A main characteristic of the bill is that it will gradually encourage seniors to use private insurers, whom the government can reimburse, rather than staying with the existing government-run Medicare plan.
The vote in the House was 220-215 and the vote for the bill was 54-44 in the Senate. Last-minute filibustering by Sen. Ted Kennedy (D-Mass.) and an unusual three-hour roll call held up the contentious bill.
One of the Democrats who voted against the bill was New Jersey Congressman and Chairman of the House Democratic Caucus Robert Menendez, a native of Union City. Menendez spoke last week at Casa Manito Adult Day Care Center in West New York, hoping to explain the changes to the assembled elderly folks who attended.
The bill, complicated even for the law-savvy, is worded to appear like a positive step forward for the elderly who rely on Medicaid for prescription drugs and doctor's visits. But according to the mainly-Democratic opposition, the bill will cause dramatic and negative change in the lives of seniors across the country, Hudson County included.
Menendez, speaking in both Spanish and English, attempted to explain exactly why he refers to this bill as "a poison pill" for the elderly.
"What began as a Democratic effort to provide our nation's seniors with a drug benefit they so dearly needed has become the stepping stone to end Medicare as we know it," said Menendez. "The Republican plan that the House and Senate passed is not a Medicare prescription drug plan, but rather a poison pill for our nation's seniors and for Medicare itself. The more you know about this bill, the less you like it."
The 200 or so seniors that gathered at Casa Manito last week listened intently as Menendez showed them charts and graphs outlining why the Democrats find this bill to be reprehensible. Many applauded when Menendez swore that this wouldn't have happened under a Democratic-controlled House and Senate.
Encourages seniors to get private insurers
From a political point of view, Menendez' visit was well-timed and well-placed as the presidential (and various other) elections come up next year. Hudson County, particularly its vast elderly Latino voting base, is a bastion of Democratic power.
The bill, which will cost an approximate $400 billion over a 10-year period, would create an interim drug discount card for seniors in Spring 2004. Democrats say the intended savings of the card have been exaggerated. The bill would also add a voluntary prescription drug benefit for seniors in 2006 through private insurance companies that seniors would have to seek out.
The legislation also would give insurers billions of dollars in subsidies to make their health plans more attractive than the traditional government-run Medicare. It calls for "pilot programs" in six metropolitan areas of the country in 2010 that would encourage seniors to switch to private insurers that the government can pay. If people choose to stay on government-run Medicare, they will pay a higher premium.
That means that if their new private insurance plan forces them to switch doctors, and they want to stay with their old doctor, they may have to pay more.
Republicans see the bill as nothing short of modernizing the Medicare system. Most (but not all) Democrats see it differently. New Jersey Sen. John Corzine and Frank Lautenberg both voted against the bill. Said Corzine in a published report, "This bill is a Trojan horse, offering a meager benefit while smuggling in land mines to undermine the Medicare program. This bill, on balance, is a bad deal for New Jersey's seniors."
Lautenberg was even more blunt in a published report last week, "Seniors in New Jersey will not find out until 2006 how complicated, meager and misleading this new drug benefit plan really is. Seniors in our state will be forced out of Medicare as we know it and into HMOs."
Said Menendez last week, "Remember, this is not a Medicare benefit plan; this is a benefit plan that gets offered through insurance companies. The benefit does not even start until well after the presidential elections, in 2006."
Continued Menendez, "This bill also does not guarantee a specific set of coverage under a specific set of circumstances. It leaves it up to private insurance companies."
It appears that the Democrats' biggest gripe with the bill is that it seeks to privatize the Medicare program, which by its very construction, is a government-based program. This bill, say most Democrats, will end Medicare.
A facet of the bill which seemed to most agitate Menendez last week was a provision that "prohibits the federal government from negotiating [with insurers] to bring down prices."
Republicans have also argued that the bill will increase aid to hospitals that take Medicare patients, something which Menendez flatly denied. Said Menendez, "This bill dramatically under-funds New Jersey hospitals."
Menendez also stated that the bill will undermine cancer care in New Jersey. Said Menendez, "New Jersey has the third highest cancer rate in the United States and this bill takes money away from cancer care providers to the tune of $552,000,000, nationwide."
Added the Congressman, "It's amazing to me that anyone could support this."
According to information provided by the congressman's office, while New Jersey has 3 percent of the nation's Medicare beneficiaries, New Jersey hospitals would receive only .5 percent (1/200th ), or $104 million of the $20 billion provider package. If New Jersey hospitals do not participate in the "quality initiative," state hospitals actually stand to lose $287 million.
When asked why, if the bill is so obviously flawed, the Republicans pushed so hard for it, Menendez had a pragmatic answer.
Said Menendez, "Republicans have always believed since its inception in 1965 that Medicare was an overly costly program. Like [then-House Speaker] Newt Gingrich said years ago, that we should let Medicare 'wither and die on the vine'... to prohibit the government from being able to negotiate for fair and affordable pricing, well, I think you see where they're going with this," making an not-so-faint allusion to the privatization of the Medicare system.