Senate is set to pass Medicare bill today

Democratic bid to block legislation is overcome by Republican pressure

November 25, 2003|By Julie Hirschfeld Davis | Julie Hirschfeld Davis,SUN NATIONAL STAFF

WASHINGTON - The Senate cleared the last hurdles yesterday to passage today of a landmark Medicare bill that would offer a new prescription drug benefit to 40 million elderly and disabled people and hand President Bush a domestic policy victory that could have weighty consequences for the 2004 elections.

Republican leaders overcame Democratic procedural blocks and barely beat back Democratic efforts to kill the bill outright. Passage today is expected on a broad bipartisan vote.

"Today is a momentous day and a historic day," said Senate Majority Leader Bill Frist, a Tennessee Republican and a heart surgeon who has made the enactment of a Medicare bill one of his own highest priorities.

The bill would produce the broadest expansion of Medicare in the program's 38-year history. It would give private insurance companies a key role in covering seniors. And it would set in motion a contentious experiment pitting the government against for-profit firms to see which could provide health benefits more cheaply.

A new Medicare law, which Congress has been trying unsuccessfully to pass for six years, would represent an unlikely phenomenon: the passage, by a Republican-led Congress and with the determined prodding of a conservative president, of the largest expansion of a government entitlement in history.

"Modernizing Medicare will make the system better and will enable us to say to millions of seniors, `We've kept our promise,'" Bush said yesterday in Colorado.

The new prescription drug program would cost about $400 billion over the next decade. The measure also includes roughly $125 billion for doctors and hospitals, subsidies for insurers to cover Medicare beneficiaries and incentives for employers who cover retirees not to drop or reduce their health benefits.

The House approved the measure in a 220-215 vote just before dawn Saturday, after House Republican leaders had spent three hours rescuing the bill from defeat by pressuring conservative opponents to change course and support it.

The Senate cleared away one obstacle to its passage yesterday when it easily amassed the 60 votes needed to overcome procedural tactics and proceed to a final yes-or-no vote. That vote was 70-29, with 21 Democrats, including Sen. Barbara A. Mikulski of Maryland, and one independent joining 48 Republicans in voting to move on. Like those other Democrats, Mikulski sought to move ahead in hopes of defeating the bill on its merits.

Three Republicans joined 26 Democrats, including Sen. Paul S. Sarbanes of Maryland, in trying to block the bill.

"We are right there for a touchdown for our seniors all across America," said Tommy G. Thompson, secretary of the Department of Health and Human Services, who visited both chambers during votes to lobby lawmakers to support the bill.

Democrats came close to killing it when they objected to it on budgetary grounds, and Republicans had trouble clearing the 60-vote hurdle. Sen. Trent Lott, a conservative Mississippi Republican who opposes large government programs, held out for more than a half-hour while Republicans surrounded him pressuring him to help them move past the Democrats' budgetary objection. Looking upset, Lott finally strode to the front of the chamber and voted "yes."

The tally was 61-39, with 11 Democrats and one independent joining 49 Republicans to support overcoming the budgetary objection. Two Republicans joined 37 Democrats, including Mikulski and Sarbanes, in pushing to sustain it.

Many Democrats remain vehemently opposed to the bill, which they say offers inadequate drug coverage, damages Medicare by shifting it toward a private-sector model and could mean higher health care and prescription costs for seniors.

All three Democratic senators seeking their party's presidential nomination - John Edwards of North Carolina, John Kerry of Massachusetts and Joseph I. Lieberman of Connecticut - said they opposed the measure.

"We all know what's going on: It's the objective of [Republicans], and that is the beginning of the dismantling of the Medicare program," said Sen. Edward M. Kennedy, the Massachusetts Democrat who led the efforts to block the bill. "The Senate is on trial today."

Under the bill, seniors could choose to stay in the traditional Medicare program or obtain health benefits and drug coverage from private plans, known as preferred provider organizations, similar to those that companies offer to employees.

Unlike Medicare, in which premiums and benefits are set and seniors have a choice of doctors, the private plans would dictate which health services and doctors would be covered. Seniors would have to pay an extra fee for additional services or physicians outside the plan.

Private companies would also offer the prescription drug coverage, starting in 2006. Recipients would pay about $35 a month and have a $250 deductible before the government began covering 75 percent of their drug costs, up to $2,250.

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