Tepid Support Gives Medicare Reform Bill a Shot

WASHINGTON -- Their support ranges mostly from chilly to lukewarm, but enough Senate Democrats and Republicans are coming out in favor of a bipartisan Medicare reform bill to give it what previous years’ proposals lacked -- a fighting chance.

As Senate Finance Committee leaders were putting the final touches Monday on their proposal to include a prescription drug benefit for all Medicare recipients, claims of victory were coming from almost every corner.

“What the president is focused on is getting more choices, better choices, better benefits and prescription drugs to our nation’s seniors,” said White House spokesman Ari Fleischer. “And ... we’re going to work with Congress to get it done.”

James P. Manley, spokesman for Sen. Edward M. Kennedy (D-Mass.), the Senate’s leading liberal on health issues, shot back: “The president’s plan to privatize Medicare is dead. This is a huge win for Democrats and senior citizens.”

Likely to help both parties is some good financial news they received Monday. The Congressional Budget Office said the Finance Committee leaders’ proposal would cost less than the $400 billion over 10 years that Congress has set aside, according to congressional aides.

As a result, the committee may be able to improve the drug benefit by reducing the premiums and deductibles that seniors would have to pay or by increasing the government’s share of prescription drug costs.

Whatever the specifics of the official bill to be released this morning, it will still leave almost every senator dissatisfied. Yet the political stars may nonetheless be aligned, as Sen. Max Baucus (D-Mont.) said last week, to add a prescription drug benefit to Medicare this year.

President Bush has put Medicare “modernization” near the top of his domestic policy agenda, after tax cuts. Republicans control both houses of Congress, and the 2004 election season is underway as American seniors, who vote in disproportionate numbers, intensify their demand for drug coverage.

In that landscape, some Democrats believe their only choice is to vote for a plan they dislike -- and then work to make it better.

“If the Finance Committee can pass a bill with bipartisan support, the Democratic leadership would be hard-pressed to say no,” said Charles N. Kahn III, president of the Federation of American Hospitals.

Sen. John D. “Jay” Rockefeller IV (D-W.Va.), one of the strongest opponents of the administration’s effort to move Medicare beneficiaries into private health plans, said last week he was weighing the costs of trying to stop it on the Senate floor.

Although “the press would say [he was] being obstructionist,” Rockefeller said he would view such action as “preventing that small amount of good that would come from passing a very, very bad bill.”

Senate Minority Leader Tom Daschle of South Dakota adamantly opposed the administration’s plan to entice seniors into preferred-provider organizations and HMOs by giving them better drug benefits than if they stayed in traditional Medicare. And he also opposed the Finance Committee leadership’s bill, which would leave the sickest seniors with a large gap in drug coverage.

Yet he has stopped short of publicly calling on Democrats to vote against the bill, which was co-authored by Finance Committee Chairman Charles E. Grassley (R-Iowa) and Baucus, the panel’s top-ranking Democrat.

“Democrats will continue the fight for a real prescription drug benefit by offering amendments in committee and on the Senate floor to improve this bill,” Daschle said.

Conservative Republicans, including Sens. Rick Santorum of Pennsylvania, Trent Lott of Mississippi and Jon Kyl of Arizona, wanted a Medicare bill that would limit Medicare drug coverage to seniors with low incomes or use a more generous private-plan benefit to weaken traditional Medicare.

By Monday, however, administration officials and other GOP leaders -- themselves less than thrilled -- were telling disaffected Republicans to get on board.

Health and Human Services Secretary Tommy G. Thompson; Medicare administrator Thomas A. Scully; and Sen. George Allen of Virginia, the chief campaign fund-raiser for Senate Republicans, huddled with GOP Finance Committee members Monday afternoon for what one aide called “a pep talk.”

Thompson told the members that Bush “is very enthusiastic” about their progress, said the Republican aide, while Allen said, “This is a good deal. We all need to get behind it.”

Senate Majority Leader Bill Frist (R-Tenn.) restated his commitment to passing a Senate bill before Congress recesses for its Fourth of July break.

Meanwhile, Sen. Olympia J. Snowe of Maine, a moderate Republican and a perennial architect of efforts to add prescription drug coverage to Medicare, could hardly contain her excitement over the prospects for Senate action.

Snowe said in a statement that Congress was “on the cusp” of enacting one of “the most significant changes in domestic social programs since creation of the Medicare system in 1965.”

California Sens. Barbara Boxer and Dianne Feinstein, both Democrats, said through their spokesmen Monday that they were waiting to see a final bill before deciding whether to support it.

Under the Finance Committee proposal unveiled last week, Medicare beneficiaries could buy prescription drug coverage for a premium of about $35 a month. After they paid a $275 annual deductible, a private health plan or the government would pay half their drug costs until the total paid by both the senior and insurance added up to $3,450.

After that, beneficiaries would be responsible for all their drug costs until the total spent reached $5,300. Then the insurer would pay 90% of all seniors’ remaining drug costs for the year.