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Part D Drug Benefit The House Ways and Means Health Subcommittee plans to conduct extensive oversight of Medicare in the 110th Congress, including examining the program's prescription drug benefit and overpayments to providers, according to full committee Chairman Charles B. Rangel (D-N.Y.). In a Jan. 17 letter to several lawmakers, Rangel said the health subcommittee would conduct oversight on just about every aspect of Medicare, from the Part D drug benefit to managed care plans to quality improvement among providers. The nine-page letter set out the scope of the work to be done by the committee and its subcommittees, including the health subcommittee, during the next two years. The health subcomittee will examine "major Medicare programs to ensure efficient use of resources, quality, and access for Medicare beneficiaries," Rangel said in his letter, sent to House Government Reform Committee Chairman Henry A. Waxman (D-Calif.), House Administration Committee Chairwoman Juanita Millender-McDonald (D-Calif.), and Ways and Means ranking minority member Jim McCrery (R-La.). The House has started quickly with its health care agenda, already passing bills allowing more public funding for embryonic stem cell research (H.R. 3) and requiring the Department of Health and Human Services to negotiate lower prescription drug prices (H.R. 4) from drug makers. Veto Threat Speaking Jan. 18 at a conference sponsored by the Stanford Group Co., Health Subcommittee Chairman Fortney (Pete) Stark (D-Calif.) sounded a pessimistic note about the negotiation legislation, saying that Health and Human Services Secretary Michael O. Leavitt "won't do anything [to negotiate] even if we order him to." President Bush has threatened to veto the House bill. The Senate has yet to act on a negotiations bill, but Senate Finance Committee Chairman Max Baucus (D-Mont.) has said he favors stripping the no-negotiations provision from the law, although not necessarily requiring HHS to negotiate with drugmakers. Baucus, as the committee's ranking member in 2003, helped Republicans craft the legislation that created the Part D drug benefit under Medicare. Under Medicare Part A and Part B, Rangel said the health subcommittee would examine the relationship between payment policy and workforce issues; adequacy of program benefits, such as mental health and cost sharing; treatment of specific populations, such as people with disabilities and low-income beneficiaries; durable medical equipment competitive bidding; a post-acute care common assessment tool; and waste, fraud, and abuse issues. The subcommittee also plans to examine Medicare managed care plans, including value and payments, benefit packages and actuarial equivalence determinations; administrative costs; quality; and plans' ability to manage and treat chronic illnesses, Rangel said. Stark told those attending the Stanford conference that the subcommittee will investigate reducing payments to Medicare managed care plans, the overpayment to some that he said has become "egregious. I do see us getting savings out of [Medicare Advantage] plans," he said. "I think there's a lot of money there." Stark said the subcommittee likely will take time to ramp up its work, since it has many new members and Democrats have not had a working relationship with the Centers for Medicare & Medicare Services since being ousted from majority status in 1994. "We have gotten precious little information from CMS over the years," Stark said. The subcommittee will examine a plethora of issues dealing with Medicare's prescription drug benefit, including treatment of dual eligibles, formularies for covered drugs and appeals, creating a Medicare-sponsored drug benefit option, and negotiated price mechanisms, Rangel said. The subcommittee also will examine the entitlement status of Medicare, including a provision in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 in which Medicare's trustees must determine whether projected general revenue funding exceeds 45 percent of Medicare financing within the next seven years. If the Medicare trustees make such a determination two years in a row, a Medicare funding warning will be given, mandating that the president propose legislation to respond to the warning in his next budget submission. The law then requires Congress to consider the proposal on a fast-track basis. The trustees issued their first warning earlier this year, and are likely to issue a second one in 2007, triggering the drug law provision and likely a discussion on entitlement spending, according to a Republican congressional aide. Stark said provisions such as the spending trigger were part of Republican plans to "dismantle or privatize" Medicare, adding that legislation may be needed "to preserve the entitlement nature" of the program. In his letter to lawmakers, Rangel also said the health subcommittee will conduct oversight of health insurance coverage, including the uninsured and options for providing coverage for them; CMS administration; and health savings accounts. The Ways and Means Committee list of subcommittee members and Rangel's letter outlining the panel's agenda is available at http://op.bna.com/hl.nsf/r?Open=sfak-6xktt2.
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