Despite Obstacles, GOP Prescription Drug Bill Passes

The Republican-controlled House early today approved long-awaited legislation to help senior citizens meet the soaring costs of prescription drugs--a pressing concern that has become an important issue in this year’s midterm elections.

The bill was passed, on a 221-208 vote. Despite broad support for the idea of providing new drug subsidies, the GOP measure faced a surprisingly tough fight. It was bitterly opposed by Democrats, who said it did not go far enough to guarantee coverage. Some Republicans, meanwhile, warned that the bill would go too far in establishing a costly government entitlement.

GOP leaders had vowed to pass the bill before Congress adjourned for its weeklong Fourth of July recess. They worked into the night Thursday, twisting arms and cutting deals to win support from recalcitrant Republicans.

Their victory came in the early morning hours today, when 212 Republicans were joined by eight Democrats and one independent in supporting the bill. Only eight Republicans defected and opposed the bill, joining 199 Democrats and one independent.

Attention now shifts to the Democrat-controlled Senate, where leaders plan debate on a more generous version of the drug benefit bill next month.

“We need action, not words, because America’s greatest generation cannot wait any longer for help on their prescription drug bills,” said House Speaker J. Dennis Hastert (R-Ill.).

If it were to become law, the bill would mark the biggest expansion of federal health subsidies for senior citizens since Medicare was created in 1965. The Senate is scheduled to take up its version of the legislation next month. But lawmakers say prospects for enactment are slim because of the vast differences between the parties over how to provide the new drug benefit--and the heavy political pressures against compromise in this election year.

Just as they did when Medicare was established, Democrats favor providing guaranteed benefits through the federal government, while Republicans want to offer subsidies through the private sector.

The political stakes are significant: Democrats have made a campaign issue out of their support for a more generous prescription drug benefit under the Medicare program. Republicans worry that unless they pass some version of their own, they will be vulnerable to charges of neglecting the most significant concern of senior citizens, who vote in large numbers and wield disproportionate political clout in off-year elections. “The battle for a drug benefit is an incredibly important subcomponent of Republican success in this cycle,” said GOP pollster Bill McInturff.

The issue is already woven deeply into the fabric of House and Senate campaigns around the country. Some Democratic candidates in Northern states have highlighted the issue by staging bus trips to Canada, where prescription medication is less expensive. The issue is dominating the Senate race in Maine, where GOP Sen. Susan Collins is being challenged by Chellie Pingree, a state legislator who sponsored a state prescription drug program.

“Make no mistake, there is one thing standing between senior citizens and affordable prescription drugs: Republican control of the House of Representatives,” said Rep. Martin Frost (D-Texas).

Republicans have worked hard to neutralize the issue by blurring differences between the parties. For the Memorial Day recess, the House leadership sent lawmakers home armed with briefing papers, PowerPoint presentations and instructions to hold town meetings on the GOP plan. Drug companies, which support the GOP approach, have financed television ads praising House Republicans who are running for reelection.

The cost of medicine has emerged in recent years as a major issue because prices have gone through the roof.

According to Families USA, an organization favoring a drug benefit, the average annual cost of prescriptions for seniors more than doubled between 1992 and 2000, from $558 to $1,211.

Prescription drugs are not covered by Medicare, the federal health insurance program for senior citizens and the disabled, in part because they were not as big a part of health care in 1965 as they are now--especially in the treatment of chronic diseases.

The GOP bill would cost $350 billion over 10 years, including about $310 billion for drug coverage. The rest of the money would go to raise payments to hospitals, health maintenance organizations, doctors and others who care for Medicare patients.

Under the GOP plan, the new drug benefit would be provided not through Medicare, but through subsidies to private insurers that offer benefits. Beneficiaries would pay premiums of $33 a month and have a deductible of $250 a year--although those fees would be paid by the government for the poor.

The program would cover 80% of drug expenses from $250 to $1,000 and 50% up to $2,000. Then there would be a gap in coverage that has been heavily criticized by Democrats: Beneficiaries would have to pay all of their expenses until their total costs hit $3,700.

After that “stop-loss” level, the government would pick up the whole bill.

Democrats say the Republican plan, by leaving much to the initiative of private insurers, does not do enough to guarantee that affordable benefits would be available.

“Republicans hope that by passing this bill, they can make the voters feel better about them in November,” said House Minority Whip Nancy Pelosi (D-San Francisco). “But the reality is, this bill does not add a benefit that seniors can count on.”

Democrats support a more expensive alternative, costing more than $800 billion over 10 years. It would have a $25 monthly premium, a $100 deductible and a $2,000 stop-loss level.

Because Democrats were virtually unanimous in their opposition to the GOP bill, Republican leaders had to keep their own members solidly behind the measure.

With Republicans’ margin of control in the House a mere 11 votes, a handful of GOP defections could kill the legislation.

Hastert and his lieutenants have worked for days behind the scenes, trying to assuage factions of Republicans who threatened to revolt.

Among the concerns:

* Some conservatives objected to the bill’s price tag and to the idea of creating an entitlement. Rep. Mac Collins (R-Ga.) called for a less expensive alternative that would target aid to the needy, rather than create a “universal entitlement,” regardless of need.

* Some Republicans argued that the bill should include provisions designed to curb the price of prescription drugs. GOP Reps. Gil Gutknecht of Wisconsin and Jo Ann Emerson of Missouri sought amendments to make it easier for pharmacies and individuals to import cheaper prescription drugs from outside the U.S. and to close a loophole in patent law that can be used to slow less expensive generic drugs from coming to market.

The result was a bidding war among Republicans, with competing demands that were difficult for GOP leaders to reconcile.

It reflected a split in the party between members who wanted to take care of home-state interests and those who recoiled at the already big increase in spending. “It’s hard to pass because everybody wants things in it,” said Rep. Thomas M. Reynolds (R-N.Y.).