GOP Drumming Up Support for Medicare Reform

President Bush and Republican congressional leaders, shoring up support for a landmark $400-billion Medicare bill, scrambled Tuesday to placate GOP conservative critics who are threatening to vote against the measure.

Bush planned to meet as soon as today with restive House Republicans to build support for the measure that would provide a prescription drug benefit under Medicare. Many conservatives say the push for Medicare reform does not go far enough to curb costs in the financially troubled program and give the private sector a bigger role in delivering medical care to seniors.

The House and Senate seem on track to meet Bush’s demand that they pass versions of the bill by week’s end. But even with the House bill -- which would go further than the Senate measure in promoting private-sector involvement -- GOP leaders have had to mount a full-court press to win over many conservatives.

“I don’t know if the bill is in jeopardy, but it would be wrong to assume it will pass easily or safely,” said Rep. Paul Ryan (R-Wis.).

Prospects for approval brightened in the Senate as conservative Republicans neared agreement on a compromise that would provide $6 billion for a pilot project to expand private-sector competition to serve Medicare beneficiaries.

The compromise, being negotiated with Democrats who support the bill, also would provide $6 billion to expand benefits under the traditional government-administered Medicare plan.

If that tentative deal becomes final, it bodes well for the bill to pass the Senate with support from a bipartisan coalition.

The Senate continued work on the bill Tuesday, rejecting a series of Democratic amendments designed to expand coverage under the measure. Two of them -- defeated by votes of 52 to 43 and 55 to 41 -- were designed to give employers more incentive to continue providing drug coverage under retiree health plans.

Another, more modest effort to induce employers to keep their benefits may be approved later this week, said Sen. Max Baucus (D-Mont.).

Lawmakers of both parties fear that if the federal government were to offer a prescription drug benefit, private employers who now offer one to retirees would drop their plans. The Congressional Budget Office recently predicted that more than a third of the nation’s retirees who currently have their drug costs covered by a former employer’s health plan could lose those benefits if the Medicare reform legislation becomes law.

Another amendment, introduced by Sen. Barbara Boxer (D-Calif.), would have eliminated a gap in proposed drug coverage. Under the Senate bill, the government would pay 50% of drug costs up to $4,500 annually, but provide no coverage for costs from $4,500 to $5,800. Boxer proposed eliminating the $1,300 break in coverage, but her amendment lost, 54 to 42.

The only Democratic amendment to pass, offered by Sen. Mark Dayton of Minnesota, would prohibit members of Congress from receiving prescription drug benefits more generous than those provided under a new Medicare program.

“If it is good enough for the seniors of America, it is as good as we should do for ourselves,” said Dayton. The amendment passed, 93 to 3, but is considered unlikely to survive negotiations with the House on a final bill.

GOP proponents of Medicare reform want to expand the role of the private sector because they believe more competition would drive down medical costs and save the government money in the long run. But many conservatives have complained about the Senate bill, saying that while it would allow more private sector health plans to participate in the program, it would subject them to many federal regulations that would impede free competition.

Last week, 27 Senate Republicans wrote to Bush, urging him to support changes to more broadly reform Medicare. Republicans saw an opportunity to advance that goal in the compromise being negotiated on how to spend $12 billion. The challenge was to devise changes that would not undermine support from Democratic sponsors of the bill, including Sen. Edward M. Kennedy of Massachusetts.

Under the emerging compromise, $6 billion would be used to set up the pilot project to allow private health plans to compete for Medicare business in certain regions without being restrained by a federal cap on prices.

Sen. Jon Kyl (R-Ariz.), a leader of conservative critics, said that would give free-market advocates a “toehold” in the program.

The other element of the compromise would allot $6 billion to expand benefits under the fee-for-service Medicare program for services, such as preventive care, that are not now covered.

Although the House bill includes more elements of competition than the Senate’s plan does, conservatives are wary that those reforms will be dropped in the negotiations to produce a final measure.

Rep. John B. Shadegg (R-Ariz.) said in a recent article for the Arizona Republic in Phoenix that he opposed the House and Senate bills because neither targeted benefits to low-income seniors but instead provided a drug benefit for all beneficiaries, including the wealthy.

“Sadly, Congress is putting politics ahead of policy,” Shadegg wrote. “In its rush to pass something -- anything -- it is on the verge of imposing a staggering financial burden on our children and grandchildren, pushing Medicare closer to financial collapse and losing a once-in-a-lifetime opportunity for reform.”

House Speaker J. Dennis Hastert of Illinois and other GOP leaders have been meeting with wavering Republicans, offering assurances that House-Senate negotiations will not water down key reforms.

A senior GOP aide said they welcomed lobbying assistance from Bush.

“It is important for some of these folks to know how important this is to the president,” the aide said.