Senate Debates Medicare After House OKs Bill

In a suspenseful and controversial predawn vote, a sharply divided House on Saturday approved and sent to the Senate the most sweeping revision of Medicare since its creation in 1965, as lawmakers from both parties said the nearly $400-billion bill represented only the start of a long-term political battle over the shape of the health-care program.

“This is just the beginning of trying to reform Medicare,” said House Speaker J. Dennis Hastert (R-Ill.), referring to the legislation that not only would provide a long-sought prescription-drug benefit but also would promote competition by giving private insurance companies billions of dollars to entice seniors and the disabled into managed-care plans.

The Senate opened debate, expected to last three days, within hours of the bill’s 220-215 passage in the House.

If it is passed by the Senate, as many observers believe is likely, and signed into law, the legislation would do more to change how the elderly and disabled receive and pay for their health care than any development since Medicare was created 38 years ago.

And that’s exactly what has Sen. Edward M. Kennedy (D-Mass.) worried.

Outraged by the action in the House, where Republican leaders held the Medicare vote open for almost three hours -- instead of the usual 15 minutes -- until pressure from President Bush and other lawmakers convinced two Republicans to switch their votes, Kennedy announced that he would seek to prevent a vote in the Senate.

“What happened in the House of Representatives in the dead of night was Florida 2000 all over again,” Kennedy told reporters in his Capitol office. “It was a rigged vote.”

Although several Democrats are expected to join a Kennedy filibuster -- presidential contender John F. Kerry of Massachusetts said he would leave the campaign trail in New Hampshire to participate -- Congress’ longtime leader on health-care issues acknowledged that he would not have the 41 votes needed to prevent a Senate vote on the bill.

But Kennedy said he hoped that a longer debate would highlight what he sees as the legislation’s shortcomings and open a broader discussion on the future of the government health-care program that covers 40 million seniors and disabled people.

Kennedy also predicted that Medicare reform would be a hot-button political issue for years.

Bush has been talking since his 2000 White House campaign about his support for prescription drug coverage along with greater involvement by the private sector in Medicare. Several Democratic presidential contenders have criticized the president and other Republicans, saying they have given too much to insurance companies and drug manufacturers in the legislation and too little to the nation’s seniors.

“This is not the end of this battle, no matter what happens on Monday or Tuesday or Wednesday. This is just the beginning,” Kennedy said. “Anybody who thinks it’s all over ... is absolutely mistaken.”

Within hours of Kennedy’s announcement, Senate Majority Leader Bill Frist (R-Tenn.) filed a motion setting up a vote to force an end to debate Monday. But he said he regretted that the Senate’s consideration of the bill had come to that.

“Those who would support a cruel filibuster of this bill would hold our parents and grandparents -- 40 million American seniors -- hostage to Washington’s politics,” Frist said. “Our seniors deserve better.”

In his radio address Saturday morning, Bush called on the Senate to approve the legislation, which he described as “the most significant opportunity for any Congress to improve health coverage for our seniors.”

Republican lawmakers and the few Democratic supporters of the Medicare legislation have tried for months to characterize their effort as bipartisan. But Saturday’s events, starting with the House Republican leaders’ tutorial in parliamentary maneuvering and sheer political power and followed by Kennedy’s response and Frist’s counter, underscored the deep divisions between Republican and Democratic lawmakers.

When the House began debating the Medicare bill late Friday, lawmakers from both parties expected the vote to be close. But no one anticipated the historic drama -- the vote was held open longer than any in memory -- that gripped the 435-member chamber for the three hours when Democrats appeared to have defeated the legislation.

Bush, just back from four days in Britain, was awakened so he could call dissident Republicans, but in the end it was the suggestion by GOP leaders that Democrats would bring a more moderate Senate version to the House that convinced two Republicans who opposed the bill to change their minds.

“There was a buzz going around on the floor that if we lost this package, we weren’t going to like what we ended up with,” said Rep. C.L. “Butch” Otter (R-Idaho), one of the two whose switch led to passage.

“I did not want to vote for this bill,” he said. “I had already told the president I couldn’t help him.”

Democrats accused Republicans of stealing the vote, which for 2 hours and 50 minutes -- from 3 a.m. to 5:50 a.m. -- stood frozen at 216 votes for the bill, 218 votes against and one lawmaker not voting.

After Otter and Rep. Trent Franks (R-Ariz.) switched their votes to give the Republicans a 218-216 victory, other lawmakers changed their votes as well, bringing the final tally minutes later to 220-215.

In the California delegation, all Republicans voted for the bill and all Democrats -- with the exception of Rep. Calvin Dooley (D-Hanford), who voted yes -- were against it.

