Deal Near on Prescription Drug Coverage for Seniors

Republican leaders on Wednesday lurched toward an agreement to add prescription drug coverage to Medicare, but prospects for final enactment of legislation appeared more uncertain than ever.

House and Senate Republican leaders said they had brokered a tentative deal Tuesday night with two Democratic negotiators.

At the same time, the formal structure for producing a compromise bill dissolved in disarray, and key Democrats said they would work to defeat any bill that, like Tuesday’s proposed deal, would require millions of seniors to join private managed-care health plans.

As described to lawmakers from both parties, the working Medicare compromise contained elements for liberals and conservatives to oppose. It included all the Medicare reform elements to which Democrats had objected, but in more limited or moderate forms than many Republicans wanted.

The House Republican proposal to require traditional Medicare to compete with private health care plans, for example, would be implemented on a temporary basis in four large metropolitan areas and one geographic region instead of the entire country.

The tentative agreement also would include Medicare spending controls, tax-sheltered accounts for medical expenses and smaller Medicare subsidies for wealthier beneficiaries.

Underscoring the fluidity of the process, lawmakers and aides from both parties said none of the apparent deals had been committed to writing.

“There are several proposals on the table ... and over the course of the day, I hope to get to an agreement,” said Senate Majority Leader Bill Frist (R-Tenn.).

Senate Minority Leader Tom Daschle (D-S.D.) said through a spokeswoman that Democrats would “discuss this again when we have some paper to look at.”

In the day’s most dramatic development, Rep. Bill Thomas, the Republican chairman of the House-Senate committee that had been working for four months to produce a compromise bill, abruptly left the Capitol. Several GOP aides said he was headed home to Bakersfield, unhappy that congressional leaders had gone around him to cobble together a tentative deal.

“I’m not going to talk about anything,” Thomas told reporters as he walked out of the Capitol. “We’re available.”

By Wednesday night, Thomas had returned to his office. But the conference committee, which has been meeting almost daily for weeks, will not convene again until Monday evening, said Christin Tinsworth, Thomas’ spokeswoman.

Thomas “has been working tirelessly to deliver a prescription drug benefit for seniors that strengthens and improves Medicare for future generations,” Tinsworth said. “He is committed to that goal.”

On Tuesday night, after Thomas’ committee broke for the evening, House Speaker J. Dennis Hastert (R-Ill.) and Democratic Sens. Max Baucus of Montana and John B. Breaux of Louisiana gathered in Frist’s office. House Majority Leader Tom DeLay (R-Texas) joined them by phone.

By 10 p.m., they had agreed to a tentative compromise and had begun informing their colleagues. When word reached Thomas, he replied that it wasn’t his deal, aides said.

Early Wednesday afternoon, as Baucus and Breaux were describing the deal to their Democratic colleagues over lunch, Thomas and DeLay headed to Hastert’s office.

Republican aides said party leaders would continue to try to work with Thomas. “Even though there’s this proposal, it’s not an agreement because Thomas hasn’t signed off on it,” said a House Republican aide.

Both Hastert and Frist “are reaching out to him,” said a Senate Republican aide while Thomas was still believed to be on his way to California. “They’re still hopeful about reaching an agreement.”

In the meantime, aides said, committee staff members would continue to draft the legislative language of the tentative compromise and would send portions of the bill to the Congressional Budget Office for cost estimates.

The House and Senate agreed earlier this year to set aside $400 billion over 10 years for a Medicare prescription drug benefit. If the CBO estimates that the compromise proposal would cost more, negotiators will have to change the bill to bring its cost down.

The brokers of the tentative deal spent much of Wednesday trying to sell it to colleagues.

Frist said he had put together a presentation so he could “educate” Republicans about the proposal and tell them “how we got where we got.”

In their luncheon meeting with Democrats, Baucus and Breaux did not even have anything written down, senators said. Sen. Dianne Feinstein (D-Calif.) took notes but said later that she wasn’t sure she understood all the details.

What Sen. Edward M. Kennedy (D-Mass.) heard he didn’t like. “We cannot accept a proposal that’s going to threaten the whole Medicare system,” he said of the competition provision.

“I still haven’t given up hope” that a final deal would be acceptable, he added. “But it’s fading rapidly.”

Sen. Hillary Rodham Clinton (D-N.Y.) criticized the competition proposal and said she was also concerned that the agreement would be bad for the “sickest and poorest” seniors.

Because the House was not in session this week, it was unclear whether a final bill along the lines of the tentative agreement would appeal to House conservatives. But DeLay’s support for the deal could persuade some of them to sign on.

Details on some of the bill’s other provisions, including a proposal to allow the importation of U.S.-made drugs from other countries, remained unclear. Several lawmakers said a final bill might include a limited pilot project for the importation of drugs from Canada only.

Negotiators were also working on a proposal that would make it easier for generic drugs to get to market.

“It’ll get done,” said Sen. Orrin G. Hatch (R-Utah).