President Jawbones Wary Republicans Over Medicare

WASHINGTON -- With Congress poised to vote on a landmark bill to overhaul and expand Medicare as early as today, President Bush on Wednesday threw himself into an eleventh-hour round of arm-twisting to convince balky Republicans that they should support his latest domestic priority.

Bush met with two groups of lawmakers, trying to overcome resistance from conservative Republicans who oppose creating an expensive prescription drug benefit under Medicare without doing more to curb the program’s long-term costs.

“We are making great progress on this issue,” Bush told reporters before one meeting. “We have an historic opportunity to seize the moment and get a good bill done.”

The House is expected to approve the bill today, although the vote could be delayed until Friday as Republican leaders try to assuage conservative critics.

In the Senate, the last significant obstacle to passage of the legislation seemed to have been cleared Wednesday when key senators crafted a compromise on how to spend $12 billion left unallocated in the bill. Most Democrats had wanted to use this money to expand benefits under the traditional government-administered Medicare plan, while most Republicans preferred using it to promote private-sector alternatives for serving the elderly.

Approval of the compromise, which split the money 50-50 between those two aims, was expected Wednesday night or today and would clear the way for passage of the bill in the Senate by week’s end.

“This is a breakthrough amendment,” said Sen. Max Baucus of Montana, a chief Democratic sponsor. “We’re now going to have clear sailing to final passage.”

Significant differences between the House and Senate versions remain to be worked out next month, after Congress returns from a weeklong recess. But it would be a big victory for Bush if both chambers passed their versions of the bill before the recess begins Saturday. That would lay the groundwork for final approval this summer of legislation that has been stalemated for years -- and that just a month ago still seemed a longshot.

Both House and Senate bills provide $400 billion for a new prescription drug benefit under Medicare. They also include provisions to expand the role of private health networks -- such as preferred provider organizations -- in government-subsidized health care for the elderly.

Conservatives have argued that more private-sector competition would help control costs and give seniors a greater choice of plans; liberals have been skeptical of private plans, fearing that they would lack the stability of a government-administered benefit.

That debate came into focus in an intense behind-the-scenes scramble involving the leftover $12 billion. Under the compromise, $6 billion would be used to expand benefits under the traditional Medicare program, adding coverage for preventive care and other services not covered.

The remainder would be used for the pilot project to allow private plans to compete for Medicare business, in certain regions, without being restrained by a federal cap on prices.

Most other amendments introduced were unsuccessful efforts by Democrats to expand benefits. One exception was an amendment by Sen. Dianne Feinstein (D-Calif.) and three Republicans that would, for the first time, have introduced a kind of financial “means test” in Medicare, a program that traditionally has made no distinction among beneficiaries based on income. The Feinstein amendment, which did not come to a vote, would require more affluent seniors -- those with incomes of $75,000 or more -- to pay more in premiums than less affluent beneficiaries. Feinstein argued that such measures, traditionally opposed by Democrats, are needed to control burgeoning costs of Medicare.

In the House, Republican leaders scrambled to put the finishing touches on a companion bill that leaned more than the Senate bill toward shifting the program into the hands of the private sector.

Hoping to broaden support, GOP leaders were expected to add a provision -- similar to one approved last week by the Senate -- to speed the marketing of lower-cost generic drugs.

They also labored through the day to explain the complex bill to baffled Republicans, struggling to increase GOP support because they have assumed that only a handful of Democrats would support the bill. Indeed, House Minority Leader Nancy Pelosi (D-San Francisco) declared, “Democrats will not give the Republicans a victory.”

That is why the complaints of conservative Republicans were so troublesome, and Bush called about 20 of them to the White House to meet with him, Vice President Dick Cheney and Health and Human Services Secretary Tommy G. Thompson.

The group told Bush they did not want to create an open-ended new entitlement without including more aggressive structural reforms to keep the program solvent when the baby-boom generation retires. Rep. Mike Pence of Indiana said Bush bridled at the suggestion that the House bill’s reforms did not go far enough, and argued that there was enough change proposed to curb long-term costs.

“He really believes in it -- that the reforms will turn the ship of Medicare away from the Niagara Falls of red ink,” said Pence, who said he would probably vote against the bill. “I’m not convinced.”