GOP presses for vote on Medicare overhaul

WASHINGTON -- In the prelude to a high-stakes vote, President Bush reached out from Air Force One on Friday and lobbied reluctant House Republicans to support sweeping Medicare prescription drug legislation.

Bush made his calls on the trip home from a state visit to England as Republican leaders worked to hand him a legislative and political victory and Democrats dug in to defeat a bill they called a threat to the government's health care program for seniors.

GOP vote counters reported progress in rounding up support and were aiming for a vote after midnight. HHS Secretary Tommy Thompson traveled to the Capitol to help with the lobbying, and Bush's intervention was a sign that additional help was needed. At least one lawmaker who took a presidential phone call was unmoved.

"I basically said it was a matter of principle, that I came to Washington not to ratify and to expand Great Society programs," said Rep. Tom Feeney, R-Fla. "He wasn't happy to hear that," the first-term lawmaker added of the president.

Two other first-term lawmakers, Reps. Marsha Blackburn of Tennessee and Trent Franks of Arizona, got the presidential pitch, as well.

Neither would disclose how they intended to vote on a bill that supporters and critics alike agreed would usher in the most far-reaching changes in Medicare since the program was established in 1965.

Discount drug cards

Beginning next year, seniors would be able to purchase discount drug cards that the Bush administration estimates would yield savings of between 15 percent and 25 percent. The card program would expire in 2006, when beneficiaries would gain access to a prescription drug benefit for the first time.

The bill also encourages private insurance companies to establish new managed care plans for seniors, either in the form of preferred provider organizations or HMOs. While Medicare currently includes an option for private coverage, most beneficiaries currently receive their health care in the form of a standard, government-defined benefit that does not vary from one region of the country to another.

For the first time, the legislation would also require seniors with annual incomes over $80,000 to pay higher premiums under Medicare Part B, which covers services outside the hospital. Also, it would establish new tax-preferred health accounts, open to individuals with high-deductible insurance policies.

The tax provision and requirement for higher premiums were part of an effort to appeal to conservatives who favor transforming Medicare and restraining its cost, yet find creation of the new prescription drug benefit distasteful.

Many Democrats argued that some of the conservative-backed elements of the bill were too dear a price to pay for the drug benefit, in particular a provision creating a limited experiment in direct competition between private plans and traditional Medicare beginning in 2010.

"This is a defining issue," said Rep. Jim McGovern, D-Mass, as he made the case for rejecting the measure. "This bill is a huge giveaway to the prescription drug companies. And worst of all, this bill shoves Medicare down that path toward privatization."

But Republican supporters said the legislation would provide better health care for seniors. "I think this bill has a great chance of injecting competition into the system," said Wisconsin Rep. Paul Ryan.

White House officials said Bush made several calls while flying home. "It is an important time for members of the United States Congress to honor our obligation to our seniors by providing a modern Medicare system," the president said shortly after walking off Marine One at the White House.

In the Capitol, support for the measure appeared to be building in the Senate. John Cornyn, R-Texas, who voted against a bill that cleared the Senate in June, said he would support the revised version. The previous measure, he said, lacked "the incentive for private plans to develop their coverage."

Senate Democratic Leader Tom Daschle said he would not support a filibuster if opponents launched one, and some rank-and-file members of his party announced their backing for the bill.

Sen. Kent Conrad was one, citing the presence of $25 billion in funding to help rural hospitals and health care providers as one reason. In addition, the North Dakota Democrat said he had received assurances of help to change a situation under which Medicare pays hospitals in Bismarck less money than facilities in Fargo, not quite 200 miles away.

Republicans staged a campaign-style event in the Capitol to stress the benefits of the legislation, and gave a prominent spot to William D. Novelli, CEO of the AARP. The organization's decision to endorse the bill marked a pivotal moment in the GOP effort to forge a compromise. The AARP's heavy advertising campaign gives powerful political support on an issue long-favored by Democrats.

The legislation includes additional funding for doctors and hospitals and other health care providers. Their lobbyists, too, helped build support for the measure, part of an extraordinary effort orchestrated by GOP leaders to push the legislation through the House.

The bill was the product of months of closed-door negotiations with key House and Senate Republicans and two Democrats, Sens. Max Baucus of Montana and John Breaux of Louisiana.

House Democrats said they were locked out of the critical negotiating sessions and were irritated by the Republicans' decision to begin debate on the measure little more than 12 hours after the text of the bill was formally filed. "What are they afraid of," said Rep. Jim Cooper of Tennessee, one of many Democrats who asked for Republicans to allow three days for the bill to be reviewed.

While most of the debate focused on the larger issues of drug coverage and competition, the bill's reach was striking.

Chiropractor services would qualify for Medicare reimbursement as part of an experimental program championed by Sen. Charles Grassley. The Iowa Republican chairs the Senate Finance Committee and played a key role in drafting the bill.