The House bill would also require all states to provide expanded Medicaid benefits for more than a million people over 65 who are living in poverty but do not have incomes low enough to qualify for welfare programs.
Waxman, who also played a pivotal role in developing the prescription drug provision, hailed the legislation as a "carefully tailored approach" that would close some "egregious gaps" in health protection for the elderly.
Republican opponents attacked the bill on grounds of cost. Rep. Judd Gregg (R-N.H.) called the Medicare expansion "the entitlement of the 1980s, and every decade seems to have one."
Gregg said that the increase in the monthly premium would fall short of paying for the new benefits.
In addition to the $2.60 increase in the monthly premium of all Medicare beneficiaries, there would be a variable premium pegged to income. The elderly who pay no federal taxes--about 60% of all those over 65--would be exempt from the variable premium. Others would pay from $10 to $580 a year.
Several Republicans said that the House bill could become very costly because it would eventually pay for costly drugs for AIDS victims, who would become eligible for Medicare benefits as disabled persons.
If AZT, a new drug costing $1,000 a month or more, became "broadly prescribed, we have an obligation to provide this drug and it will be provided," said California Rep. William E. Dannemeyer (R-Fullerton). "But we should not obligate the senior citizens to pay for it out of Medicare trust funds."
Do Not Live Long Enough
Waxman said that most AIDS patients do not now live long enough to qualify for Medicare disability benefits, which are available only 29 months after diagnosis. As better drugs and therapies are discovered to prolong the lives of AIDS patients, Congress will decide the best way to pay for their drugs, Waxman said.
Before the House adopted its Medicare bill, it rejected by a vote of 242 to 190 a Republican substitute establishing a $2,000 cap on combined out-of-pocket spending and limiting the drug benefit to low-income people over 65.
The final vote for passage of the Democratic Medicare plan closely followed party lines, with 241 Democrats and 61 Republicans voting for the measure and 113 Republicans and 14 Democrats opposing it.