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Jen K.
Medicare Deductibles. The Senate reconciliation bill doubled deductibles from $100 a
year in 1995 to $210 a year in 2002. Medicare beneficiaries already spend 21% of their
income on health care, and doubling their deductibles would have increased beneficiary
costs by more than $10 billion over 7 years. The House bill and the vetoed conference
agreement did not increase deductibles.
Medicare Eligibility Age. The Senate Finance Committee reconciliation bill gradually
increased the Medicare eligibility age from 65 to 67 beginning in 2003, matching the
increase in the Social Security retirement age. Under the Senate proposal, people would
have had to work longer and pay more taxes to get fewer years of Medicare. And while
retirees can get Social Security benefits before reaching the official retirement age, they
could not receive Medicare, and many people ages 65 to 67 would be unable to continue
working or to purchase individual health insurance. This provision was eliminated on the
Senate floor without a recorded vote for violating the Byrd Rule.
Medicare Coverage of State & Local Government Employees. The Senate
reconciliation bill extended Medicare coverage to all state and local government
employees. It would have subjected nearly 2 million additional state and local employees,
teachers. police officers. and fire fighters and their state and local government employers
to the Medicare payroll tax. Many states, including Illinois. California, Ohio, and Texas,
have a large number of employees who are not currently covered by Medicare. [Note:
Also included in the Administration's Health Security Act.]
Medicare Premiums. The Senate, House, and conference reconciliation bills and the
vetoed second CR all increased premiums to 31.5%. raising premiums for an elderly
couple by $264 in 1996 alone. Rather than maintaining the traditional 25% premium,
their reconciliation bills raised premiums for an elderly couple by at least $1,700 over 7
years. compared to your proposal.
s
Medicaid. The Senate Medicaid proposal were extreme. but generally less so than the
House proposals. Both the House and Senate proposals could have forced states to deny
coverage to more than 8 million people in 2002, including more than 4 million children.
The Senate Finance Committee voted to repeal completely federal nursing home standards,
but Republicans later voted on the Senate floor to restore them with a waiver provision.
The Senate went further than the House, however, in repealing financial protections for
adult children of nursing home residents.
Medicare Deductibles. The Senate reconciliation bill doubled deductibles from $100 a
year in 1995 to $210 a year in 2002. Medicare beneficiaries already spend 21% of their
income on health care, and doubling their deductibles would have increased beneficiary
costs by more than $10 billion over 7 years. The House bill and the vetoed conference
agreement did not increase deductibles.
Medicare Eligibility Age. The Senate Finance Committee reconciliation bill gradually
increased the Medicare eligibility age from 65 to 67 beginning in 2003, matching the
increase in the Social Security retirement age. Under the Senate proposal, people would
have had to work longer and pay more taxes to get fewer years of Medicare. And while
retirees can get Social Security benefits before reaching the official retirement age, they
could not receive Medicare, and many people ages 65 to 67 would be unable to continue
working or to purchase individual health insurance. This provision was eliminated on the
Senate floor without a recorded vote for violating the Byrd Rule.
Medicare Coverage of State & Local Government Employees. The Senate
reconciliation bill extended Medicare coverage to all state and local government
employees. It would have subjected nearly 2 million additional state and local employees,
teachers, police officers. and fire fighters and their state and local government employers
to the Medicare payroll tax. Many states, including Illinois, California, Ohio, and Texas,
have a large number of employees who are not currently covered by Medicare. [Note:
Also included in the Administration's Health Security Act.]
Medicare Premiums. The Senate, House, and conference reconciliation bills and the
vetoed second CR all increased premiums to 31.5%, raising premiums for an elderly
couple by $264 in 1996 alone. Rather than maintaining the traditional 25% premium.
their reconciliation bills raised premiums for an elderly couple by at least $1.700 over 7
years. compared to your proposal.
Medicaid. The Senate Medicaid proposal were extreme. but generally less so than the
House proposals. Both the House and Senate proposals could have forced states to deny
coverage to more than 8 million people in 2002, including more than 4 million children.
