Congressman Paul Ryan (R-WI) discussed his vision of the final Medicare bill today at a briefing hosted by the Cato Institute in the Rayburn House Office Building.

Congressman Ryan said the Medicare reforms in the House bill are ?minimally acceptable? and put us on a road ?crawling toward competition.? He suggested improving the House bill by allowing private health plans to deliver the updated Medicare benefits before 2006 if they are ready before then. He also would like to see competition between traditional Medicare and the private plans start before 2010. ?It?s the definition of competition that is important, not a target date,? said Ryan.

Congressman Ryan also voiced strong support for the Health Savings Account (HSA) provision in the House bill and believes it will be in the conference committee report. He said the Medicare bill provides an opportunity to set in place broader reforms to the health care system that put consumers in control of their health care decisions.

Since the president very much wants a Medicare bill, Congressman Ryan said he does not see a scenario where the conference committee doesn?t produce a report. However, Ryan said he is prepared to organize an effort to oppose the report if it does not include enough competition and structural reforms to the Medicare program. He said he has already began such an effort by writing two letters to congressional leadership and the president urging more competition in the final bill. Many conservative House members signed the letters.

On the reimportation issue, Congressman Ryan said, ?No one knows what we are going to be voting on tomorrow.? Ryan said Congressman Gil Gutknecht?s bill keeps changing and that Congresswoman Jo Ann Emerson (R-MO) has a substitute bill that would contain more stringent safety measures by the Food and Drug Administration and limit the reimported drugs to only those from Canada, at least in the beginning. Ryan concluded that regardless of the outcome of the vote tomorrow, the debate has created momentum that makes it likely that some form of importation will be included in the final Medicare bill.

Tom Miller of the Cato Institute also discussed his preferences for the conference committee product. He said it is important to include more than three private plan options in each geographical area and to let them compete on a level playing field with traditional Medicare. ?We don?t get competition by limiting competition to three players,? said Miller.

Miller also supports rebate incentives that would allow private plans to keep some of the money if they are efficient and produce cost-savings. But the provision in the House and Senate bills that Miller prefers is the transitional coverage from 2004 to 2006 that has a drug discount card and special assistance for the low-income. ?This would be good by itself, if it were the only thing in the bill,? said Miller.

Like Ryan, Miller suggested starting the competitive portions of the bill earlier and including the HSA provision. Miller also would encourage less first-dollar drug coverage by moving the deductible higher and having more generous catastrophic coverage. Instead of means-testing the premiums, Miller would like to see higher deductibles for people with higher incomes.

Miller said it is likely that the conference committee will have to produce more than one conference report. Miller encouraged the conference committee to produce as many reports as needed until they get it right.

–Joe Moser
Galen Institute

Congressman Paul Ryan (R-WI) discussed his vision of the final Medicare bill today at a briefing hosted by the Cato Institute in the Rayburn House Office Building.

Congressman Ryan said the Medicare reforms in the House bill are ?minimally acceptable? and put us on a road ?crawling toward competition.? He suggested improving the House bill by allowing private health plans to deliver the updated Medicare benefits before 2006 if they are ready before then. He also would like to see competition between traditional Medicare and the private plans start before 2010. ?It?s the definition of competition that is important, not a target date,? said Ryan.

Congressman Ryan also voiced strong support for the Health Savings Account (HSA) provision in the House bill and believes it will be in the conference committee report. He said the Medicare bill provides an opportunity to set in place broader reforms to the health care system that put consumers in control of their health care decisions.

Since the president very much wants a Medicare bill, Congressman Ryan said he does not see a scenario where the conference committee doesn?t produce a report. However, Ryan said he is prepared to organize an effort to oppose the report if it does not include enough competition and structural reforms to the Medicare program. He said he has already began such an effort by writing two letters to congressional leadership and the president urging more competition in the final bill. Many conservative House members signed the letters.

On the reimportation issue, Congressman Ryan said, ?No one knows what we are going to be voting on tomorrow.? Ryan said Congressman Gil Gutknecht?s bill keeps changing and that Congresswoman Jo Ann Emerson (R-MO) has a substitute bill that would contain more stringent safety measures by the Food and Drug Administration and limit the reimported drugs to only those from Canada, at least in the beginning. Ryan concluded that regardless of the outcome of the vote tomorrow, the debate has created momentum that makes it likely that some form of importation will be included in the final Medicare bill.

Tom Miller of the Cato Institute also discussed his preferences for the conference committee product. He said it is important to include more than three private plan options in each geographical area and to let them compete on a level playing field with traditional Medicare. ?We don?t get competition by limiting competition to three players,? said Miller.

Miller also supports rebate incentives that would allow private plans to keep some of the money if they are efficient and produce cost-savings. But the provision in the House and Senate bills that Miller prefers is the transitional coverage from 2004 to 2006 that has a drug discount card and special assistance for the low-income. ?This would be good by itself, if it were the only thing in the bill,? said Miller.

Like Ryan, Miller suggested starting the competitive portions of the bill earlier and including the HSA provision. Miller also would encourage less first-dollar drug coverage by moving the deductible higher and having more generous catastrophic coverage. Instead of means-testing the premiums, Miller would like to see higher deductibles for people with higher incomes.

Miller said it is likely that the conference committee will have to produce more than one conference report. Miller encouraged the conference committee to produce as many reports as needed until they get it right.

–Joe Moser
Galen Institute