“For three hours tonight, the seniors of America won the vote on Medicare prescription drug coverage. But then this vote was stolen from us by the Republicans,” said House Minority Leader Nancy Pelosi (D-San Francisco). “We won it fair and square, so they stole it by hook or crook.”

When the Senate opened its debate, most Democrats denounced the legislation as a threat to the continued existence of traditional Medicare, but the bill’s supporters underscored its momentous significance.

“Today we stand at the precipice of opportunity ... to pass legislation that will forever change the face of Medicare,” said Sen. Olympia Snowe (R-Maine), a moderate who swallowed reservations to throw her support behind the bill.

Others saw the historic significance of the day in another light.

“We may be signing off on the assisted suicide of Medicare as we know it,” said Sen. Robert C. Byrd (D-W.Va.).

Sen. Richard Durbin (D-Ill.) urged elderly voters to call their senators to protest the bill, and urged members of AARP, the nation’s largest seniors’ organization, to protest the group’s endorsement of the bill. He displayed a huge poster showing AARP’s phone number on the Senate floor.

At the center of the 681-page Medicare bill is an optional prescription drug benefit that would begin in 2006. Those who chose to join would pay monthly premiums of about $35.

For the first $2,250 in drug costs, Medicare would pay 75% after a $250 deductible. Then there would be a gap in coverage, with patients being solely responsible for the next $2,850 in drug costs. Once seniors had paid $3,600 out of their own pockets for drugs, Medicare would cover 95% of the cost of subsequent prescriptions.

The premiums and deductibles would increase with inflation; by 2013 monthly premiums would average $58, and annual deductibles would be about $445, according to the Congressional Budget Office.

Seniors with incomes just below or above 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 -- $1 for generic drugs and $3 for brand-name medication -- for their prescriptions.

For the more than 4 million retirees who have supplemental health coverage through their unions or former employers, the drug benefits they receive are more generous than the Medicare benefit. To encourage employers to maintain that coverage, the bill includes more than $71 billion in subsidies.

Other groups that stand to benefit from the legislation include private insurance companies and health plans, which would have access to $14 billion in subsidies and risk-sharing payments from the government; rural hospitals and doctors, which would receive about $25 billion in additional payments; and hospitals that treat large numbers of illegal immigrants in their emergency rooms. They would receive an additional $1 billion over 10 years.

In addition, the bill would allow Americans of all ages with high-deductible health insurance policies to bank thousands of dollars each year in tax-sheltered health savings accounts. Health-related withdrawals would also be tax-free.

One of the bill’s most controversial provisions calls for traditional Medicare to begin competing against private managed-care plans in six areas of the country in 2010.

Those seniors who remained in fee-for-service Medicare would face premium increases beyond inflation if the government’s share of their health costs was higher than that for seniors in private plans.

Drug companies would also benefit from the bill, which does very little to control drug prices.

Republicans sponsors beat back the attempt of some lawmakers -- prodded by millions of seniors -- to allow the legal importation of U.S.-made drugs from Canada. Provisions to make it easier for generic drugs to get to market were included in the bill in a somewhat weakened form.

Times staff writer Janet Hook contributed to this report.

*

(BEGIN TEXT OF INFOBOX)

Legislation at a glance

Key measures pending before Congress:

Energy: Senate opponents of the energy bill blocked consideration of the measure Friday, largely over its cost and a provision that would limit the liability of manufacturers of a fuel additive blamed for contaminating water supplies across the country. The House passed the legislation last week. Another vote could occur in the Senate this week.

Medicare: The Senate is debating the nearly $400-billion Medicare bill -- the largest expansion of the government’s health-care program for the elderly and disabled since it was created in 1968. A vote is expected Monday. The House passed the legislation early Saturday, 220 to 215.

Spending: The “omnibus” spending bill -- which includes $390 billion for 11 government departments, several independent agencies and the District of Columbia government -- will be considered by the House early next month after members returns from Thanksgiving recess. The Senate hopes to complete its work on the bill this week. The bill provides funding for the 2004 fiscal year, which began Oct. 1. On Saturday, President Bush signed a continuing resolution to fund

the government through

January.

Spam: By 392 to 5, the House passed legislation early Saturday authorizing the Federal Trade Commission to set up a “do not e-mail” list similar to the FTC’s telephone “do not call” list. The Senate has passed similar legislation and must approve the changes made in the House.

*

The House has recessed for the Thanksgiving holiday and will return Dec. 2. The Senate hopes to complete its work this week and then plans to recess through the end of the year.

Source: Times staff and wire reports

Los Angeles Times