House Backs Limits on Medical Bills of Elderly

The House overwhelmingly approved a landmark bill today designed to cap out-of-pocket medical expenses and cover some prescription drug costs for the nation’s 32 million elderly and disabled Medicare recipients.

The measure, approved 328 to 72, marks the most sweeping reform of the Medicare program in its 23-year history. It goes to the Senate and, if accepted, on to the White House.

President Reagan has not announced his position on the legislation, but Health and Human Services Secretary Otis R. Bowen said he will urge the President to sign it.

‘Landmark,’ ‘Long Overdue’

The bill, which supporters dubbed “landmark” and “long overdue,” limits out-of-pocket expenses of Medicare beneficiaries for hospital and physician costs. The key provision is the bill’s guarantee of unlimited free hospital care for Medicare patients after payment of an initial annual deductible of $564 starting in 1989, increasing annually. Medicare currently provides only the first 60 days free after a deductible.

Beginning in 1991, Medicare would cover up to half of a beneficiary’s prescription drug costs, rising to 80% by 1993, after a deductible. Medicare does not currently pay for prescription drug costs except for organ transplant patients.

It would also protect the spouses of nursing home patients from financial ruin by increasing the permissible limit of financial assets they can retain without jeopardizing Medicaid coverage for their disabled spouse.

And it would extend health insurance protection for poor Americans who fall below the poverty line but earn too much to qualify for Medicaid coverage.

Expensive Extras Claimed

Opponents, mainly Republicans, charged that the bill contains too many expensive extras such as Medicare coverage of mammogram screening for women over 65, new “respite” benefits covering up to 80 hours a year of temporary home health services to provide relief for a caretaker of a Medicare beneficiary who cannot be left alone, and prescription drug coverage for the elderly and disabled, including AIDS patients.

The expanded benefits would be entirely financed by Medicare beneficiaries through a two-step scheme. First, the bill provides for an increase in the supplemental monthly premiums that most beneficiaries pay to cover doctors’ bills and other outpatient services. The premium, currently set at $24.80 per month, would increase by $4 per month in 1989, gradually increasing to an additional $10.20 per month by 1993.

In addition, the bill calls for a new surcharge to be paid by Medicare beneficiaries with $150 or more in federal income tax liability--a provision hotly contested by opponents as expensive and unfair because the elderly would finance medical expenses of some younger, disabled beneficiaries.