House and Senate leaders on health issues said yesterday that they have abandoned efforts to produce legislation this year reforming the nation's Medicare system, dropping for now the popular idea of helping elderly Americans pay for prescription drugs.
Instead, the only changes to Medicare that lawmakers will consider this fall are proposals that would steer more money to the health care industry, which has griped persistently about steps Congress took two years ago to slow spending in the financially fragile health insurance program.
Lawmakers in both chambers this week have released plans that would begin to reverse those steps, giving billions of extra dollars to hospitals, nursing homes, HMOs and companies that provide home health services and rehabilitation therapy.
Yesterday, the chairman of the House Ways and Means health subcommittee, Rep. Bill Thomas (R-Calif.), proposed spreading $15 billion over the next five years among virtually every segment of the health care industry that has been lobbying for more money. His plan calls for Congress to approve $9.4 billion worth of payment changes and attempts to put pressure on the Clinton administration to make other payment changes administratively that would give hospitals, health plans and home health agencies another $5.6 billion.
Thomas issued his plan, which is supported by the House's Republican leadership and is scheduled for a subcommittee vote Friday, the day after the Senate Finance Committee Chairman William V. Roth Jr. (R-Del.) released an outline of a separate plan that would help the same segments of the health care industry in slightly different ways. Senate aides said that legislative budget analysts had not finished tallying the price tag for Roth's plan but that it was likely to be similar to Thomas's over the first five years.
The two proposals have emerged as Congress finds itself struggling to devise a budget for next year that does not break the spending limits it gave itself under a 1997 agreement to balance the federal budget. Part of that agreement called for $115 billion in Medicare savings by slowing the growth of payments to the medical industry.
At a briefing for reporters and lobbyists, Thomas yesterday noted that his plan envisioned no "new starts." He shied away from major changes even though he was the co-chairman of a Medicare reform commission that deadlocked last spring. He has favored adding a prescription drug benefit for some--but not all--elderly patients and is a proponent of changing the program to rely more heavily on competition among private health plans.
Meanwhile, Senate aides said that Roth, who has for months promised that his committee would produce a major Medicare proposal this year, no longer believes that is possible. "Consensus is not there on some of the issues, such as how we do prescription drugs," an aide said.
President Clinton has proposed devoting $7.5 billion over the next decade to help certain providers of health care hurt by the 1997 agreement. Yesterday, Chris Jennings, the White House's chief health policy adviser, said the administration "is going to work with Congress on this," but reiterated that Clinton believes the government should increase payments only if it also makes "at least a down payment on reform" to help keep the Medicare program from running out of money.