Lawmakers want to tailor Medicare to meet their states' needs

WASHINGTON -- Democratic Sen. Kent Conrad of North Dakota wants help for two hospitals in Bismarck, facilities reimbursed by Medicare at a lower rate than those in Fargo, yet obliged to compete in hiring doctors and other staff.

Ditto for Sen. Jim Jeffords, I-Vt., who is seeking more Medicare money for Fletcher Allen Medical center in Burlington. And Sen. Charles Grassley, R-Iowa, who wants a limited, temporary program created to extend Medicare coverage to chiropractor services.

After months of struggle, the structure of a sweeping Medicare bill is in place. But not all the detail work, particularly the provisions of interest to one lawmaker or another -- items that can influence votes and thus the prospects for passage.

"They are listening, but that doesn't necessarily mean they'll agree," Sen. Ben Nelson, D-Neb., said recently of the Republican leadership, working to deliver Medicare legislation to President Bush's desk before Thanksgiving. Nelson's wish list includes help with rehabilitation hospitals in his state and elsewhere.

Overall, the legislation would add a prescription drug benefit and mark the largest single expansion of Medicare since the program's creation in 1965.

For the most part, say aides for both parties in both houses, many rank-and-file lawmakers are just beginning to focus on the legislation, which has been the subject of secretive House-Senate negotiations for months.

Health and Human Services Secretary Tommy Thompson predicted passage, adding, "I think it's going to be tough for a candidate for re-election to say, 'I voted against a Medicare drug provision because there were other parts I didn't like.'"