Medicare drug program faces two key hurdles

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As the House and Senate begin negotiations this month to create a Medicare prescription-drug benefit, two key hurdles will be how much wealthy seniors should benefit and whether the program should compete with private health care plans.

"This is going to be a very tough negotiation," said John Feehery, spokesman for House Speaker J. Dennis Hastert, Illinois Republican. "Both sides will be making decisions on what they can pass and what they can't pass."

Key to the passage is a senator who will not even be part of the official House-Senate conference -- Edward M. Kennedy, Massachusetts Democrat.

"He is a key player who is going to have to be dealt with," said a House Republican aide. "He's going to get some of what he wants."

Mr. Kennedy threatened to filibuster the Senate bill just hours before its passage, when a bipartisan group of senators tried to offer an income-related or "means-testing" provision. The provision -- favored by the majority of the Senate -- would have required wealthier seniors to pay a higher share of doctor costs. Mr. Kennedy opposed it.

"All seniors pay into it, all seniors should benefit from it," he said of Medicare. "I will continue to strongly oppose the inclusion of a means-testing provision in any Medicare prescription-drug bill."

But conservatives in both the House and Senate will push the conference to require means testing as a way of reducing government costs. They would like to target the new drug benefit only to those who need it, instead of promising a new government entitlement to all.

"Why the Senate liberals think we need to have taxpayers pay for Ross Perot's prescription drugs is beyond me," said Rep. Patrick J. Toomey, Pennsylvania Republican.

"If Senator Kennedy really wants to filibuster over entitlements for rich people, let's have that fight," said Rep. Mike Pence, Indiana Republican. "I really believe seniors are prepared to support a drug benefit for seniors who need it most."