WASHINGTON — Efforts to expand health insurance for children could greatly affect their grandparents.
House Democrats want to eliminate Medicare participants' share of the costs when they get cancer screenings such as mammographies and colonoscopies — an approach designed to promote disease prevention.
They also would lower seniors' share of the cost from 50 percent to 20 percent when they see a psychiatrist for treatment of depression and other mental illnesses — the same cost-sharing that would occur for a physical illness.
And, many of the poorest seniors would newly qualify for extra help in paying for their medicine or monthly premiums, thanks to changes that let them maintain more assets.
But the legislation, likely to be considered in the House next week, has parts that will upset millions of seniors.
Around the country, about 8.2 million elderly and disabled Americans are enrolled in private health plans through Medicare. The plans often charge lower premiums than what's available through traditional Medicare, or they offer extra benefits, such as dental care or free annual eye exams.
The federal government subsidizes seniors' care, on average, at a greater rate in the private plans than it does in traditional Medicare.
The children's health bill would gradually end that practice. It would lower payments to the insurers administering those health plans, sometimes substantially, depending upon the location of the plan.
Overall, payments would drop from about $587 billion to $537 billion during the next five years, a reduction of 8.5 percent. As a result, some insurance plans will scale back benefits. Some plans can be expected to drop out of certain states altogether, particularly in rural areas.
Peter Orszag, director of the Congressional Budget Office, told lawmakers Thursday that the number of seniors participating in private plans will drop to about 5.5 million by 2012 if the House bill becomes law.
The reduced access to the private plans will be a critical aspect of the debate over children's health insurance. Critics of the proposed changes want to make the debate less about payments to insurance companies and more about seniors' losing benefits.
"Hold on to your wallet," said Rep. Marsha Blackburn, R-Tenn., during a hearing on the children's bill. "This committee is on a spending frenzy at the expense of the nation's seniors."
Blackburn's committee, the House Energy and Commerce Committee, reviewed the bill on Thursday and Friday. The hearing was acrimonious, to say the least.
Republicans accused the Democrats of rushing through a 465-page health bill without giving them adequate opportunity to review its contents. They refused to agree to a customary waiver of the reading of the bill. When a clerk began reading the bill and missed the word "a," Republicans objected and asked that she read the bill correctly. She started over. She began Thursday afternoon and was still at it Friday afternoon when the committee adjourned without even voting on the bill.
The partisan rancor began early in the members' opening statements when Rep. Ed Markey, D-Mass., said: "I think if you kick a Republican in the heart, you're going to break your toe."
To which, Rep. Cliff Stearns, R-Fla, replied: "I submit that if you kick a Democrat in the heart, you would break the bank."
The bill would increase spending on children's health insurance by about $50 billion over five years, raising total spending to $75 billion. The program is designed to provide health coverage to children whose income is too great for Medicaid but not enough to pay for private insurance. President Bush had recommended total spending of $30 billion.
Another committee with jurisdiction over the health legislation did vote — at about 2 a.m. The House Ways and Means Committee approved the Children's Health and Medicare Protection Act by a 24-17 vote, strictly along party lines.
Payment cuts to health insurers pay for the biggest chunk of the new benefits for children and for Medicare beneficiaries. However, a 45-cent increase in the tax on a pack of cigarettes would also generate about $27 billion over five years.
Scores of other Medicare providers would also face payment reductions over the coming five years. Their opposition to the proposed cuts complicates prospects for the bill's passage.
For example, nursing homes stand to lose about $2.7 billion over the next five years. That money would come out of about $111 billion they would get from Medicare during that time.
"When funding is unstable, as it surely would be if the proposed cuts are enacted into law, quality undoubtedly will suffer," said Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care.
Suppliers of oxygen equipment for patients with chronic breathing problems would lose about $1.8 billion over five years, or about 15 percent of their total Medicare payments during that time, says the American Association for Homecare.
The suppliers serve about 1.5 million beneficiaries by setting them up with their oxygen tanks and educating them on how to use it. They also service the equipment to make sure it's working properly. Employees are on-call at all hours to help patients and can save the Medicare system money by keeping the patients at home for their treatment.
Among other Medicare providers, home health agencies would see payments reduced by about $2.2 billion over five years. That's about a 3 percent cut in overall payments.
About 3 million seniors and disabled Medicare participants get care at home, such as speech therapy for strokes, or rehabilitation therapy for patients with hip replacements.
Profit margins vary greatly depending upon the agency. Some may have problems taking on patients because their costs would exceed what they're being paid, said Theresa Forster, vice president for policy at the National Association for Home Care and Hospice.
AARP, the advocacy group for seniors, has endorsed the bill. The organization says that, overall, seniors would see their premiums go down as a result of payments to insurers being lowered.
The Senate will also take up its version of the children's health bill next week. The Senate bill relies strictly on a tobacco tax to increase funding for the children's health program.
--The Associated Press