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A rubber tire gantry crane at the State Ports Authority's Wando Terminal lowers a shipping container on to a tractor-trailer.

WASHINGTON -- Millions of Medicare patients would be spared monthly premium increases next year under a bill passed by the House on Thursday.

The House voted 406-18 to eliminate all premium increases for Medicare Part B, which provides coverage for visits to doctors. The bill now goes to the Senate, where the Finance Committee is expected to take it up soon, though no hearings are scheduled.

Lawmakers said older Americans shouldn't have to pay higher Medicare Part B premiums because they are not expected to get a cost-of-living increase from Social Security. Most seniors have their Medicare premiums deducted from their Social Security payments.

Under the law, the vast majority of Medicare recipients already are exempt from Part B premium increases whenever there is no increase in Social Security payments.

Still, without congressional action, several million would face monthly premium increases of $8 to $23. The standard monthly premium is $96.40 this year.

"Our nation's seniors are already experiencing difficult financial times," said Rep. Charles Rangel, D-N.Y., chairman of the House Ways and Means Committee, which oversees Medicare.

"The prospect that some may face a disproportionate increase in their Medicare premiums is inherently unfair."

The bill would not affect scheduled increases in premiums for the Medicare prescription drug program, known as Part D. Average monthly premiums for the drug program will increase slightly, from $28 this year to $30 in 2010.

House Majority Leader Steny Hoyer of Maryland, in a rare break with fellow Democrats, voted against the measure, saying it would mainly help wealthy Medicare recipients.

"If we take care of everybody, we won't be able to take care of those who need us most," Hoyer said.

About 42 million seniors and people with disabilities are enrolled in Medicare Part B. By law, about three-fourths are exempt from premium increases when there is no increase in Social Security payments.

The Social Security Administration projects no cost-of-living increases for the next two years because the adjustments are pegged to inflation, which has been negative this year, largely because energy prices are below 2008 levels.

It will mark the first time without an increase since automatic adjustments were adopted in 1975.

Most of the 11 million or so patients who are not exempt from premium increases are low-income people who also qualify for Medicaid. Medicaid, the state-federal health insurance program for the poor, pays their Medicare premiums, meaning states would bear some of the costs.

Among the rest who are not exempt, a little more than 2 million are high-income seniors, singles making more than $85,000 a year and couples making more than $170,000. Also, about 1.3 million new enrollees would not be exempt.