In Deadlock With Senate, House Prepares Limited Catastrophic Care Benefits Plan

The House and Senate remained deadlocked Monday night over the fate of Medicare’s controversial catastrophic care program.

House leaders were preparing to make a new proposal that would delete all the major new benefits from the program but retain some of the less costly benefits. The House had originally voted to repeal the entire program.

Senate negotiators are trying to retain the program’s expanded hospital care, one of the three major benefits. That was the Senate’s initial position when it voted last month not to repeal all of the program.

Both approaches would end the unpopular surtax that Congress enacted to finance the program. The 15% surtax, up to a maximum of $800 a year, must be paid by the 40% of the elderly who earn enough money to pay federal income taxes under the current law.

House Speaker Thomas S. Foley (D-Wash.) said that he “cannot imagine” Congress will adjourn this week without taking action to modify catastrophic care.

The new program, enacted just 17 months ago, was hailed then as the biggest expansion of federal health benefits since Medicare was established in 1965. But the new surtax triggered a storm of protest by the elderly who must pay it.

In addition to the surtax, the new program imposed an additional $4-a-month premium on all 33 million Medicare beneficiaries. The pared-down program preferred by the Senate would pay for 364 days a year of free hospital care after Medicare patients pay $560 for the first day.

The Senate plan would also feature more liberal coverage for skilled nursing care, expanded payments for home health care and Medicare payments for mammography screenings for breast cancer.

Sen. John McCain (R-Ariz.), principal author of the Senate plan, which was approved 99 to 0 last month, said that his approach is vital to protect the interests of millions of senior citizens. “If you saw a firestorm over the surtax, which we are going to repeal, you ain’t seen nothing yet,” he said.

McCain had threatened a filibuster Saturday when it appeared that Senate negotiators would bow to the House and accept total repeal. But Senate negotiators Sunday said that they would insist on retaining the benefits outlined in McCain’s plan.

McCain told the Senate on Monday that he is willing to compromise “to prevent an outcome truly catastrophic--total repeal.”

The new compromise being prepared by House negotiators would provide Medicare payments for as much as 38 days of home health care when certified as necessary by a physician, compared with the current limit of 21 days. The 210-day limit on payments for hospice care for the dying would be eliminated.

Families caring for a person with serious health disabilities unable to perform activities of daily living, could receive funds to hire outside workers for a respite period of 80 hours a year. The new mammography benefit would be retained, with Medicare paying 80% of the cost of a screening up to a maximum of $50.

The House package would be financed by an additional 80-cents-a-month premium paid by Medicare beneficiaries, compared with $4 a month in current law. The premium would rise to about $1.20 a month in the next four years.

The premium is in addition to the $29 a month that beneficiaries pay for insurance to cover their doctor bills.

The new House plan, retaining a fraction of the original catastrophic care program, was first proposed informally last week but Senate negotiators declared it inadequate.

However, the plan may look more attractive as Congress speeds toward adjournment. McCain met with House negotiators late Monday to discuss a compromise.

BACKGROUND

Medicare’s new catastrophic care program, hailed last year for providing the elderly with new protections from the high cost of medical treatment, proved wildly unpopular with senior citizens because it imposed a surtax of up to $800 a year on the 40% of those over 65 who pay federal income taxes. The House voted Oct. 4 to repeal the entire program. The Senate proposed two days later to repeal the surtax but to keep one of the new benefits--coverage of unlimited hospital stays--to be financed by an increase in the monthly premium paid by all Medicare beneficiaries.