Bush Presses Congress to Move on Medicare Reform

President Bush stepped up the pressure on Congress Wednesday to approve far-reaching Medicare legislation, calling on the House and Senate to pass their separate versions by the Fourth of July.

Both bills would include prescription-drug coverage under Medicare for the first time. But unlike Bush’s original proposal, which would have covered drug costs only for seniors who joined HMOs and other private health networks, the House and Senate bills would guarantee an equal drug benefit to seniors who remained in traditional fee-for-service medicine.

In the Senate, the bill drafted by the bipartisan leadership of the Finance Committee continued to attract support. The full committee is expected to meet today to approve the version that could be voted on the Senate floor as early as next week.

Partisan divisions remained sharper in the House, where Republican leaders have yet to circulate a draft bill. Leading Democrats said they suspected the Republicans would try to find a formula for favoring managed care over fee-for-service Medicare.

Both chambers are working toward a Medicare expansion budget of $400 billion over 10 years. That is the amount Bush requested in his budget proposal for next year -- and the amount Congress set aside in its annual budget framework.

Bush, addressing the Illinois State Medical Society, said adding a prescription-drug benefit would merely be bringing Medicare up to date. Drugs are a far higher share of medical costs today, he said, than they were when Congress enacted Medicare in 1965.

“Time and time again, Medicare’s failure to pay for drugs means our seniors risk serious illnesses, disease and injuries,” the president said. “The need for Medicare reform is absolutely clear to me.”

He cited several examples to emphasize his conviction that new medications increasingly offer less expensive and more effective treatments for a variety of conditions, including ulcers and strokes, than surgery and other techniques.

Bush is scheduled to speak again on prescription-drug coverage today in a visit to a senior center in New Britain, Conn.

Bush’s campaign to provide seniors with prescription-drug coverage also highlights anew his pragmatic streak.

Just as he did in 2001, when he gave up on school vouchers to win broad Democratic support for a major education reform bill, Bush quickly abandoned his intention to offer a two-tiered prescription-drug coverage plan as a way to induce seniors to enroll in less expensive, private health plans.

That strategy has worked well in the Senate, where Senate Finance Committee Chairman Charles E. Grassley (R-Iowa) and Sen. Max Baucus of Montana, the committee’s ranking Democrat, co-sponsored the draft bill that may be voted on by the committee today.

Their bill, in turn, has won the support of Sen. Edward M. Kennedy (D-Mass.) -- who also was a key Bush collaborator in the enactment of the No Child Left Behind Act.

And Senate Minority Leader Tom Daschle (D-S.D.) said Wednesday that he expected the Senate would pass a Medicare drug benefit -- and that he might vote for it. Sen. Debbie Stabenow (D-Mich.), who is not a Finance Committee member, said she would offer the full Senate an alternative to the committee’s bill.

Sen. Barbara Boxer (D-Calif.) suggested she would vote for the Finance Committee bill if it allowed seniors to remain in fee-for-service medicine. “This bill is an experiment,” Boxer said, “and I don’t mind experiments as long as Medicare is still there.”

House Democrats offered more resistance. The Ways and Means and the Energy and Commerce committees share jurisdiction over Medicare in the House, and they have yet to circulate a draft bill.

Rep. John D. Dingell of Michigan, the ranking Democrat on Energy and Commerce, warned that any bill that recognized private health-care networks would do “likely damage to traditional fee-for-service Medicare that has served the country so well.”

And Rep. Charles B. Rangel of New York, the top Democrat on Ways and Means, said he feared the Medicare overhaul would leave seniors “to the wolves of the free market.”

Dingell and Rangel appeared at a news conference with House Minority Leader Nancy Pelosi (D-San Francisco), who criticized the bills moving through Congress for still leaving seniors with “huge out-of-pocket costs” for their drugs.

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Chen reported from Chicago and Gest from Washington.