Accord nearer on Medicare drug bill

Although those trying to craft a final Medicare prescription-drug bill by today fell short and still face many unresolved issues, there was general agreement this week to make wealthy seniors pay more for some Medicare services.

Lawmakers and aides insist they have made steady progress on the bill, and the self-imposed Oct. 17 goal was effective in moving things along. Negotiators were meeting late yesterday and it was not clear whether they would produce a broad outline of what has been agreed to in the bill so far.

“We’ve come a long way, but we have a long way to go, too,” said Sen. Orrin G. Hatch, Utah Republican and one of the negotiators.

This week, negotiators said there is general support among them to “means-test” the Medicare “Part B” premiums, which would mean wealthier seniors will have to pay higher premiums for their doctor visits and outpatient services under Medicare. The details of how to implement it and what income levels would trigger the higher costs haven’t been decided.

House conservatives — many of whom voted against the House Medicare bill and are threatening to oppose the final bill as well — have been pushing for some type of means-testing in the final Medicare drug bill, as a way to reduce government costs.

A House Republican leadership aide said the negotiators’ move to include it in the final bill will be “viewed very favorably by House conservatives,” and will be touted by House Republican leaders as a good sign that the final measure is moving in their direction.

Negotiators have reached some agreements on how private health plans would compete with each other to provide the new drug benefits, and how they would be reimbursed by the government.

But they are leaving the most critical decisions for the end, including whether Medicare will be required to compete directly against private health plans starting in 2010. House conservatives and some lobbying groups have made it clear this requirement must be in the final bill in order for them to support it.

While it seems likely means-testing of premiums will be included in the final bill, Medicare negotiators seem to be rejecting the idea of means-testing the new drug benefit itself — which many conservatives would like to do. The House bill would have required wealthier seniors to spend more of their own money before the government would help out with catastrophic drug costs.

“There’s a move away from that and towards means-testing the premium,” a Senate Republican aide said.

Sen. Edward M. Kennedy, Massachusetts Democrat, says any means-testing would undermine the universal nature of Medicare benefits. He has threatened to filibuster the Senate Medicare bill if it includes means-testing.

Mr. Kennedy repeated his opposition of means-testing yesterday, but said he is “reserving all judgments” until he sees a final package.

In another good sign for House conservatives, the top Senate Medicare negotiator said this week he is willing to consider including a cost-containment provision in the Medicare prescription-drug bill.

“I’m willing to look at it,” said Sen. Charles E. Grassley, Iowa Republican and head of the Senate delegation trying to craft a final bill with the House. “The bill looks too open-ended for some people to vote for it.”

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