Seeking votes on health reform

House Republicans lobby conservatives to support $400 billion Medicare bill

Many Democrats also opposed

Senate expects to vote on measure next week

November 22, 2003|By Julie Hirschfeld Davis | Julie Hirschfeld Davis,SUN NATIONAL STAFF

WASHINGTON - House leaders scrambled last night for votes to approve a landmark Medicare bill that would offer 40 million senior citizens government help in buying prescription drugs. But stiff opposition from Democrats and a group of conservative Republicans threatened to defeat the measure.

Still unsure of the outcome, Republican leaders began debate on the bill just before midnight.

Approval of the $400 billion plan would make the most sweeping changes in the health program for the elderly and disabled since its inception in 1965, and would hand President Bush a major victory on an issue that ranks at the top of seniors' wish lists.

But the bill has been hammered by critics on the left and the right. Most House Democrats say it is too stingy and contains the seeds of Medicare's destruction. Some conservative Republicans fear that it will pile more federal money on a program that is growing beyond its means.

The Senate plans to begin considering the package this weekend and expects to vote on it early next week. Proponents there seemed to be inching closer to enough support for the measure's approval. Two centrist Republicans - Sens. Susan M. Collins and Olympia J. Snowe, both of Maine - said they would back it.

But in the House, Republican leaders met determined resistance from about 20 of their most hard-line conservatives, who were balking at a costly new entitlement program that would constitute the largest expansion of Medicare in its history.

"For the physical health of seniors, for the fiscal health of Medicare, the time has come to strengthen Medicare with a much-needed prescription drug benefit," said House Speaker Dennis Hastert, an Illinois Republican. "It's now or never."

Most Democrats were expected to oppose the measure. Republican leaders worked into the night trying to persuade their rank and file that the bill was worth approval, whatever its flaws. Rep. Zach Wamp, a Tennessee Republican, said he would likely vote against it because a provision was dropped that would have allowed the reimportation of U.S.-made drugs from foreign countries. Wamp said: "The pressure at a certain point is counterproductive. I think a lot of heels have dug in in the last 48 hours."

The White House has increased its pressure on House Republicans in recent days, several of them said, with Karl Rove, Bush's top political adviser, placing calls from Buckingham Palace, where Bush was staying during a state visit. Even as Bush returned from Britain, he was placing calls from Air Force One to try to sway lawmakers.

The predicament Republicans were facing reflected the fine line they are trying to walk with the Medicare bill. The measure includes elements that appeal to broad sections of both parties, but contains others that alienate some on the left and the right.

The most popular provision is the creation of a prescription drug benefit under Medicare in 2006. In the interim, seniors would get discount cards to buy medicine at lower prices.

In their drive to approve the bill, Republican leaders staged a news conference at which they gave an unusual, high-profile role to the chief executive of AARP, which represents 35 million seniors and whose vigorous endorsement of the measure was a coup for its backers.

"This bill will do a lot of good for a lot of people," said William D. Novelli, chief executive of AARP. "We are asking Congress to keep its promise. Let's get this done."

Under the bill, once the drug benefit begins, seniors would pay a monthly premium of about $35. They would also have to pay a $250 deductible, after which the government would cover 75 percent of their drug costs, up to $2,250. Recipients would have to absorb all prescription costs between $2,251 and $3,600. Then the government would cover 95 percent of all remaining costs.

Those who earn $12,123 or less would receive more aid. Their discount card would entitle them to a $600 annual subsidy. Once the drug benefit begins, they would not have to pay a premium or a deductible, and would not face the same coverage gap between $2,251 and $3,600 that applies to others. To qualify for those extra benefits, seniors could not have assets that exceed $6,000.

Many Democrats argue that the drug benefit is inadequate, and express particular concern about the coverage gap.

"What we are delivering to seniors," said Rep. Elijah E. Cummings, a Baltimore Democrat and chairman of the Congressional Black Caucus, "is a bad bill of goods."

But the larger problem for Republican leaders was the group of conservatives who said they could not support a costly new government program.

"I didn't come here to create the largest expansion of Medicare in history," said Rep. Jeff Flake, an Arizona Republican. "I didn't come here to create the largest new entitlement in history."

Conservatives pushed unsuccessfully for several provisions, such as giving the private sector a larger role in providing health care and restraining the ballooning costs of Medicare.

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