Panel Backs Senior Drug Card

A sharply divided House-Senate conference committee tentatively agreed Tuesday to offer seniors a Medicare-endorsed drug discount card but raised new doubts about prospects for a comprehensive Medicare prescription drug benefit.

The card, which would become available no later than six months after enactment of a Medicare overhaul bill, is designed to give beneficiaries some relief from medication expenses until a Medicare drug benefit could take effect. That would be no sooner than Jan. 1, 2006.

But some Democrats suggested that a final bill would not pass the Senate if it contained certain House-passed provisions -- or if Republicans, who hold a majority in both chambers of Congress, squeezed Democrats out of negotiations.

“If I feel that’s happening, I’m going to have to reconsider my position on this legislation,” said Sen. Max Baucus (D-Mont.), who helped draft the Senate-passed bill. “I’d rather have a good bill. But no bill is better than a bad bill.”

House Republicans countered that, in the words of Rep. Nancy L. Johnson of Connecticut, Congress did “not have the luxury of not passing a bill.”

There were signs of bipartisan cooperation.

Conservative Sen. Don Nickles (R-Okla.), who voted against the Senate bill, and liberal Rep. John D. Dingell (D-Mich.), who voted against the House bill, worked out a co-payment plan for low-income seniors using a drug discount card.

The panel approved that and other aspects of the temporary drug discount card, as well as a few other largely technical, noncontroversial issues.

Congressional aides estimated that the discount card would save Medicare beneficiaries 15% to 25% for each prescription.

Drug manufacturers, pharmaceutical benefit managers, retail pharmacies and others could submit their discount cards to the government for a “Medicare stamp of approval.” To win that approval, discount card programs would have to meet certain government standards, including guaranteed access to participating pharmacies. Card providers could charge seniors an annual fee of up to $30.

Seniors could choose a single Medicare-endorsed card, although they could continue to use other discount cards as well. Card providers would pass on to seniors some or all of the discount they received from drug manufacturers.

Beneficiaries with incomes of less than $12,123 for an individual or $16,362 for a couple (135% of the poverty level) would qualify for a federal subsidy on the drug card of up to $600 a year.

The government would also pay the enrollment fee for low-income beneficiaries, but they would be responsible for a modest co-payment on each drug.

Those with incomes below the poverty level -- $8,980 for an individual or $12,120 for a couple -- would pay 5% of a drug’s discounted cost. Seniors with slightly higher incomes would pay 10% of each drug’s cost.

Committee members also agreed to increase Medicare payments to so-called critical-access hospitals, about 800 facilities largely in rural areas, and to expand Medicare coverage to include certain screening tests for heart disease and diabetes.

Beyond such matters, the third meeting of the full, 17-member conference committee was laced with partisan accusations and recriminations. “I know that the really tough issues are still ahead of us,” said Sen. Charles E. Grassley (R-Iowa), vice chairman of the committee.

Sen. John D. “Jay” Rockefeller IV (D-W. Va.) listed four issues that he said could change the fundamental nature of Medicare, which offers equal benefits to all 40 million seniors and disabled people in the U.S.: market competition, treatment of the poorest seniors, a “fallback” plan to have Medicare administer the drug benefit in underserved areas and higher payments for doctors, hospitals and nursing homes in rural areas.

Rockefeller, who voted against the Senate bill, supported the House position on only one of the four, concerning treatment of the poorest seniors.

Noting the Senate rule that requires 60 votes to cut off debate, Baucus said a final overhaul bill designed to win a simple majority of 51 votes would be doomed. “The only way to pass legislation here

“We have strong feelings on the House side too,” said Rep. W. J. “Billy” Tauzin (R-La.). “We have to find a way to accommodate each other.... The last thing we ought to be doing is challenging each other.”