The $400 billion new drug bill overshadows these cost-saving efforts. But the dispute over money may intensify if the new drug benefit, now before a Senate-House conference committee, comes on line as expected in 2006. "There's a general trepidation that I hear from health-care executives that, what Medicare gives in one way, they're going to cut in another," said Lawton R. Burns, director of the Wharton Center for Health Management and Economics.
Bruce Vladeck, former administrator of the agency now known as the Centers for Medicare and Medicaid Services, said: "There's no question that Congress and [the agency] are looking for savings in Medicare. But that's more a function of some of the other goodies they want to put in over and above the drug benefit."
The final bill could spend $25 billion more over 10 years on rural health and spend billions more on raising the rates to HMOs offering Medicare+Choice plans, said Vladeck, now a health policy professor at Mount Sinai School of Medicine in New York City.
A debate is brewing over a new co-pay for Medicare patients needing home-health care. U.S. Rep. Bill Thomas (R., Calif.), chairman of the House Ways and Means Committee, wants Medicare patients to make a $40 to $50 co-pay for each 60-day episode of care. The poorest recipients would be exempted.
Backers say the co-pay is needed to put home health in line with other Medicare services and prevent unnecessary home visits. Medicare spending on home care - estimated at $10.1 billion for fiscal 2003 - is projected to double in six years, if current projections continue.
