Medicare Prescription Drug, Improvement, and Modernization Act

The Medicare Prescription Drug, Improvement, and Modernization Act (Public Law 108-173, also called "MMA legislation" http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/01_Overview.asp) is a law of the United States which was passed in 2003. It produced the largest overhaul of Medicare in its 38-year history.

It was signed by President George W. Bush on December 8, 2003, after barely passing in Congress.

One month later, the ten-year cost estimate was boosted to $534 billion, up more than $100 billion over the figure presented by the Bush administration during Congressional debate. The inaccurate figure helped secure support from fiscally conservative Republicans who had promised to vote against the bill if it cost more than $400 billion. It was reported that administration officials had concealed the higher estimate and threatened to fire government analyst Richard Foster if he revealed ithttp://dir.salon.com/story/news/feature/2004/04/05/medicare/index.html.

Prescription drug benefit

Its most touted change is the introduction of an entitlement benefit for prescription drugs, through tax breaks and subsidies.

In the years since Medicare's creation in 1965, the role of prescription drugs in U.S. patient care has significantly increased. As new and expensive drugs have come into use, patients, particularly senior citizens for whom Medicare was designed, have found prescriptions harder to afford. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA), is meant to address this problem.

The benefit is funded in a complex way, reflecting the diverse priorities of the lobbyists and constituencies whose support was needed:

it provides a subsidy for large employers to discourage them from eliminating private prescription coverage to retired workers (a key AARP goal; the 2005 Annual Report for IBM estimates that company will receive a $400 million subsidy during the six-year period beginning in 2006)Notes to Consolidated Financial Statements, p. 95 (from IBM's 2005 Annual Report);
it prohibits the Federal government from negotiating discounts with drug companies (unlike the practice in most other countries);
it prevents the government from establishing a formulary, though does not prevent private providers such as HMOs from doing so.

Basic prescription drug coverage

Beginning 2006, a complicated prescription drug benefit, called Medicare Part D, will be available though with substantial out-of-pocket costs. Coverage will be available only through insurance companies and HMOs. Though enrollment will be “voluntary,” there will be considerable financial pressure to enroll at once. (It will be costly to enroll at a later time.)

Benefit: Enrollees will pay the following initial costs for the initial benefits described herein. A minimum monthly premium of $37.23 ($446.76 per year) (premiums may vary), a $250 annual deductible, 25% of costs up to $2,250, 100% of costs up to $5,100 (a gap of $2,850) commonly referred to as doughnut hole, and 5% of costs above $5,100.

Medicare Advantage plans

For the last 20 years, the Federal government has offered Medicare beneficiaries the option to receive their Medicare benefit through private health insurance plans, instead of receiving it from the "Original Medicare" plans (Part A and Part B). The Medicare program originally called these plans Medicare + Choice, but they have often been colloquially referred to as Part C. The Medicare Modernization Act changed compensation and business practices for insurers that offer these plan. In conjunction with this, CMS re-branded these plans as Medicare Advantage plans. In addition to offering comparable coverage to Part A and Part B, Medicare Advantage plans may also offer Part D coverage.

Changes to plans

When the Medicare + Choice option was first offered, plans were established by several major health care insurers including Humana, Aetna, and the Blue Cross/Blue Shield plans. These plans were organized along traditional HMO (Health Maintenance Organization) business plans, but patients could freely switch back to traditional Medicare insurance. Some felt that these plans lacked the ability to truly manage care , and some plans did cut back their service areas and stopped enrolling new patients.

With the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, new Medicare Advantage plans were established with several advantages over the previous Medicare + Choice plans:

enrollees sign on for a whole year
care can be restricted to networks of providers
formularies can be used to restrict prescription drug choices
prescription coverage can be deferred to the patient or a Medicare Part D prescription plan
care other than emergency care can be restricted to a particular region
federal reimbursement can be adjusted according to the health risk of the enrollees

The attraction for health insurers is the large difference between normal healthcare premiums and the federal Medicare premium. Typical health insurance premiums (for someone working or healthy enough to be allowed to enroll) are generally $150 to $350 a month, depending on the level of service desired, health status, and deductibles. For a healthy Medicare-eligible enrollee, the health insurer can receive around $800 a month, more than double the premium for younger citizens. This federal premium can increase to $2000 a month through a complex risk adjustment involving the health status of the eligible enrollee. These plans are being aggressively marketed. Among other benefits, the senior gets an immediate financial boost, as many plans let them skip paying Part B and Part D premiums, waive usual deductibles, and waive copays, all while covering preventive physicals and providing a prescription drug benefit. While the insurance plan can realize immense initial profits, every single Medicare enrollee, no matter their underlying health status, can be expected to undergo between one and six life threatening major illnesses before they die. The pathology and illnesses associated with aging are innumerable and ultimately unbeatable.

The ultimate economic viability of a Medicare Advantage plan will not be known for 10 to 15 years. For seniors, the initial cost savings is balanced against insurance companies’ healthcare rationing through restrictive prescription drug formularies, requiring documentation of medical necessity for imaging studies such as CT scans and MRIs, decreasing physician access, and rationing of lab tests, and ancillary care.

