WASHINGTON, Aug. 19 (UPI) -- The likelihood a Medicare prescription drug bill will pass this year is waning with the hot August weather, collapsing under the weight of party politics, complex and confusing language and a groundswell of senior unhappiness.
The optimism that prevailed in June, spurred by the House and Senate each passing bills to add a limited prescription drug benefit to the 38-year-old senior health care program, has given way to late summer pessimism -- experts now doubt anything will get done this year.
Marilyn Moon of the American Institutes for Research, Joseph Antos of the American Enterprise Institute and Dale Yamamoto of Hewitt Associates -- analysts who look at Medicare from multiple political and economic vantage points -- all say it is only an even bet a Medicare drug bill will make it out of the conference committee to President Bush's desk. The president acknowledged in July there was tough work ahead.
"It's 50-50 now," Moon said. "It used to be higher."
In June, a bipartisan compromise was floating through Congress like a fresh summer breeze and Yamamoto said he thought at the time the Medicare bill had an 80 percent chance of passage.
Since then, Republicans and Democrats have retrenched closer to party lines on what they will accept in a final bill, which must be approved by both the House and Senate. There is talk of a possible Senate filibuster by Democrats if the conference bill emerges looking like the House measure, while House Democrats think the Republicans railroaded that bill through.
Republicans hold a slim advantage in the Senate but need Democrats to push the final measure though.
GOP conservatives want the House bill and are looking to the White House for a helping hand. President Bush has said, in effect, he will sign just about anything, but analysts expect him to be more involved in the fall negotiations.
Rather than a clean prescription drug bill for Medicare under consideration, the legislation has turned out to be a $400 billion, 10-year, complex, thousand-page plan combining drug coverage and, in some form, the privatization of Medicare via private health plans.
Even worse, basic party politics -- the same philosophical party views that were argued when Medicare was created in 1965 -- are strong enough to collapse the whole deal unless lawmakers conduct some heavy-handed negotiating when they return after Labor Day.
Democrats generally want to keep Medicare a government entitlement program available equally to all seniors. They also want to give seniors choices, so some go along with the Senate bill language, which allows preferred provider organizations to participate in a revamped and renamed Medicare+Choice program that requires PPOs to bid for Medicare business. The Democrats insist on keeping traditional Medicare a strong yet separate component of the plan, however, and draw the line at the House bill language tying the government subsidy for traditional, fee-for-service Medicare to private plan bids in 2010, saying it would destroy the traditional program.
The Republicans, on the other hand, seek to meld Medicare with private health plans. They want to see if consumer demands -- coupled with market responses and varying benefit levels and payments -- can make the program more efficient, give seniors choices and do it all for less money. The Republicans argue tying traditional Medicare to private plan spending will help keep that part of the program -- predicted to go into the red within 23 years -- financially in check.
Even if the bill contained only the drug benefit provision, it still would be a challenge to pass, experts said.
"This is a very complex bill," Moon said. "(If I were a senior) I would find this very confusing."
Seniors themselves, meanwhile are beginning to understand $400 billion over 10 years does not go very far.
The House and Senate bills both start the drug program in 2006 but begin funding in 2004 to help the money go farther. Both versions contain annual deductibles -- $250 in the Senate bill and $275 in the House. Each contains a monthly premium -- around $35 -- that could increase yearly, and both have gaps in coverage -- $4,500 to $5,813 in the Senate bill and $2,000 to $4,900 in the House -- during which seniors would pay all of their annual drug expenses out of pocket.
Low-income patients would receive extra help, but the bills differ on how Medicaid-eligible seniors would be treated -- many seniors with modest incomes or higher would not benefit from either of these plans. Those still working are worried that employers now offering health coverage to retirees would drop it if a Medicare drug plan -- which would likely be less generous than most employer-sponsored plans -- is passed.
"From the standpoint of an insurance policy, (the coverage gap) doesn't make a lot of sense," said Joseph Antos, an analyst with the Alliance for Health Reform in Washington, D.C. He acknowledged, however, lawmakers had to make tough choices to forge a viable deal in the face of future health care spending rises.
Other interested parties are not so sure.
"I think the chances (of passage) are decreasing," Richard Fiesta, head of the Alliance for Retired Americans in Washington, D.C., a group that claims 3 million members nationwide, told United Press International. "They are less than they were a month ago."
The alliance also has been busy during the summer recess, organizing more than 30 events nationwide, at which seniors protest against the legislation. For example, last week in Tucson, some 125 seniors demonstrated -- and two were arrested -- during an event in front of the office of Sen. Jon Kyl, R-Ariz. More than 150 seniors also demonstrated outside the Pittsburgh office of Sen. Rick Santorum, R-Pa.
Fiesta said he thinks seniors can and will make a difference in Washington and noted anecdotal reports of Republicans on the conference committee crafting the final Medicare legislation being offered help by others in the GOP if they are confronted by senior groups on the issue.
The AFL-CIO is using its Web site to urge seniors to write to their congressional representatives asking for a better bill. The site noted scores of seniors in Illinois recently greeted House Speaker Dennis Hastert, R-Ill., with protests and placards demonstrating against what they regard is inadequate drug coverage in both the House and Senate bills.
The American Association of Retired Persons, which has declared the current bills a good starting point, urges seniors on its Web site to push their elected officials to improve the offerings by getting rid of the coverage gap.
Democrats, such as Rep. John Dingell, D-Mich., hope seniors will voice their unhappiness with the drug proposals in conference committee.
"I'm going to do everything I can to generate that," he told UPI. "Seniors to whom I am speaking are now becoming aware. ... The seniors will be very disappointed (in the legislation)."
Analysts also are very skeptical about provisions setting up how private plans would participate -- both as PPOs in a new Medicare+Choice and as stand alone drug plans in both the Senate and House bill. They caution subsidy and risk sharing guarantees might not be enough to entice plans to participate. Or, the plans might try the program for a year or so and then pull out, creating chaos and uncertainty for seniors.
Antos said Democrats who fear the concept of privatization under the House and Senate bills "will be disappointed" because it likely will not work, anyway.
Julie James, an analyst with Health Policy Alternatives Inc., in Washington, D.C., said there "obviously are literally hundreds of differences between the two bills" in conference committee but added she believes congressional staff can settle most of the minor ones before the summer recess is over.
After that, James said, tough negotiations remain on bigger items, such as how the drug benefit is structured and priced, guarantees seniors will have access to drug coverage, how much additional help the low-income will get and how employer plans will be encouraged to retain their retiree coverage.
Meanwhile, talk of deadlines comes and goes and though the president was hopeful a final bill could come out of committee by the end of September, he probably will not find anyone willing to bet on that outcome.
