WASHINGTON -- The addition of prescription drug coverage to the federal Medicare health plan could be approved soon as the House and Senate prepare to vote on major legislation this weekend.
Some Nevada lawmakers are still deciding how to vote on the controversial legislation, but Rep. Jim Gibbons, R-Nev., will vote for the bill and supports the proposed plan.
"He is happy to see that we are closer than ever before on reforming Medicare to reflect the needs of seniors and move our health care capabilities into the 21st century," Gibbons' spokeswoman, Amy Spanbauer, said.
House and Senate negotiators finished the final version of the major Medicare legislation late Thursday. The 403-page conference report could go to the House floor today and if approved would move to the Senate over the weekend. Both chambers may be in session through Tuesday to finish up the Medicare and several spending bills that still need approval.
Rep. Jon Porter, R-Nev., has not made public his plans on the bill, but spokesman Adam Mayberry said Thursday he was supportive of the legislation so far.
Jack Finn, spokesman for Sen. John Ensign, said the conference report has "consumed (Ensign's) every waking hour" but he has not decided how to vote for the bill.
Sen. Harry Reid, D-Nev., is also undecided.
"It's a very complicated bill and he is still weighing the various provisions and the effects the legislation would have on Nevada," spokeswoman Tesssa Hafen said via e-mail today.
Spanbauer said putting a prescription drug benefit into Medicare is cost-effective and also better for patients. For example, she said, if patients have easier access to a drug such a Lipitor, which controls high cholestrol, it will help prevent their health from deteriorating into congestive heart failure or advanced stages of heart disease and other ailments that can cost $6,000 per hospital visit. She noted patients often need to visit hospitals multiple times, but giving them the drugs they need could eliminate those costs.
Through the proposed reform, starting in 2006, Medicare users will have a $250 deductible and 75 percent of prescription drug coverage up to $2,250, according to a summary of the bill from the House Ways and Means Committee, which controlled its creation. After that the law would cover $3,600 in "out-of-pocket catastrophic coverage."
The bill also contains $21 million in payments for Nevada hospitals, mostly concentrated on facilities with 110 beds or less in rural counties, she said.
"There are payments and reform beyond just the prescription drug benefit," Spanbauer said.
Initial physician exams not previously covered under the federal health plan would also be added.
Nevada Rep. Shelley Berkley was still undecided before her Democrat caucus meeting this morning on how she will finally vote, but she has been critical of the plan.
"This is no longer just a prescription drug benefit plan, but in my opinion seeks to privatize the Medicare system," Berkley said earlier today. "I'm in favor of a prescription drug plan and don't know why we have to play games with our older Americans."
She said the bill creates a huge "doughnut hole" in coverage since even though seniors would be paying monthly premiums and deductibles after paying $2,000 into the system, they would have "nothing, zero, nada" coverage until they hit $5,000 in some cases, she said.
Meanwhile, also according to the summary, the report blocks a pending 4.5 percent cut to physician reimbursements in 2004 and instead raises the pay-back rate by 1.5 percent.
Berkley had wanted that in the bill.
Floor debate late Wednesday on Berkley's motion brought up simliar arguments to those heard today on the pending bill.
"Simply attempting to transfer dollars from patients to physicians through some ambiguous, unspecified mechanism, as is intended under the motion to instruct, would not change the flawed Medicare payment formula and thus would not ensure long-term access for Medicare patients," according to the American Medical Association.
Rep. Michael Burgess, R-Texas, an opponent of Berkley's motion, read the AMA's statement on the floor of the House.
Berkley takes issues with the language that will create test cities for health insurance companies to receive subsidies to treat Medicare users. Berkley spokesman David Cherry said the cities have not been selected but Las Vegas would fit proposed criteria to be a test city.
Berkley said if Las Vegas became a test city, seniors in Clark County could be paying up to $2,000 for their Medicare coverage while seniors in other cities would be paying substantially less.
"It's a major flaw in the bill," she said. The test city provision is an issue with other members too.
"They will raise their premiums, they will cherry-pick, and only the sick seniors, the old seniors who have the highest costs will be left with straight Medicare," Lois Capps, D-Calif., said. "That is not a choice and that is going to happen. It will be happening before the end of this decade if this bill is passed and goes into effect."
Republicans criticized Berkley's motion saying it was not going to change anything.
"They are simply political tools used in a desperate attempt to divert attention away from the fact that the Republican House will in a matter of days deliver, it will deliver on its commitment to providing seniors with access to meaningful, affordable and comprehensive prescription drug coverage," Rep. Phil Gingrey, R-Ga., said.
"Being a doctor's wife and having a stepdaughter who is a third-year medical student, I do not need to be lectured by the other side of how the effect of these Medicare reimbursements are affecting doctors because I know firsthand and personal what it is doing," Berkley said.
"Make no mistake about it, this legislation, rather than being a prescription drug plan, rather than being a Medicare reimbursement plan for doctors, what this is is the first step in privatizing Medicare, and that would be a disaster our for seniors."
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