Narrow Vote Belies Broad Support for Medicare Reform Measure

Published January 1, 2004

While Congress approved H.R. 1, the Medicare Prescription Drug and Modernization Act, by the narrowest of margins, support for the measure was broad among health care groups with a range of political agendas.

According to Michael Heaney, a fellow in the Centennial Center of the American Political Science Association, “The bill’s margin of approval was far more lopsided among health advocacy organizations than it was among lawmakers.” In a November 25 essay for the Washington Times, Heaney noted “the Republican congressional leadership and the White House marshaled an impressive coalition of more than 300 organizations to promote the compromise agreement on Medicare reform.”

More than 15,000 AARP members, riled by the group’s surprise backing of the reform legislation, burned their cards or cancelled their memberships. But AARP was not alone in its support for the measure. According to Heaney, who reviewed the reaction of nearly two dozen major health care advocacy groups, “While all cited the creation of a prescription-drug entitlement for seniors as one reason for backing the legislation, they also had a host of special-interest considerations high on their agendas.”

According to Heaney,

All in Favor

  • The American Hospital Association supported the bill because it expands payments to rural hospitals and places a moratorium on the creation of specialty hospitals.
  • The American Medical Association’s support came because the measure reverses proposed cuts in physician reimbursements and subsidizes recruiting and physician retention in rural areas.
  • The Blue Cross and Blue Shield Association signed on because it expected the bill would lower prescription drug costs by reducing the time it takes for generic drugs to become available.
  • The American Diabetes Association came aboard because the measure funds diabetes diagnostic screenings for seniors and praised the creation of a “Welcome to Medicare” physical examination for all new Medicare beneficiaries.
  • The American Association of Nurse Anesthetists, representing nurses who administer two-thirds of all anesthetics, praised increased reimbursements for outpatient health care and provisions supporting health care in rural areas, where nurse anesthetists play a large role.
  • The National Association of Community Health Centers, a lobbying group representing 3,000 not-for-profit providers of health care, endorsed the bill as a compromise that ensures adequate reimbursement of health centers under Medicare Advantage plans and provides for technical improvements in billing skilled-nursing facilities.
  • The American Chiropractic Association approved of the measure’s new chiropractic demonstration project and increased payment for chiropractic services.
  • While the American Heart Association did not endorse the overall bill, it praised the inclusion of cardiovascular screening provisions, favored the extension of a moratorium on rehabilitation therapy caps, and supported the Medicare “welcome” physical.

Split Decision

  • The American Cancer Society was pleased with the initial physical exam and transitional coverage for oral anti-cancer drugs. But it expressed serious concerns about gaps in coverage for low-income beneficiaries and reductions in reimbursements for oncologists.
  • The Alzheimer’s Association urged passage of Medicare reform as a “compromise” that will improve patient care, but disliked the idea of market competition in the Medicare program.

Among those leaning against passage was the National Breast Cancer Coalition. Its mostly negative view of the measure was based on a concern about significant gaps in coverage under the prescription drug benefit, the “doughnut hole” reported in past issues of Health Care News. The group also objected to the inclusion of tax-advantaged Health Savings Accounts.

America’s largest nursing organization, the American Nurses Association, gave the measure thumbs down, raising strenuous objections to provisions that allow free enterprise and private managed care plans to compete with the traditional Medicare program.

Conrad F. Meier is managing editor of Health Care News. His email address is [email protected].