WASHINGTON -- The Medicare prescription drug bill appeared headed for defeat unless Republican House leaders could turn two votes. That made a four-term member from Missouri the most powerful lawmaker on the floor.
A half-hour after GOP leaders huddled around Republican Rep. Jo Ann Emerson, the Southeast Missouri congresswoman emerged with a green card in hand. She presented it to the clerk, changing her vote from "no" to "aye" -- breaking a tie to rescue the bill, 216-215.
Emerson, who sat calmly while Speaker Dennis Hastert and other leaders hovered over her, said she didn't feel pressured.
After all, she said, she had won a promise that the final bill would strip the ability of the Food and Drug Administration to block the importation of prescription drugs from Canada, where drugs are cheaper because of price controls.
"The only pressure I felt was self-imposed pressure, to extract from the leadership a commitment," Emerson said afterward.
However, Hastert told reporters that Emerson was guaranteed a vote on the issue on another piece of legislation, although he also said the outcome of that vote would determine "the will of the House" when it came time to bargain with the Senate.
Emerson has pushed for the change for several years, spurred by older Americans who board buses to Canada to buy cheaper drugs.
"They finally agreed to do that," she said. "I said all along I was on the line between voting yes and no based on whether they would agree to do that."
Emerson said she also was pleased with several provisions that would result in an infusion of Medicare dollars into rural areas.
Tensions ran high and grew after the vote began early Friday. Leaders took nearly an hour to round up enough support.
Their focus turned to Emerson, Rep. Butch Otter and other supporters of drug reimportation, and Minnesota Republican Rep. Gil Gutknecht, upset by the pressure, stormed off the floor.
With GOP leaders encircling Emerson, New York Democrat Nita Lowey walked onto the floor and demanded of them: "Why Jo Ann Emerson? Why not some of the other men who voted against the bill?"
Rep. Todd Tiahrt, R-Kan., was in the throng trying to rally support when Emerson reached the agreement with Hastert, Ways and Means Chairman Bill Thomas of California and others.
"At that moment in time, she was the most powerful person on the floor," Tiahrt said.
Then Emerson filled out her green card --"no" cards are red. So did Otter, and their names were read.
Lowey hugged Emerson at the clerk's desk.
Several observers remarked that Emerson looked emotional.
"I wasn't upset. I was intense," she said. "I guess I was praying I could trust what the leadership said."
Ultimately, she and the other Missourians came down on party lines.
Republican Reps. Todd Akin, Roy Blunt, Sam Graves and Kenny Hulshof voted in favor of the measure, while Democratic Reps. William Lacy Clay, Dick Gephardt, Karen McCarthy and Ike Skelton voted against it.
Emerson wasn't the only Republican in the delegation to hold out. Earlier in the week, President Bush brought a group of House conservatives including Akin to the White House.
The Medicare bill easily won passage in the Senate, where the vote was 76-21. Republicans Kit Bond and Jim Talent voted in favor of the bill.
Blunt, the House majority whip, helped assemble the House bill that passed. It gives private companies a strong new position by forcing the government-run Medicare to compete on price with private plans.
"Competition is the right way to make sure the government-run Medicare system and the private sector options are run as efficiently as possible, lowering costs for seniors," Blunt said.
McCarthy countered the GOP plan "fails to make prescription drugs more affordable and, disturbingly, ends the Medicare system that has been an indispensable safety net to millions of people for the past four decades."
Nine Democrats voted for the bill and 195 voted against it. On the Republican side, 207 voted for it and 19 voted against.
Hulshof said he is optimistic the differences between House and Senate versions, "and put on the president's desk a voluntary prescription drug benefit that offers a plan to all seniors who want one and adds some much-needed reforms in order to help the Medicare system remain solvent."
Talent said people's parents and grandparents won World War II and kept the economy and communities strong. "We owe it to them to provide a Medicare prescription drug benefit that is immediate, permanent, voluntary and provides most of the relief for low-income seniors," he said.
Bond said: "After years of false starts, we have finally delivered on a prescription drug benefit that will make a real and positive difference in the lives of many senior citizens."