Paul Abrams
Senator Maria Cantwell (D-WA) had already convinced Baucus to accept her changes in his "modified mark" that put a stake in the fee-for-service system that provides perverse financial incentives for volume of patients and procedures rather than outcomes. This stems the inexorability of healthcare cost inflation exceeding the CPI, and thus will have a major impact on improving outcomes and bending the cost curve down.
Senator John Kerry (D-MA) offered an amendment to reduce the amount of decrease in payments for home health care delivery. The Senator correctly pointed out that home health care is highly desired by the elderly community, improves outcomes and is substantially less expensive than institutional or hospital care. He noted that home healthcare was taking a larger percentage hit than any other area, and that such priorities were misplaced.
Senator Bill Nelson (D-FLA) proposed that Medicare part D be permitted to reimburse drug companies at Medicaid rates for seniors who qualify for both programs, approximately 8 million people. He noted that those were the rates that applied prior to the (Republican Congress) outlawing that practice in its Part D plan in 2005, and he was merely suggesting a rollback to the prior practice. This would save the system $86 billion over 10 years that would enable the donut-hole ($2700-5800 of drug expenses for which seniors pay premiums but receive no benefit) to be filled and still leave a cool $30B to satisfy other needs in the system.
Democrat after Democrat applauded Nelson and requested to be added as co-sponsors. Senator Schumer wondered aloud how anyone could oppose it, and bluntly stated that many in the room had supported provisions to aid one or another interest group, and it was time for the Committee to do something for the American people. For a while, the Republicans just squirmed, although Chuck Grassley, with whom Baucus was "negotiating" for months, blurted several sarcastic remarks.
Enter, Senator Tom Carper (D-Del). He began carping about the 'unfairness' to the pharma industry that had 'negotiated' an $80B deal--although not, Senators Kerry and Schumer pointed out, with Congress, but rather (supposedly) with people in the White House. He suggested that, since drug costs were only 10% of healthcare expenses, whereas hospital costs were 35%, that hospitals should be contributing 3.5X the amount the drug companies did "in order to be fair". His position was carefully fileted by Senators Kerry and Schumer, who noted that many hospitals are non-profits, some are losing money, and others have very thin profit margins.
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