The Senate Finance Committee voted to repeal completely federal nursing home standards.
but Republicans later voted on the Senate floor to restore them with a waiver provision.
The Senate went further than the House, however, in repealing financial protections for
adult children of nursing home residents.
Nursing Home Quality Standards. The Senate Finance Committee bill repealed
federal nursing home quality standards and federal enforcement. Since enactment of
these standards in 1987 under President Reagan, nursing home quality has improved
dramatically: the use of physical restraints has declined 25%, dehydration has decline
50%, and hospitalization rates have declined 31%. All Republican Senators except
Senator Chafee voted against an amendment in Committee to restore the standards.
Most Republicans, including the Majority Leader, also voted against a Pryor floor
amendment to restore the standards, and instead supported a Roth floor amendment
that restored the standards but allowed states with "equivalent or stricter" standards
and enforcement to receive waivers. The federal government would be unable to
enforce the standards in these states. The Senate, House, and conference agreements
also repealed federal standards for institutions caring for people with mental illness
and mental retardation.
Medicaid Financial Protections.
Adult Children. The Senate reconciliation bill went further than the House or
conference bills in repealing current protections for adult children of nursing home
residents. The Senate bill would have allowed states to force adult children to
contribute toward their parents' nursing home care. regardless of the income of the
children. The vetoed conference bill protected adult children with incomes below the
state median.
Nursing Home Fees. The Senate, House, and conference bills allowed nursing homes
to charge up-front payments as the price of admission.
Homes. The Senate, House, and conference bills repealed all federal laws protecting
a minimum level of income and assets in determining Medicaid eligibility. This
allows states to count the value on one's home, family farm, and car in determining
Medicaid eligibility, which could force the sick to sell them to qualify for Medicaid.
Liens. The Senate bill allowed states to impose liens on homes as a condition of
eligibility, but not if the spouse's home were of modest value or a family farm.
Current law restricts states from imposing liens, protecting family members living in
the homes.
Spousal Impoverishment. The Senate bill retained current federal spousa!
impoverishment protections, but made it more difficult for the federal government to
ensure that states comply with the protections. The vetoed conference bill also
prevented individuals from enforcing the protections in federal court.
Premiums/Cost-sharing. The Senate, House and conference bills removed most
protections, letting states impose premiums and cost-sharing on Medicaid recipients.
with the exception of no premiums on families with a pregnant woman or child below
poverty, and cost-sharing for primary and preventive care for poor children and
pregnant women must be "nominal."
Backdoor Medicaid Deals. Under last-minute Republican deals, the Senate changed
its formula for distributing Medicaid funding among the states. Overall, states with
two Democratic senators lost an additional $4 billion and states with two Republicans
senators gained $11 billion. According to the Washington Post, one Republican aide
described the last-minute dealings as "Let's make a deal, with Bob Dole as your host.'
Under these changes:
California lost an additional $4.2 billion in federal funding. This drastic cut would
have forced California to eliminate Medicaid coverage for as many as 1 million
people in 2002, including nearly half a million children. [Based on HHS
estimates.]
Texas gained an additional $5 billion;
Kansas gained $616 million, reducing its cut from 12% to 1% cut over the 7 years.
Delaware gained $107 million, reducing its cut from 7% to 0% over 7 years!
The average percentage cut in 2002 was 29%, but the cuts to states ranged from
4% to 52%.
Pension Reversion. The Senate Finance Committee reconciliation bill and the final
reconciliation bill would have given corporations the green light to raid their employees'
pensions. The provision would have let corporations reduce pension fund assets by about
$15 billion, affecting an estimated 3.7 million workers in 5,000 companies. However, the
full Senate voted to delete this provision from the Senate reconciliation bill. with both the
Majority and Minority Leaders voting to delete it.
EITC. The Senate reconciliation bill cut the EITC by $43.5 billion, increasing taxes on
17 million working families. It would have cut these families' EITC by an average of
$302 in 1996, and would have cut the EITC of working families with two or more
children by $410 in 1996. The vetoed reconciliation bill cut the EITC by $31 billion,
cutting the EITC for 12.6 million working families with 14.5 million children by an
average of $332 in 1996. After accounting for the child tax credit, the bill increased net
taxes on 7.7 million families by an average of $318. and on 3.3 million families with 6.8
million children by an average of $508.
