Medicare and Pharmacy Benefits for Seniors
The same principles are true regarding the growing debate about adding a prescription drug benefit to Medicare.
Recent polls indicate that the No. 1 senior healthcare issue is the growing cost of prescription drugs. The average 15-percent-per-year increases in prescription drug costs for seniors, who do not have outpatient drug coverage under the traditional Medicare program, are adding up to become a real burden.
Clinton and Gore staked out the debate last year by proposing a new Medicare drug benefit in response to this growing senior anxiety. They have proposed adding a first-dollar prescription drug benefit to Medicare that would pay 50 percent of a senior’s outpatient drug charges to a first-year maximum payout of $1,000, which would ultimately grow to a $2,500 maximum payout. Seniors would be responsible for 50 percent of the cost of the program — $26 per month in premiums in the first year. Seniors below 150 percent of the poverty level would not have a co-payment. Clinton and Gore would pay for the federal share of the cost by using projected budget surpluses.
Until recently, the pharmaceutical industry was taking the point in running national ads questioning the creation of one giant new government program that covered all seniors alike. But all of that suddenly changed when the industry shifted its position and announced that it supported passage of a prescription drug plan — albeit one that was not part of a Clinton/Gore Medicare plan that they believe could ultimately result in pharmaceutical price controls.
Instead, the pharmaceutical industry seems to be leaning toward a plan written by Senators Olympia Snowe and Ron Wyden that would create separate, competing, private-sector pharmacy plans. Their program would fully subsidize low-income seniors (under 150 percent of poverty) and pay at least 25 percent of the cost for all seniors buying the plan — insurance plans that would pay “market rates” for greater access to drugs. Medigap issuers could issue pharmacy plans and would have to comply with new rules to offer pharmacy benefits within a Medigap plan.
The upshot is that Clinton/Gore, Bill Bradley and the pharmaceutical industry all have drug programs for seniors while many of the Republican presidential candidates are calling for expanded pharmacy options for seniors. On the other hand, the Republican congressional leadership has no pharmacy plan.
The Republican leadership is now saying they are going to develop one — most likely along the lines of the drug industry-favored Snowe/Wyden outline that keeps any new programs in the private sector. In the Senate, they will bring their drug plan forward as part of a comprehensive Medicare reform proposal similar to the one developed by the Bipartisan Medicare Commission last year.
Election-Year Patient Rights or Prescription Drug Legislation?
In both patient rights and drug benefits for seniors, the congressional Republican leadership is being driven farther than they want to be by the presidential election and the positions their candidates are finding they have to take in order to be responsive to voters.
The wild card for Republicans will be the election year process.
If it becomes clear to the Republican members of Congress, during their re-election campaigns, that there is no choice but to pass a patient rights bill or a prescription drug bill that Clinton will sign, then we will get one.
Today, the only patient rights or prescription drug bill Republicans would pass would be a bill that Clinton would be eager to veto. And, the Republicans would love to see him veto their bills — all the better to take the high ground on healthcare in an election year. If Clinton vetoes a Republican healthcare bill, Republicans would argue, the Democrats could no longer claim they were running against a “do-nothing” Congress or that the Republicans were the ones obstructing health reform.
You should expect that the next few months will produce a series of attempts at healthcare one-upmanship as each side tries to outflank the other on patient rights, prescription drugs and the uninsured.
Clinton Keeps Healthcare Pressure on Republicans
The Democrats intend to attack the Republicans on the healthcare issue throughout the campaign.
Clinton dramatized this in his State of the Union address reminding Congress of numerous Clinton/Gore healthcare proposals left over from last year’s budget debate, as well as formally introducing some of the new ideas Gore has advocated on the campaign trail.
In addition to his support for the Norwood-Dingell patient rights bill and the Clinton/Gore Medicare plan, Clinton proposed what is essentially an abbreviated Gore campaign program to reduce the 44 million uninsured. He proposed spending $110 billion over 10 years from future projected budget surpluses to create a number of new health insurance options to reduce the number of uninsured (Gore estimates his plan for the uninsured costs $146 billion over 10 years)
FamilyCare — an expansion of Medicaid to provide higher matching state payments to expand coverage of uninsured parents of children covered under Medicaid. This is essentially one of Gore’
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