GOP Bloc May Vote Against Medicare Bill

A small but crucial bloc of House Republicans, whose late-night votes in June kept alive the prospect of a Medicare prescription drug benefit, is threatening to vote against any compromise bill that does not meet its conservative demands.

The group’s conditions, to be presented at a news conference today, comprise the latest in a series of lines in the sand seeking to influence the House-Senate conference committee that is working to hammer out differences between competing bills.

But although previous vote-withholding threats have underlined the differences between Republicans and Democrats and the House and Senate, today’s action by 15 House conservatives highlights deep divisions over Medicare within the Republican Party and adds new uncertainty to the legislation’s already doubtful future.

“The conservative revolt against this is very unified,” said Stephen Moore, president of the Club for Growth, a Washington group that supports the campaigns of Republicans committed to tax cuts and limits on government spending.

To win their votes, the fiscal conservatives say in their letter to House Speaker J. Dennis Hastert (R-Ill.), a final Medicare bill must include some of the most controversial provisions of the original House bill -- free-market competition between Medicare and private health plans and $174 billion in tax-favored health savings accounts for all taxpayers. In addition, they say, there must be a $400-billion lid on the cost of the drug benefit and a prohibition against price controls on prescription drugs.

“There is a growing concern that we can’t do this” legislation, says Rep. Patrick J. Toomey (R-Pa.), ringleader of the breakaway group. “A strong case can be made for going back to the drawing board on this.”

The conservatives’ power play comes as the conference committee, chaired by Rep. Bill Thomas (R-Bakersfield), is just beginning to tackle the most significant issues separating the House and Senate bills. Their demands are sure to highlight those differences.

Beyond these specific differences, the House and Senate bills reflect a deep philosophical divide.

Conservative Republicans -- many of whom voted against the House and Senate bills -- want to use Medicare reform legislation to transform Medicare from an open-ended, government-run entitlement program to a leaner, market-driven health-care system.

They are also concerned about the potential cost of Medicare drug coverage, saying an open-ended benefit could bust the federal budget. More recently, they have begun to talk about some seniors who worry that a Medicare drug benefit would prompt their former employers to drop retiree health coverage.

Rep. Trent Franks (R-Ariz.), a signer of Toomey’s letter, represents the retirement haven of Sun City and says his elderly constituents have given him “a lot of mixed messages” about the Medicare legislation.

“I want to do the right thing, but I don’t think I would do the seniors right in the long run” by voting for a bill that doesn’t control costs and provide private-market competition, he said. “The highway of history is littered with the wreckage of governments that presumed they could do things better than free enterprise.”

Liberal Democrats, meanwhile, view Medicare as the blueprint for government-run social programs and want nothing more than to improve and expand it.

All but 10 House Democrats voted against their chamber’s legislation, which passed by only one vote. In the Senate, a majority of Democrats voted for the Medicare bill, but several of them, including Edward M. Kennedy of Massachusetts, have threatened to vote against a final bill if it includes the House provision requiring Medicare to compete with private health plans or if it fails to include the government as a “fallback” provider of the drug benefit.

The very provisions needed to win the votes of many Senate Democrats would provoke no votes from many House Republicans.

Several members of the House-Senate conference committee are looking to the White House to lead them out of this deepening impasse, but President Bush has simply encouraged the conferees to work together.

“The White House has to intervene to keep this thing moving, but I don’t think they will until they have to,” said John Rother, policy director of the 35-million-member seniors group AARP. “To the degree that this is a dispute within the Republican Party, the only person who could resolve that is the president.”

A senior White House official said Bush “has led from the beginning ... and he’s going to continue to exert leadership” on Medicare reform legislation. “The president has his people meeting with committee members and staff every day,” said the official, who spoke on condition on anonymity. “We have conveyed [to them] the president’s policy.”

The conservatives, meanwhile, are confident their letter will help shape the outcome of Medicare negotiations.

“I think that Republican members of the conference committee agree with [our demands],” Toomey said.

One of those members, House Majority Leader and conference committee member Tom DeLay of Texas, said Tuesday that “it’s more important to get the bill done right than to get it done right now.”

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Times staff writer Janet Hook contributed to this report.