Child Support Enforcement Fees. The Senate Finance Committee reconciliation bill
required States to charge parents not on AFDC a fee equal to 10% of the amount of child
support collected. No fees could be charged to custodial parents below 185% of the
poverty line, and fees would be limited to 2% of support collected for custodial parents
between 185% and 300% of the poverty line. The bill's child support enforcement fees
would have imposed a $4 billion cost on single-parent families. A Bradley amendment
to strike the fees was defeated in committee on a party line vote. But in response to
criticism, this provision was deleted on the Senate floor by a Nickels-Dole amendment.
March 14, 1996
MEDICARE
SENATE
HOUSE
CONFERENCE
Reconciliation:
The House and Senate plans were generally similar, both saving $270 billion
The Conference agreement cut
over 7 years. The Senate plan, however, increased beneficiary costs more than
Medicare by $270 billion, reducing
the House plan, mainly by raising deductibles and setting lower income
federal Medicare spending per
thresholds for means-tested premiums.
beneficiary $1,700 below projections
for 2002, while raising Medicare
Senate Republicans voted against amendments to reduce the size of the tax
premiums per beneficiary by $143 in
cuts and use the savings to reduce the size of the Medicare or Medicaid cuts.
2002, compared to the President's
plan.
Deductibles
Doubled deductibles from $100 a
Did not increase deductibles.
House provision; did not increase
year in 1995 to $210 a year in
deductibles.
2002.
Premiums
Set premiums at specific dollar
Set premiums at 31.5% of program
House provision; set premiums at
amounts intended to equal 31.5%
costs, instead of the traditional
31.5% of program costs, raising
of program costs.
25%.
premiums for an elderly couple by
$264 in 1996 alone, and by at
least $1,700 over 7 years,
compared to the President's
proposal.
Means-Tested
Individuals with incomes over
Means-tested premiums began at
Set the thresholds higher than the
Premiums
$50,000 and couples with incomes
higher incomes. Individuals with
Senate and lower than the House:
over $75,000 would pay higher
incomes over $75,000 and couples
$60,000 for individuals and
premiums, and individuals with
with incomes over $125,000 would
$90,000 for couples.
incomes over $100,000 and
pay higher premiums, and
couples with incomes over
individuals with incomes over
$150,000 would pay premiums
$100,000 and couples with
equal to 100% of Part B program
incomes over $175,000 would pay
costs. The premium would be
premiums equal to 100% of Part B
taken directly out of their Social
program costs.
Security check.
Implemented based on income
Implemented similar to Senate, but
Implemented according to House.
declared by beneficiary to HHS
IRS would supply income
rather than being implemented
information to HHS.
through the tax code, requiring a
new bureaucracy to verify the
incomes reported to SSA.
Medicare
Senate Finance Committee bill
No proposal.
No proposal.
Eligibility Age
gradually increased the Medicare
eligibility age from 65 to 67
beginning in 2003. Under this
proposal, people would have to
work longer and pay more taxes to
get fewer years of Medicare.
While retirees can get Social
Security benefits before reaching
the official retirement age, they
could not receive Medicare, and
many people ages 65 to 67 would
be unable to purchase health
insurance.
Provision was eliminated on the
Senate floor without a recorded
vote for violating the Byrd Rule.
Medicare
Extended Medicare coverage to all
No proposal.
No proposal.
Coverage of State
state and local government
& Local
employees. Subjects nearly 2
Government
million additional state and local
Employees
employees, teachers, police
officers, and fire fighters to the
Medicare payroll tax. Many states,
including Illinois, California, Ohio,
and Texas, have a large number of
employees who are not currently
covered by Medicare.
Balance Billing
Allowed doctors to charge above
Similar to Senate proposal.
Similar to Senate proposal.
Medicare payment rates, or
"balance bill," in the new private
plans.
