Senate Offers Pared-Down Catastrophic Care Benefits Plan : Health: Proposal is an attempt to break a stalemate with the House. Backers seek to retain parts of original bill rather than accept total repeal.

The Senate proposed a pared-down package of catastrophic care benefits Tuesday, hoping to persuade adamant House members to drop their insistence on total repeal of the controversial Medicare program.

“It’s a pretty thin gruel,” said Sen. Lloyd Bentsen (D-Tex.), referring to the latest Senate plan, which would pay for lengthy hospital stays, expanded home health care benefits, and mammography screening for breast cancer.

Even so, Bentsen said, “this is our best chance to avoid repeal.”

The House, in a skeptical mood, was to meet again late Tuesday to consider the Senate’s offer. Earlier in the day, the House had voted 352 to 63 for repeal, the third time it has called for abolition of the controversial legislation.

“We’re trying to re-create this catastrophic bill, and we’re only going to make it worse,” said Rep. Henry A. Waxman (D-Los Angeles), referring to last-ditch efforts to save the program. “The only sensible thing is to repeal and come back next year . . . and figure out something the seniors want and can pay for.”

Before adjourning for the year, however, Congress appeared determined to abolish the major financing mechanism for catastrophic care, a special surtax that has come under vociferous attack from angry senior citizens. The tax, ranging from $22 to $800 a year, would be paid by the 40% of Medicare beneficiaries who pay federal income taxes.

Abolition of the tax means that catastrophic benefits must be curtailed, too. Without the surtax, the Medicare system lacks the necessary revenue to pay for the most costly benefits contained in the 1988 law: a ceiling on patients’ personal spending for doctor bills and Medicare coverage of prescription drugs.

With apparent agreement on the need to eliminate the surtax, the debate in Congress centered on which of the remaining benefits, if any, to retain. The House was holding out for complete abolition, while the Senate was arguing that senior citizens need some of the benefits.

“We may be treated to the sight of senior citizens who are critically ill being removed from hospitals because they cannot pay the bills,” said Sen. John McCain (R-Ariz.), author of the Senate plan.

Although willing to eliminate the surtax, the Senate wanted to retain the premium paid by all 33 million Medicare beneficiaries to finance the stripped-down benefits. Currently $4 a month, the premium would be set at $3 a month next year, rising to $6 a month in 1994.

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

The hospital portion of the catastrophic law became effective this year, with patients receiving free care after paying $560 for the first day in the hospital. The deductible would rise to $592 next year.

Under the latest Senate plan, patients also would be responsible for paying a second deductible, set at $560, if they return to the hospital more than 60 days after being discharged from a first stay.

The latest Senate offer also would preserve other benefits, including expanded coverage for health care, mammography screening and a respite program paying for outside help to give family members time off when caring for a seriously ill person.

“We implore our colleagues on the House side to take a look at this compromise,” said Senate Minority Leader Bob Dole (R-Kan.). “It is a gesture toward the House.”

The revised benefit package “is getting a little thin, but it still helps those who need help,” Dole said. He called for White House support, noting that the latest Senate plan offers an “opportunity for the President of the United States to take the high ground.”

The Bush Administration has remained on the sidelines while Congress has fought over catastrophic care. Louis W. Sullivan, secretary of health and human services, was the only high-ranking official to offer strong support for the current catastrophic law.

McCain said he felt “sorrow” over the “lack of involvement by the White House.”

Major groups representing the elderly were supporting Senate efforts to retain some of the benefits included in the original catastrophic care law. The measure was adopted overwhelmingly by Congress 17 months ago and hailed as the major piece of social legislation of the Ronald Reagan presidency.