WASHINGTON - Republican lawmakers showed the same disdain for President Bush (news - web sites)'s latest Medicare prescription drug plan Tuesday as they did his first one a month ago, promising that after two failed attempts by the White House they will write their own plan with bigger benefits for older Americans.
The administration spent the day explaining facets of the proposal, which offers a general outline but leaves specifics to Congress. At the center of it is a plan to offer older people seniors increased prescription drug coverage if they join HMOs or other private health plans.
As Bush was outlining his proposal in a speech to the American Medical Association, senior Republicans in Congress responsible for putting legislation together were picking it apart.
"The way I see it, we need a universal drug benefit so seniors who want to stay in traditional Medicare get a prescription drug plan that's just as good as those who chose a new option," said Senate Finance Committee Chairman Chuck Grassley, R-Iowa.
House Energy and Commerce Committee Chairman Billy Tauzin, R-La., analyzed the situation with a terse comment about his mother: "You couldn't drive her out of Medicare with a bulldozer." He said the plan his panel will write will have a traditional Medicare drug benefit that is "as strong if not the same as private market plans."
"We've got to respond to that population that wants to stay," said Tauzin. "My committee almost certainly will want a strong and adequate prescription drug benefit within fee-for-service (traditional Medicare)."
Rep. Bill Thomas, R-Calif., chairman of the House Ways and Means Committee, said, comparing the White House plan with a congressional plan, "The starting point will be slightly different."
Even Senate Majority Leader Bill Frist, R-Tenn., a close Bush ally, appearing at the AMA meeting before the president, indicated the senators will produce their own bill. "The Senate is going to go through the Finance Committee," Frist said.
President Bush has said he wants to spend $400 billion over 10 years to overhaul Medicare and add a prescription drug benefit. House Democrats unveiled their drug proposal Monday, which would cost $700 billion to $900 billion over 10 years. And Senate Democrats have reintroduced the same $594 billion 10-year plan they offered last year. Both plans would establish low deductibles and premiums along with benefits available for all Medicare beneficiaries.
"Leaders of both political parties have talked for years about this issue. ... The time for action is now," Bush told the AMA on Tuesday. "A modern Medicare system must offer more choices and better benefits to every senior."
The president's newest proposal essentially would give Medicare beneficiaries three options. All would provide low-income seniors with an additional $600 in annual subsidies for pay prescription bills.
Those who stay in traditional Medicare, where the government pays 80 percent of costs but seniors choose their own doctor, would get a discount drug card and help with huge out-of-pocket drug costs. The administration did not specify when that help on out-of-pocket costs, known as catastrophic coverage, would begin. The drug cards would be offered by private companies and give holders of them at least a 10 percent discount on their prescriptions.
A second option would allow seniors to join what would be known as "Enhanced Medicare." In that plan, seniors would join preferred provider organizations, also known as PPOs. PPOs are health plans that are similar to HMOs but less restrictive. Under PPOs, patients are allowed to seek outside doctors but there would be incentives (like lower costs) if they see certain doctors.
The third option would be an HMO program similar to one Medicare has had since 1999. Such programs provide lower basic fees but participants must use designated doctors and hospitals.
Many lawmakers said they are reluctant to support the Bush plan's reliance on private health plans at a time when many HMOs participating in Medicare have fled areas and abandoned beneficiaries to escape rising health care costs they say are squeezing them too much. Just this year, 33 health plans withdrew from the program or reduced their services, dropping coverage for nearly 200,000 people.
"I am concerned that under this plan, if the private, HMO and preferred provider options don't succeed, seniors will not have any fallback available under the traditional fee-for-service Medicare program, as they do today," said Sen. Olympia Snowe, R-Maine. "Every senior should have access to comprehensive prescription drug coverage, regardless of which Medicare option they choose."
Senate Democratic leader Tom Daschle of South Dakota complained that Bush's plan "forces seniors to choose between the doctors they know and trust and the drugs they need."
"I won't say it's dead on arrival, but I will say it has very little chance of survival," Daschle said.