Medical Savings
Included in Senate plan, but struck
Similar to Senate proposal.
Similar to Senate proposal.
Accounts
on the Senate floor for violating
the Byrd Rule.
Look-Back/-
Included look-back that cut
Similar look-back included to meet
Similar to House.
Spending Limit
provider payments if spending
savings target. saving about $32
exceeded a set limit, but the
billion.
provision was struck on the Senate
floor for violating the Byrd Rule
because CBO concluded the Senate
look-back did not save money.
"Regulatory
No provisions similar to the House.
Allowed doctors to refer patients to
Allowed doctors to refer patients
Relief"
labs in which the doctor has a
to labs in which the doctor has a
All Senate Republicans voted
financial interest.
financial interest.
against consideration of a Harkin
Weakens anti-kickback laws and
Weakens anti-kickback laws and
amendment to strengthen efforts to
makes it more difficult to impose
makes it more difficult to impose
combat Medicare waste, fraud, and
penalties.
penalties.
abuse.
Capped malpractice damage
No cap on malpractice damage
awards.
awards.
Provided broad anti-trust
Anti-trust exemptions were deleted
exemptions for Physician Service
from the conference agreement in
Networks.
the Senate under the Byrd Rule.
Exempted clinical labs in doctors'
Lab exemptions were deleted from
offices from regulations, except for
the conference agreement in the
pap smear tests.
Senate under the Byrd Rule.
MEDICAID
SENATE
HOUSE
CONFERENCE
Budget
The Senate budget resolution assumed $175 billion in Medicaid savings,
Conference budget resolution
Resolution:
compared to $187 billion in the House. The House assumed Medicaid would
assumed $182 billion in Medicaid
be block granted, while the Senate explicitly did not recommend how the
savings, but did not specify how the
savings should be achieved.
savings should be achieved.
Reconciliation:
Both the Senate- and House-passed reconciliation bills block granted Medicaid
Conference agreement block granted
and cut federal funding by about $170 billion, and could have denied coverage
Medicaid and cut federal funding by
to more than 8 million people in 2002, including over 4 million children.
$163 billion. It could have denied
nearly 8 million people coverage.
Structure
Budget resolution did not specify
House budget resolution assumed a
Budget resolution conference
how the assumed savings would be
block grant.
agreement was similar to the
achieved. The committee report
Senate, making no assumptions
stated that its recommendation was
about the individual entitlement,
"designed to be compatible with a
benefits, etc.
wide range of Medicaid
restructuring proposals and makes
no assumption about individual
entitlement, eligibility groups,
benefits, payment rates, financing
structures."
Reconciliation conference
Reconciliation bill block granted
House reconciliation bill block
agreement block granted
Medicaid.
granted Medicaid.
Medicaid.
Size of
Senate Finance Committee bill saved
House Committee bill saved $182
Vetoed conference agreement saved
Federal Cuts
$182 billion, but money was added on
billion but about $12 billion was
$163 billion.
the Senate floor so that the Senate-
restored on the House floor by further
passed bill saved about $170 billion.
lowering the discretionary caps. The
House-passed bill saved about $170
Under the Senate floor amendments:
billion.
California lost an additional $4
billion in federal funding;
Texas gained an additional $5
billion;
Kansas gained $616 million,
reducing its cut from 12% to 1%
cut over the 7 years.
Delaware gained $107 million,
reducing its cut from 7% to 0%!
The average percentage cut in
2002 was 29%, but the cuts to
states ranged from 4% to 52%.
Eligibility
Senate Finance Committee adopted
No assurance of coverage. The
Adopted the Senate Finance
the Chafee amendment to require
House Commerce Committee
Committee proposal: required
states to cover poor pregnant
defeated an amendment to assure
states to cover poor pregnant
women, children 12 and under, and
coverage for children.
women, children 12 and under,
people with disabilities, but the
and people with disabilities, but
definition of disability was
states would define eligible
ultimately left up the states.
disabilities.
Full Senate later adopted a Chafee
amendment to require states to use
the SSI definition of disability. as
amended by the welfare bill.
