THIS WEEK'S AGENDA Question on Medicare Rx Drugs Question on Patients Rights Medicare Prescription Drugs Question 1: Debate on the House Republican Medicare prescription drug plan could begin as early as Wednesday. What will be the general outlines of the debate? Answer: Expect two separate themes. Republicans will say that their $350 billion plan is the more fiscally responsible one, because it would not only add prescription drugs to the Medicare program but also would give more money to Medicare providers and add some measures, such as competitive bidding demonstrations, that they say would help save Medicare money. Democrats will argue that Congress should spend as much as it needs to give seniors the type of drug coverage they need, so Democrats say that their $800 billion plan is the better way to go. Question 2: Is the House GOP plan expected to pass? Answer: Yes, but a close vote is expected. When House Republicans passed a drug-only package for Medicare recipients two years ago, it squeaked through the House by just a handful of votes and the same sort of outcome is expected this time. House Republican leaders want to pass this bill before they go home at the end of the week for July 4, but they won't bring it to the floor unless they have the votes. So if the timetable slips beyond this week, it will likely be a sign that there aren't enough votes at this point to pass it. Question 3: Now, why would a House Republican vote against this bill? Don't they need this kind of legislative victory to show that Republicans are just as concerned as Democrats are about adding prescription drugs to Medicare? Answer: Republicans certainly know that this is a huge political issue and that Democrats are campaigning really hard on it. But there are a lot of opinions within the party on how to add such a costly program to Medicare, which is already facing a major onslaught when Baby Boomers begin to flood it in 2010. Some Republicans are worried about the financial burden of adding drug coverage to the program. Some, perhaps with the fall elections in mind, think the program should be more generous. Some Republicans did not want any reforms -- such as a competitive bidding and demonstrtation project on managed-care insurers in Medicare --- in the bill, while others wanted even more reform. But the bottom line is it would be tough for a Republican to vote against this bill on the floor. Question 4: Beyond questioning the size of the Republican plan, how else will Democrats attack it? Answer: They will go after what has been dubbed the "donut" of the plan -- the portion that beneficiaries have to pay themselves before catastrophic coverage kicks in . In the Ways and Means plan, beneficiaries would be responsible for $2.001 to $3,800 in costs. In the Energy and Commerce plan, that stop-loss level begins at $3,700. There is no such coverage gap in the Democrats' plan, and their stop- loss begins at $2,000. Democrats also will say that the Republican plan does not guarantee what amount beneficiaries would pay in deductibles or premiums because insurers would have the flexibility to design packages that could offer various amounts. Republicans will say that there will be adequate oversight to guarantee that any package offered to seniors is equivalent to the standard package outlined in their bill. Question 5: If the House Republican bill does pass, does that mean it will be voted on next in the Senate? Answer: That probably will not happen. Senate Majority Leader Tom Daschle has said he wants to have the chamber debate Medicare prescription drug legislation in the early part of July, but he and other Democrats prefer a measure from Democrat senators Bob Graham of Florida, Zell Miller of Georgia and Edward M. Kennedy of Massachusetts that would spend about $450 billion over the next seven years to add prescription drug coverage to Medicare. It's unclear, however, if that bill has enough support to pass the Senate. Question 6: Will we end the year – and head into the November elections – without Congress passing Medicare drug legislation? Answer: That's certainly the conventional wisdom, and it's the scenario I've predicted in my work for Congressional Quarterly. But two key figures in this debate , House Ways and Means Chairman Bill Thomas, a California Republican, and Sen. Bob Graham, a Florida Democrat, have said that they want to defy the conventional wisdom by having Congress pass Medicare drug legislation passed this year and signed into law by President Bush. Perhaps those lawmakers see a way out of this that we don't. And with so many Democrats and Republicans alike talking so much about how seniors need this coverage so desperately, maybe something will come out of all this action. Patients' Bill of Rights Question 1: Last week, the Supreme Court voted to uphold state laws giving patients the right to seek an independent review of denial of care issued by their managed care company. What effect, if any, could that have on the stalled patients'-rights debate? Answer: Probably not much. If the court had struck down the laws, which are now on the books in 42 states and the District of Columbia, it might have put pressure on Congress to enact a uniform federal standard that all states would follow. Some business groups might actually prefer to have one federal law, rather than having to comply with the current patchwork of laws. Question 2: Will business groups push Congress to take action on patients' rights since the Supreme Court allowed the state appeals boards to remain in place? Answer: Many of the same groups that complain about having to answer to so many different state appeals boards oppose a federal patients' bill of rights because they say it would expose employers to lawsuits and drive already skyrocketing health insurance premiums even higher. Of course, there are some lawmakers who think that Congress should take action to give consumers a federal law that would expand their right to sue a health insurer. For example, Edward M. Kennedy, a Massachusetts Democrat who has played a key role in pushing for a federal patients' bill of rights, still believes that federal action is needed to protect patients all across the country. But for now it looks like negotiations between the White House and Kennedy and other Capitol Hill lawmakers are not anywhere close to a deal.