What: All Issues : Health Care : Aid to the Chronically Ill : H.R. 1. Prescription Drug Benefit/Vote on Final Passage of a Conference Report on Prescription Drug Legislation. (2003 house Roll Call 669)
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H.R. 1. Prescription Drug Benefit/Vote on Final Passage of a Conference Report on Prescription Drug Legislation.
house Roll Call 669     Nov 22, 2003
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The subject of this vote was final passage of the Republican-crafted prescription drug bill. When Medicare was created in 1965, prescription drugs were not an essential component of patient care. However, medical advancements in recent decades have enabled doctors to treat a wide range of diseases and ailments with prescription drugs. But the costs of prescription drugs have skyrocketed and many seniors are now unable to afford the drugs they need to stay healthy. Legislative proposals aimed at expanding prescription drug coverage and reducing drug prices have been a fixture on the congressional agenda since 1999 but, until 2003, policymakers have been unable to reach a compromise on the issue because the two political parties have fundamentally different ideas about how to expand drug coverage and address the rising costs of prescription drugs. Republicans have typically favored approaches that would subsidize private insurance companies to provide the coverage, while Democrats have advocated for adding a prescription drug benefit to the Medicare program. Earlier in the year, both the House and the Senate completed action on their respective proposals to provide Medicare recipients with prescription drug coverage through private insurers (rather than through Medicare). The House and Senate versions of the legislation, however, were not identical and a conference committee was convened to reconcile differences between the two versions of the legislation. The conference committee produced a conference report, the final version of the legislation, and the measure was brought to a final vote. Progressives opposed final passage of the prescription drug conference report for two main reasons. First, Progressives objected to what they characterized as a "donut hole" in drug coverage which was contained in the prescription drug conference report. The conference report, Progressives noted, would provide zero drug coverage to seniors for yearly drug expenditures above $2250 and below $4900; seniors would be required to pay full price for drug costs incurred within that gap in drug coverage under the Republican-drafted plan. Progressives characterized the coverage gap as irresponsible and mischievous lawmaking on the part of Republicans and argued that if Congress was serious about prescription drugs, then seniors should receive at least some drug coverage for all drug purchases regardless of their yearly expenditures on prescription drugs. Second, Progressives opposed language in the conference report which would create a pilot program to allow private health plans to compete directly with Medicare by 2010. In the view of Progressives, allowing private plans to compete directly with Medicare would reduce the quality of health coverage for the nation's seniors. In contrast to private insurance plans-which can drop an individual's coverage on a whim, limit a patient's treatment options to only those doctors and hospitals that have been approved by the insurance company, and provide unequal coverage to individuals based demographic or geographic data-the health coverage provided through Medicare applies equally to all seniors, is never reduced based on one's health needs, and allows seniors to choose their doctor and hospital. Conservatives voted in favor of final passage and argued that the free-market provisions contained in the prescription drug conference report would reduce prescription drug costs and increase the drug coverage choices available to seniors. On a close vote of 220-215, the prescription drug conference report was adopted and President Bush signed the measure into law on December 8, 2003. (Note: The original cost estimate of the prescription drug bill by the Office of Management and Budget (OMB)-the budget arm of the White House-was $395 billion. Several weeks after final passage, however, the OMB revised its cost estimate upward to $534 billion which prompted allegations that the Bush Administration purposely underestimated the cost of the bill in order to attract support for the measure among fiscal conservatives. At the time of this vote, however, lawmakers were operating under the assumption that the true cost of the measure was $395 billion.)

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