Benefits
Senate Finance Committee rejected
No minimum benefits package.
No minimum benefits package.
a Chafee amendment to require
The only required benefits were
states to provide a minimum
immunizations and limited family
benefit package. All other
planning.
Republicans on the Committee
opposed it.
Nursing Home
Senate Finance Committee bill
Repealed both the federal nursing
Retained most of the federal
Quality
repealed federal nursing home
home quality standards and federal
standards, but repealed federal
Standards
quality standards and enforcement.
enforcement. States would set
enforcement and some federal
The Committee rejected an
their own standards and enforce
standards.
amendment to restore them, with
them.
all Republicans except Senator
Chafee voting against the
amendment.
Full Senate passed a Pryor
amendment (51-48) to retain
federal standards, but most
Republicans, including the
Majority Leader, voted against the
Pryor Amendment, arguing that a
Roth amendment was superior.
Full Senate subsequently adopted
the Roth amendment that watered
down the Pryor Amendment.
Thus, the final Senate bill retained
the federal standards but allowed
states with "equivalent or stricter"
standards and enforcement to
receive waivers. The federal
government would have no way to
enforce standards in the states with
waivers.
Quality
Senate completely eliminated
Same as Senate.
Also completely repealed federal
Standards for
federal quality standards for
standards.
Institutions
institutions caring for people with
Caring for People
mental illnesses and mental
with Mental
retardation.
Retardation
Spousal
Committee bill and Senate-passed
House Commerce Committee bill
Adopted the House proposal,
Impoverishment
bill retained current federal spousal
completely eliminated federal
barring individuals from enforcing
impoverishment protections, but
spousal impoverishment protections
spousal protections in federal
made it more difficult for the
that ensure that spouses can keep a
court. Also eliminated the
federal government to ensure that
minimum amount of their income
guarantee of nursing home
states comply with the protections.
and assets.
coverage, and would let states
In response to criticism, the House
define the scope of nursing home
reinstated the provisions, but made
coverage.
it more difficult for the federal
government to enforce the
protections and barred individuals
from enforcing the protections in
federal court.
Other
Adult Children. Allowed states to
Adult Children. Allowed states to
Adult Children. Allowed states
Financial
force adult children to contribute
force adult children to contribute to
to require adult children to
Protections
toward their parents' nursing home
their parents' nursing home care,
contribute toward their parents'
care.
but not if they were of "moderate
nursing home care if their income
Nursing Home Fees. Allowed
means."
were above the state median
nursing homes to charge up-front
income.
payments as the price of
Nursing Home Fees. Same as
Nursing Home Fees. Same as
admission.
Senate.
Senate.
Homes. Repealed all federal laws
Homes. Same as Senate.
Homes. Same as Senate.
protecting a minimum level of
Liens. Allowed states to put liens
Liens. Similar to House.
income and assets in determining
on the homes and family farms of
Allowed states to impose liens on
Medicaid eligibility. This allows
Medicaid recipients.
homes and family farms.
states to count the value on one's
Premiums/Cost-sharing. Similar
Premiums/Cost-sharing. Similar
home, family farm, and car in
to Senate.
to Senate.
determining Medicaid eligibility,
which could force the sick to sell
them to qualify for Medicaid.
Liens. States could impose liens
on homes as a condition of
eligibility, but not if the spouse's
home is of modest value or a
family farm. Current law restricts
states from imposing liens,
protecting family members living
in the homes.
Premiums/Cost-sharing.
Removed most protections, letting
states impose premiums and cost-
sharing on Medicaid recipients,
with the exception of no premiums
on families with a pregnant woman
or child below poverty, and cost-
sharing for primary and preventive
care for poor children and pregnant
women must be "nominal."
Medicaid
Eliminated the guarantee of
Similar to Senate provision.
Similar to Senate provision.
Assistance with
assistance to low-income Medicare
Medicare
beneficiaries. Set aside no funding
Premiums
to cover deductibles and copays,
and set aside less than half of the
amount needed to cover just
premiums for more than 5 million
low-income Medicare beneficiaries.