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COPYRIGHT 2003 Thomson Financial Inc.
Medicare legislation to add a prescription-drug benefit and inject more private health-plan competition into the program has passed both houses of Congress. But uncertainties still abound, starting with whether a conference committee can bridge differences between the two bills to keep more liberal senators and more conservative House members from bolting when a final vote arrives.
If and when a law is enacted, there still are future cliffhangers aplenty. Stakeholders will continue to struggle over rules setting up the new programs. And since many of the mechanisms the legislation proposes are new and untried, advocates on all sides will stay vigilant for the inevitable unintended consequences.
Here's a sample of issues still in question:
* Will private plans save money? Gospel among Republicans is the proposition that a new private-plan portion of Medicare will significantly hold down costs. Indeed, for many this proposition constitutes the primary stated rationale for retooling Medicare to depend on private insurers. But health plans don't necessarily tout that selling point the way lawmakers do.
At a June 26 briefing on Capitol Hill, American Association of Health Plans Executive Vice President Diana Dennett stressed the importance to insurers of having their reimbursements tied to local Medicare fee-for-service spending.
An audience member at the forum sponsored by the Alliance for Health Reform and the Kaiser Family Foundation wondered why, given that private plans work at holding down prices and motivating providers to offer the most effective and cost-effective care.
Health plans can do a bit to bring care closer to sensible norms in areas where there's underuse or over-use, Dennett said.
But she went on to emphasize that "the underlying driver of...
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