Other provisions

While nearly all agreed that some form of prescription drug benefit would be included, other provisions were the subject of prolonged debate in Congress. The complex legislation also changes Medicare in the following ways:

it mandates a six-city trial of a partly-privatized Medicare system (by 2010);
it gives an extra $25 billion to rural hospitals (at the request of congressional representatives in the rural West);
it requires higher fees from wealthier seniors; and
it adds a pretax health savings account for working people.

Legislative history

The bill was debated and negotiated for nearly six years in Congress, and finally passed amid unusual circumstances. Several times in the legislative process the bill had appeared to have failed, but each time was saved when a couple of Congressmen and Senators switched positions on the bill.

The bill was introduced in the House of Representatives early on June 25 as H.R. 1, sponsored by Speaker Dennis Hastert. All that day and the next the bill was debated, and it was apparent that the bill would be very divisive. In the early morning of June 27, a floor vote was taken. After the initial electronic vote, the count stood at 214 ayes, 218 noes.

Three Republican representatives then changed their votes. One opponent of the bill, Ernest J. Istook, Jr. (R-OK-5), changed his vote to "present" upon being told that C.W. Bill Young (R-FL-10), who was absent due to a death in the family, would have voted "aye" if he had been present. Next, Republicans Butch Otter (ID-1) and Jo Ann Emerson (MO-8) switched their vote to "aye" under pressure from the party leadership. The bill passed by one vote, 216-215.

On June 26, the Senate passed its version of the bill, 76-21. The bills were unified in conference, and on November 21, the bill came back to the House for approval. Former U.S. House Majority Leader Dick Armey, an influential Republican working as Chairman of the limited government group FreedomWorks, wrote an op-ed the day of the vote in the Wall Street Journal ("Say 'No' to the Medicare Bill") opposing the bill that swayed several Members.

The bill came to a vote at 3 a.m. on November 22. After 45 minutes, the bill was losing, 219-215, with David Wu (D-OR-1) not voting. Speaker Dennis Hastert and Majority Leader Tom DeLay sought to convince some of dissenting Republicans to switch their votes, as they had in June. Istook, who had always been a wavering vote, consented quickly, producing a 218-216 tally. In a highly unusual move, the House leadership held the vote open for house as they sought two more votes. Some of the dissenters said that they had been bribed to switch, allegations Hastert denied.

About 5:50 a.m., convinced Otter and Trent Franks (AZ-2) to switch their votes. With passage assured, Wu voted yea as well, and Democrats Calvin M. Dooley (CA-20), Jim Marshall (GA-3) and David Scott (GA-13) changed their votes to the affirmative. But Brad Miller (D-NC-13), and then, Republican John Culberson (TX-7), reversed their votes from "yea" to "nay". The bill passed 220-215.

The Democrats cried foul, and Bill Thomas, the Republican chairman of the Ways and Means committee, challenged the result in an empty gesture to satisfy the minority. He subsequently voted to table his own challenge; the tally to table was 210 ayes, 193 noes.

The Senate's consideration of the conference report was somewhat less heated, as cloture on it was invoked by a vote of 70-29 http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=108&session=1&vote=00457. However, a budget point of order raised by Tom Daschle, and voted on. As 60 votes were necessary to override it, the challenge was actually considered to have a credible chance of passing.

For several minutes, the vote total was stuck at 58-39, until Senators Lindsey Graham (R-SC), Trent Lott (R-MS), and Ron Wyden (D-OR) voted in quick succession in favour to pass the vote 61-39http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=108&session=1&vote=00458. The bill itself was finally passed 54-44 http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=108&session=1&vote=00459 on November 25, 2003, and was signed into law by the President on December 8.

References

External links

Medicare

Centers for Medicare & Medicaid Services (CMS)
- Medicare Modernization Act — includes PDF file of the actual text of the law.
Medicare.gov — the official website for people with Medicare
- Medicare Modernization Act at Medicare.gov
- Prescription Drug Coverage homepage at Medicare.gov — a central location for Medicare's web-based information about the Part D benefit
  - Enroll in a Medicare Prescription Drug Plan at Medicare.gov — the web-based tool for enrolling online in a Part D plan
- Medicare Plan Choices at Medicare.gov — basic information about plan choices for Medicare beneficiaries, including Medicare Advantage Plans
  - Medicare Personal Plan Finder at Medicare.gov — more detailed information about Medicare Advantage Plans; includes ability to do tailored searches based on specified criteria
- Landscape of plans — state-by-state breakdown of all plans available an area, both Stand-alone Part D plans, as well as Medicare Advantage plans
- Official Medicare publications at Medicare.gov — includes official publications about current Medicare benefits
  - Medicare & You handbook for 2006 at Medicare.gov — includes information about current Medicare benefits
- Information about the 1-800-MEDICARE helpline from Medicare.gov — a 24X7 toll-free number where anyone can call with questions about Medicare
Read Congressional Research Service (CRS) Reports regarding the Medicare Prescription Drug Act

Prescription drug benefit

Basic prescription drug coverage

Medicare Advantage plans

Changes to plans

Other provisions

Legislative history

See also

References

External links

Medicare

Other articles

Gourt Home::Gourt :: Medicare Prescription Drug, Improvement, and Modernization Act

Prescription drug benefit

Basic prescription drug coverage

Medicare Advantage plans

Changes to plans

Other provisions

Legislative history

See also

References

External links

Medicare

Other articles