GOP Conferees Hopeful on Final Medicare Bill

On the day congressional leaders had set as a deadline for agreement on a Medicare prescription drug bill, House and Senate conferees said Friday they have resolved few of the major differences between them.

Yet the Republican members of the conference, who are joined in negotiating sessions by just two Democrats, said they are making progress and remain optimistic that they will produce a compromise bill that reforms Medicare and offers beneficiaries limited coverage for prescription drugs.

More than three months after the House and Senate passed different bills, Rep. Michael Bilirakis (R-Fla.) described the current stage of negotiations as members “letting their hair down.” The good news, he said, is “we haven’t had any yelling lately.”

Senate Majority Leader Bill Frist (R-Tenn.) declined to set a new timetable for action. But with lawmakers hoping to adjourn in a month or so, the House and Senate could vote on a final Medicare bill in the first or second week of November.

Before then, however, the conferees must work out several key components fundamental to the bill.

They include coverage for the poorest seniors and disabled persons; making wealthier seniors pay more for doctors’ visits and other outpatient services, as well as medications; subsidies to encourage corporations to maintain health coverage for their retirees; competition between Medicare and private health plans; and, finally, the structure and amount of prescription drug coverage.

In recent days, some conferees and their aides have “leaked” news of tentative agreements on various issues, including a plan to link Medicare benefits to income for the first time in the program’s 38-year history.

Until now, all seniors, regardless of income, have paid the same premiums and had access to hospital and outpatient services for the same price.

Within hours, however, other lawmakers and aides denied that agreements had been reached on “means-testing” or other matters, such as co-payments for home health care.

“Everything at this point is fluid,” said a Senate Republican aide who spoke on condition of anonymity. “You have to really make all these decisions at the same time.”

The complexity of the $400-billion, 10-year bill -- its provisions range from the reimbursement rate for chemotherapy drugs to how to provide benefits to seniors living in rural areas -- is one of the greatest challenges facing lawmakers. In addition, many of the bill’s provisions are interrelated.

“It’s a matrix that has to all work together,” said Rep. W. J. “Billy” Tauzin (R-La.).

Sen. Charles E. Grassley (R-Iowa) said conferees were close to producing an outline that their staff members could use to draft the specifics of a compromise bill.

But as conferees tinker with various provisions of the bill, cost estimates change. And since lawmakers are committed to spending no more than $400 billion, agreements that increase costs in one element of the bill will require cutbacks in other areas.

The Congressional Budget Office is working to determine the cost of tentative agreements, and the various price tags could send conferees back to the drawing board, congressional aides said.

Meanwhile, conferees are “trying to get irreconcilable provisions resolved or dropped or handled” in such a way that a compromise bill could pass both chambers, said Sen. Max Baucus (D-Mont.).

Lawmakers acknowledged some time ago that they would not meet today’s deadline set by Frist and House Speaker J. Dennis Hastert (R-Ill.), but they indicated this week that they would likely report significant progress by then.