House Votes Down Catastrophic Care : Action to Repeal Portion of Medicare Plan Spurred by Protests Over Surtax

The House voted overwhelmingly Wednesday to repeal Medicare’s catastrophic care program, which Congress had enacted just 16 months ago as a major expansion of health benefits for the elderly.

The 360-66 vote culminated a determined protest campaign by retired persons who were outraged by the special surtax levied on the elderly to provide the bulk of the money for the new benefits.

“The people of this country have spoken out,” Rep. E. Clay Shaw Jr. (R-Fla.) said during Wednesday’s occasionally emotional debate. “Let us be honest and face the fact we made a mistake a year ago.”

In an effort to salvage a fragment of the program, its supporters offered a shrunken version containing the prescription drug benefit and several other provisions. They proposed to repeal the surtax and keep only a $4-a-month increase in the monthly premium paid by all Medicare beneficiaries. But even that proposal was rejected, 269 to 156.

Senate to Vote

The huge margin for repeal in the House strengthens the likelihood that the Senate, which will vote on the issue today or Friday, will follow suit.

“This gives us a powerful boost,” said a spokesman for Sen. John C. Danforth (R-Mo.), who plans to offer an amendment to repeal the program.

The House attached the measure to a massive deficit reduction bill that includes such controversial issues as the House-backed capital gains tax cut. The House hopes to complete action on the bill today and send it to the Senate, but final action could be several weeks away.

The House vote cast a shadow over future efforts that Congress might have planned to expand Medicare or other social programs. New programs must be “carefully considered to ensure (that) they have broad public support,” House Speaker Thomas S. Foley (D-Wash.) said after the vote.

Wednesday’s House action represented an amazing turnabout by the House, which last year had voted, 328 to 71, to approve the catastrophic care program. The program’s benefits include unlimited free hospital care after the first day, a ceiling on personal spending for doctor bills and partial coverage of prescription drug costs.

But Congress, breaking with the tradition that the cost of social programs is spread across the entire population, mandated that the benefits of the catastrophic care program be paid for exclusively by the beneficiaries.

Catastrophic care was still a relative bargain for 60% of the 33 million Medicare beneficiaries. Their only new expense was the additional $4-a-month Medicare premium.

But the other 40%--those who earn enough money to owe federal income taxes--were hit by a new surtax of 15%, ranging up to $800 a year. These angry taxpayers, many of whom already had supplemental health insurance that provided many of the same benefits as the catastrophic care program, galvanized a congressional campaign for repeal.

Congress “completely missed what seniors wanted,” said Rep. Rod Chandler (R-Wash.) “We put this on the backs of the middle-income elderly.” The handful of defenders of the law accused the House of retreating in panic. “When you hear the screams of protest from a well-organized constituency, you simply can’t stand the heat,” said Ways and Means Committee Chairman Dan Rostenkowski (D-Ill.).

Rep. Pete Stark (D-Oakland), one of the prime authors of the catastrophic plan, called it “one of the shortest legislative victories in my career. We are being stampeded by a small group of the wealthy to deny needed benefits to seniors.”

By repealing catastrophic care, which would have helped pay for mammogram screenings for breast cancer, “you are going to cause the death of 4,000 elderly women,” Stark told his colleagues.

Rep. Brian Donnelly (D-Mass.), leader of the repeal forces, called Stark’s comments “outrageous.”

For Rep. Harris W. Fawell (R-Ill.), one of a tiny band of congressional opponents who began pushing for repeal when Congress began work in January, Wednesday was a particularly sweet day. “Perhaps never before have American seniors spoken so clearly, so overwhelmingly and so unanimously on an issue before Congress,” he said after the vote. “The House of Representatives today got the message.”

The vote was a sharp rebuke to a variety of organizations involved in issues affecting the elderly.

The American Assn. of Retired Persons, with 30 million members, was a strong supporter of the original legislation resoundingly repealed Wednesday. As a fallback position, AARP backed the truncated prescription-drug version that also went down to defeat.

The National Council of Senior Citizens, which includes many retired union members, also supported the unsuccessful prescription drug plan as preferable to outright repeal.

The National Committee to Preserve Social Security and Medicare had been a strong opponent of the surtax from the beginning, but it favored a change in the financing system over total repeal.

Under the House-passed measure, current catastrophic care rules, including expanded benefits for care in hospitals and skilled nursing facilities, would remain in effect until Jan. 1, 1990. After repeal, the old Medicare rules would resume, reducing the number of free hospital days and requiring greater payments by patients.

The House bill would retain two relatively minor benefits: expansion of health coverage for poor people and some income protection for the spouses of people in nursing homes.

VOTE ON CATASTROPHIC HEALTH CARE

WASHINGTON -- Here is how members of the California delegation voted Wednesday on legislation to repeal the Medicare catastrophic illness insurance program:

Democrats for--Bates, Beilenson, Bosco, Boxer, Brown, Condit, Dellums, Dixon, Dymally, Fazio, Lantos, Lehman, Levine, Martinez, Matsui, Mineta, Pelosi, Torres.

Republicans for--Campbell, Cox, Dannemeyer, Dornan, Dreier, Gallegly, Herger, Hunter, Lagomarsino, Lewis, Lowery, McCandless, Moorhead, Packard, Pashayan, Rohrabacher, Shumway, Thomas.

Democrats against--Anderson, Berman, Edwards, Hawkins, Miller, Panetta, Roybal, Stark, Waxman.

Republicans against--none.