Senators Reject Bid to Change Drug Bill

WASHINGTON -- The Senate on Wednesday thwarted the first challenge to a major overhaul of Medicare, rejecting a Democratic proposal that would have undercut the bill’s core effort to give the private sector a bigger role in the health-care program.

The bill would give private insurers primary responsibility for providing a long-sought prescription drug benefit for seniors. But Democrats proposed an amendment to allow the elderly to receive the drug benefit directly from Medicare as well.

The 58-37 vote against the amendment was a decisive defeat for a principle that has been the cornerstone of the Democratic position on Medicare: that any new drug benefit should be provided by the government, not left to marketplace vagaries.

Six Democrats joined the Senate’s 51 Republicans and its one independent in supporting the bill’s new, more market-oriented approach as a way to spur competition and control costs.

The vote came as President Bush stepped up pressure on Congress to act quickly on Medicare, which has emerged as his top domestic priority now that Congress has enacted a tax cut and spending package of $350 billion to stimulate the economy.

Bush met with a bipartisan group of senators and urged them to act quickly on the bill before them -- even though it does not include his initial proposal to provide the drug benefit only to people who agree to switch from the Medicare program into private-sector alternatives. “We’re committed to reforming the Medicare system so America’s seniors get the health care they need,” Bush told reporters at the start of the session.

Afterward, Sen. Rick Santorum (R-Pa.) said Republicans wanted to strengthen incentives for seniors to switch from Medicare into private health-care networks, such as preferred provider organizations.

The House and Senate are pushing to approve versions of the bill before the end of next week, when Congress begins a weeklong recess. The House measure would provide more incentives to encourage use of private plans by seniors.

One apparent casualty of the focus on Medicare legislation is Bush’s earlier demand for quick action on a bill to extend tax benefits to low-income families. The House and Senate have disagreed on that legislation and now are unlikely to resolve their differences before mid-July.

The Senate Medicare bill has drawn criticism from the right and the left. Conservatives say it does not go far enough in reforming the program to control costs and boost efficiency; liberals say the drug benefits are too limited.

Under the Senate proposal, beginning in 2006, the government would pay half of beneficiaries’ drug costs up to $4,500 a year, and 90% once out-of-pocket expenses exceed $5,800. Beneficiaries would pay a premium that would average $35 a month and have a deductible of $275 a year. Beneficiaries could get drug coverage by joining a PPO or other managed-care plan participating in Medicare. Alternatively, they could remain in Medicare’s traditional fee-for-service program and obtain drug coverage from a stand-alone policy from a private insurer. If at least two such drug policies are not available in a given region, the government would provide the benefit.

The Senate bill would provide $400 billion over 10 years to provide a prescription drug benefit through Medicare.

Under Wednesday’s Democratic amendment, the government benefit would be a choice for all Medicare participants, not just a fallback option. Proponents said that seniors should have the option to receive all their health care -- including prescription drugs -- through the Medicare program they know and trust.

But GOP opponents said drug insurance offered by the government, with its purchasing power and other competitive advantages, would discourage private insurance companies from entering the market.

In the final roll call, the Democrats who voted against the amendment were Max Baucus of Montana, John B. Breaux of Louisiana, Thomas Carper of Delaware, Mary Landrieu of Louisiana, Zell Miller of Georgia and Ben Nelson of Nebraska.

Absent from the vote were three of the Democratic senators running for president: John Edwards of North Carolina, John F. Kerry of Massachusetts and Joseph I. Lieberman of Connecticut. The fourth senator seeking the Democratic nomination, Bob Graham of Florida, voted for the amendment.