Republicans Line Up Support for Medicare Bill

The House was preparing to vote early Saturday on a $400-billion Medicare bill that would dramatically increase the role of private health plans in the 38-year-old program for the elderly and disabled while creating a prescription drug benefit.

Republican leaders, seeking additional time to line up support for the bill, did not press for a vote on the bill before midnight.

Late in the evening, Republicans convened a final meeting designed to convince members opposed to the legislation to change their minds.

“We’re still counting. We’re still growing the vote,” said Rep. W.J. “Billy” Tauzin (R-La.) as lawmakers gathered for serious talk and chicken tenders in a large room in the Capitol basement.

The hard sell appeared to be producing results. Rep. Randy “Duke” Cunningham (R-San Diego) said his vote was secured by further increases in Medicare payments to oncologists -- to counter cuts in fees for doctor-administered cancer drugs -- and the creation of a three-member panel, on which he would serve, to ensure that the new payment system was not unduly harming doctors.

That approach also appeared to secure the votes of two other Republicans.

While House Republicans strategized, Senate leaders tentatively planned to open their debate of the bill this morning. Senators are expected to vote on the bill Monday.

If passed by both chambers, the bill would significantly change the U.S. health-care system, not only for the 40 million current Medicare beneficiaries but for the tens of millions of baby boomers who will retire in the coming years.

Of the nine Democratic presidential candidates, seven have expressed opposition to the Medicare legislation. Sen. Joe Lieberman (D-Conn.) is “troubled about several provisions” of the measure but is “reserving judgment,” a spokesman said. The Rev. Al Sharpton could not be reached for comment.

Republican leaders in the House and Senate had hoped to put the massive bill on a fast track to approval. The legislation gained significant momentum Monday when the seniors group AARP threw its weight behind it.

But eleventh-hour negotiations and cost estimates slowed down the process, and Republicans did not file the final bill in the House until the wee hours Friday morning.

Despite an earlier pledge from Speaker J. Dennis Hastert (R-Ill.) that House members would have three full days to consider the final bill, Republican leaders planned a Friday vote.

Throughout the day, however, many lawmakers complained that they had not had enough time to carefully examine the extraordinarily complex legislation.

As it turned out, Republican leaders needed every minute of the day to line up votes. They used all kinds of carrots and sticks -- including many provisions tucked into a still-fluid, year-end spending bill -- to convince their ranks to vote for the Medicare bill.

The White House also weighed in.

Rep. Mike Pence of Indiana, one of 19 Republicans who voted against the House Medicare bill in June and remained opposed to the final bill, said conservative holdouts were getting “a lot of phone calls from Buckingham Palace,” where Karl Rove, the president’s chief political strategist, had accompanied President Bush on a state visit to the Queen Elizabeth II.

The House membership consists of 229 Republicans, 205 Democrats and one independent who often votes with the Democrats.

Rep. Jeff Flake (R-Ariz.) said he would vote against the final bill despite its inclusion of tax-sheltered health savings accounts worth almost $7 billion over 10 years.

Rep. Paul Ryan (R-Wis.), who said he had talked to White House Chief of Staff Andrew H. Card Jr., said he decided to support the bill after canvassing the top executives of every preferred-provider organization in the country. Ryan said the executives told him they would participate in Medicare, which convinced him that the bill’s provision requiring traditional Medicare to compete with private health plans was workable.

Upon returning from England on Friday evening, Bush made another pitch for the Medicare legislation.

“It is an important time for members of the U.S. Congress to honor our obligations to our seniors by providing a modern Medicare system, a system that includes prescription drugs and choices for our seniors,” Bush said on the White House lawn. “I urge the House and the Senate to pass this good piece of legislation.”

House Democrats also were working to keep their members lined up against the bill. While just nine Democrats had voted for the House bill in June, midday counts put the tally of likely Democratic votes for the final bill at 10 to 15.

Rep. Jane Harman (D-Venice), who voted against the original House bill in June, had not decided whether to oppose the final legislation.

Provisions of the bill include giving seniors access to a Medicare-endorsed discount drug card as soon as next spring. The full Medicare prescription drug benefit would not take effect until 2006.

For most seniors, monthly premiums would average $35 in the first year of the program. After seniors paid a deductible of $250, Medicare would pay 75% of their drug costs up to $2,250.

Seniors would be required to pay $3,600 in out-of-pocket drug costs before catastrophic coverage kicked in. After that, the government would cover 95% of their drug costs.

Seniors with incomes under the federal poverty line -- $8,980 for an individual and $12,120 for a couple -- would have no deductibles, premiums or gaps in coverage. They would have to make minimal co-payments for their prescriptions.

The bill also includes $14 billion in subsidies and incentives to private health plans and $25 billion for doctors and hospitals in rural areas.

Times staff writers Nick Anderson and Janet Hook contributed to this report.