Sen. Max Baucus (D-Mont.) told reporters after Tuesday’s negotiating session, although he said Friday’s target date would pass without an agreement, ”I think there’s a good chance we’ll pass a bill this year.”
The House and Senate earlier this year approved separate bills to add outpatient prescription drug coverage to Medicare, the federal health program for Americans aged 65 and over.
The two bills differed greatly on the specifics, leaving the conference committee with the difficult task of crafting a compromise bill.
GOP congressional leaders set the Oct. 17 goal several weeks ago, when the negotiations were plagued by policy, political and personality differences. Since then, lawmakers have made tentative decisions on a variety of issues, and have held daily talks this week on a variety of controversial items.
The major issues include determining how much to spend on encouraging private sector managed-care plans to join Medicare, how to subsidize the prescriptions for the poor, and how to discourage companies from abandoning drug coverage they now provide retirees. Lawmakers must also decide whether wealthier seniors should pay more for Medicare coverage.
Perhaps of most direct concern to the 40 million Americans on Medicare, lawmakers have not agreed on the amount that low-income and other seniors would have to pay toward their drug coverage in the form of premiums, deductibles, co-payments and other expenses.
On Wednesday lawmakers were scheduled to discuss whether upper-income seniors should pay more for their Medicare health coverage than other beneficiaries. Neither bill includes such a measure, but the Senate signaled its support for the idea last summer, and the House is on record in favor of requiring higher-income seniors with high drug use to pay more than others. Negotiators are also considering adding a co-payment to home care services.
Lawmakers Tuesday made some headway toward a plan to preserve employer-sponsored drug coverage for the estimated 12 million retirees who currently have this benefit.
Sen. Charles Grassley (R-Iowa) said Tuesday that a core group of negotiators would likely agree to spend $75 billion to $80 billion over a decade to help companies maintain existing retiree benefits.
Lawmakers have also been moving toward agreement on a plan to give low-income and disabled seniors pharmaceutical coverage through Medicare, rather than through Medicaid programs that can vary from state to state.
Sen. John Breaux (D-La.) told reporters in early October that the negotiations were headed in that direction. Health policy analysts said the apparent consensus would be a setback for the White House and a victory for the nation’s governors, who have lobbied to have the federal government assume responsibility for covering the estimated 6 million people eligible for both programs.
Despite the progress that has been made, lawmakers are still struggling to craft a bill that will provide a prescription drug benefit within the $400 billion target price tag.
“We have $400 billion (to spend) and $600 billion in ideas, some people more than that,” Rep. Bill Thomas (R-Calif.) said recently.