[MOL] Medical Regorm....Expanded prescription drug coverag.... [00609] Medicine On Line

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[MOL] Medical Regorm....Expanded prescription drug coverag....

Monday, December 18, 2000
So What Will Bush Do for Our Health?

New Prez Pushes Medicare Reform, Expanded Prescription Drug Coverage

By Sean Martin
WebMD Washington Correspondent

Reviewed by Dr. Dominique S. Walton

Dec. 15, 2000 (Washington) -- Well over a month after election day and the ensuing electoral chaos, it's now finally certain that Republican Texas Gov. George W. Bush has gained the Presidency of the United States. The triumph, though a controversial one, ends 8 years of Democratic control of the White House under Bill Clinton. So what will our new President do for our health?

What will happen on national healthcare questions is one of the big unknowns in the new Administration.

In his widely publicized "acceptance" speech Wednesday night, Bush said, "Together, we will strengthen Medicare and offer prescription drug coverage to all of our seniors. ... These priorities are not merely Republican concerns or Democratic concerns, these are American responsibilities."

Nonetheless, Bush faces a Congress with just a razor-thin Republican majority, especially in the Senate, where Vice President Elect Dick Cheney will serve to break an even 50-50 party split.

This narrow GOP edge will require the party to seek Democratic support if legislation is to make it into law, but the prevailing tone on Capitol Hill has been short on bipartisanship.

During this year's campaign, Bush said he backed passage of a national "patients' bill of rights," a Medicare prescription drug benefit, other reforms to modernize Medicare, and tax-relief measures to encourage more Americans to purchase health insurance and long-term care coverage.

On rights for patients in HMOs, Bush campaigned on his record in Texas. In 1997, during his tenure as Texas governor, the state legislature passed landmark patients' rights legislation that allowed consumers the right to sue health plans in certain situations. But Bush let that legislation become law without his signature, although he did sign other provisions to increase patient access to specialists and emergency care.

Although he favors national patients' rights legislation, Bush may not favor applying its provisions to all Americans. During the campaign, he signaled that such legislation should not interfere with states' authority; state laws currently regulate health plans that cover tens of millions of Americans.

With Bush's continued interest in the issue, reaching a final agreement on patients' rights legislation may be possible next year. Congressional Democrats still see a bill as a top priority, and the party has gained the leverage of a few more seats in the Senate, where a House-passed bill got bottled up this year by GOP leaders.

On the other hand, Medicare reform -- including a prescription drug benefit -- may be a daunting policy challenge. Bush believes that Medicare is "headed toward financial collapse," since "its 'one-size-fits-all' benefits package is outdated, covering neither prescription drugs nor routine services, such as annual physicals, vision tests, and hearing aids."

Bush's campaign supported wholesale changes to the Medicare system; he plans to appoint a special commission to make recommendations for fast-track congressional approval. Bush said he would reform Medicare so seniors could "choose their own modern, comprehensive health plan."

But most Democrats are nervous that drastic Medicare changes could endanger what they view as a successful program that needs less-sweeping repairs.

During the campaign, Bush took heat from Gore and the media for not having a Medicare prescription drug plan, a centerpiece issue of national concern considering skyrocketing drug prices. But Bush soon produced a proposal that would provide a full subsidy for drug costs for the very poor. For other seniors, Bush would partially fund private drug insurance premiums.

Democrats still say the Bush plan would fail to include millions of needy seniors.

As for those Americans without health insurance, Bush has resisted calling for expansion of the Medicaid or federal children's health programs, but he has proposed several relatively modest solutions. He would, for example, provide individuals with a $2,000 refundable health credit "so that they can choose health plans and physicians that fit their needs." He also promised to make it easier for small businesses -- which he said employ 60% of the uninsured -- to obtain lower cost insurance by banding together with other firms.

Bush also backs changes in the tax code that would encourage Americans to purchase long-term care insurance, and he said he would push for legislation to provide new tax exemptions for family members who take care of their elderly.

Bush's antiabortion stance touches upon several new developments in the health arena. He has signaled his displeasure with the FDA's recent approval of the early abortion pill RU-486, although it is unclear whether he could -- or would -- reverse the agency's decision.

Bush has also taken issue with the current Democratic Administration's support for federal funding of research on embryonic stem cells.

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