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SEN. McCAIN's PROPOSAL TO REPEAL FULL CATASTROPHIC DRUG BENEFIT, PART B CAP WILL BE DEBATED IN SENATE BY OCT. 7; BENTSEN STILL SEEKS BIPARTISAN PLAN

Executive Summary

Sen. McCain's (R-Ariz.) proposal to repeal the catastrophic care outpatient drug benefit, except for home I.V. drugs and immunosuppressives, is scheduled to be debated on the Senate floor by Oct. 7. The plan to debate McCain's proposal was agreed to late Sept. 28, after the Arizona Republican attempted to introduce his proposal as an amendment to a Defense Department appropriations bill on the Senate floor. McCain later agreed to offer the proposal as a separate bill on the assurance that the bill would be debated by the full Senate before Oct. 7. The bill will be subject to amendments, with no limit on the number of amendments that may be offered. The measure would also repeal the catastrophic cap on out-of-pocket expenses for Part B services. The benefit reductions would allow for repeal of the supplemental premium now required under the program, according to McCain. The proposal would retain catastrophic benefits currently in place and keep a modified version of skilled nursing facility coverage. The McCain proposal further hurts the chances that the outpatient drug benefit will survive in the Senate. However, there may be growing support in the House for keeping the benefit (see following story), which could mean that the fate of the benefit will be decided in a House/Senate conference. The Finance Committee postponed its Sept. 26 markup of a modification proposal after members failed to agree on a compromise catastrophic care modification plan during a same-day private meeting. "There is obviously not bipartisan support for any proposal," Chairman Bentsen (D-Tex.) told reporters. The Finance Committee has not yet set further meeting dates for a catastrophic care proposal. However, the committee may want to have a proposal ready to offer as an amendment to the McCain bill when it reaches the floor. The committee plans to take up budget reconciliation legislation the week ending Oct. 7. The House Ways and Means Committee used budget reconciliation as the vehicle for modifications to the program; however, the Finance Committee does not appear to be interested in following the same path. In their closed-door session, members reviewed the latest modification proposal developed by staff. Similar to proposals offered earlier, the latest modification plan would have repealed the full drug benefit while retaining coverage for home I.V. and immunosuppressive therapies ("The Pink Sheet" Sept. 25, p. 3). However, the newest version also contained new financing provisions and would have gone to non-beneficiary funding for the program. Bentsen expressed frustration at the lack of bipartisan agreement and at the Administration's failure, he said, to encourage committee Republicans to support a compromise even though the White House has indicated it would accept a proposal that retains the "core" catastrophic care benefits. "I await the Administration to show they have some influence with their own [Republican] members," Bentsen said. He declared: "There has to be some political courage shown." Bentsen met with Minority Leader Dole (R-Kan.), who is also a member of the Finance Committee, and Sen. Durenberger (R-Minn.) on Sept. 28 to urge support for a bipartisan proposal. Despite Bentsen's show of frustration, Durenberger said the committee is "getting closer" to an agreement. Durenberger is pushing another plan that would repeal the full drug benefit and limit the catastrophic care program to expansions in basic Part A services, a cap on out-of-pocket spending for Part B services, and coverage for home I.V. and immunosuppressive drugs. The plan would reduce the supplemental premium maximum to $ 250 and the tax rate to 10%.
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