Competition issue may snag Hill Medicare agreement

House Majority Leader Tom DeLay yesterday drew a line in the sand by saying, hours before the Medicare conference committee opened, that House Republicans will not accept a bill that doesn’t force Medicare to compete directly with private health care plans by 2010.

“We’re trying to design a plan that meets those needs and at the same time hold down costs by introducing competition and introducing choice for seniors — that’s really important to those who voted for the bill that came out of the House, and I know I can’t see a bill coming out of conference with less than that,” Mr. DeLay, Texas Republican, told reporters at his weekly briefing.

On Monday, Mr. DeLay was named one of five Republican House members to the Medicare prescription-drug conference, which met for the first time yesterday.

One of the key sticking points House and Senate negotiators will have to resolve is whether to accept a House provision that would require traditional Medicare to compete against private health plans by 2010. House conservatives demand the provision, saying it will force Medicare to modernize and become more cost-effective. The Senate bill does not include that provision and most Democrats strongly oppose it.

Now House conservatives are looking to the White House to weigh in and back them up by supporting the provision.

“We need those reforms in the conference report, and we need the president’s help to do that,” said Rep. Paul D. Ryan, Wisconsin Republican.

Mr. Ryan and 75 other Republicans sent a letter to the president last week urging that the 2010 competition stipulation be included in the conference report. Mr. Ryan said the letter was meant to urge the White House to take a stand on the issue.

Mr. Ryan said conservatives are “fearful that the White House may end up siding with the Senate bill.”

Rep. Jim DeMint, South Carolina Republican, said he is confident the president will weigh in on the issue “either visibly or under the radar.” Mr. DeMint said that it has been the president’s vision all along to introduce competition with the new drug benefit and to create a setup like federal employees’ health-benefits program.

But Democrats said the competition provisions are a deal-breaker.

“That’s not 2010 competition; that’s 2010 destruction of Medicare,” said Rep. John D. Dingell, Michigan Democrat and a conferee.

No action was taken to meld the two bills yesterday, but the conference hopes to meet again by early next week at the latest.

While House Republicans don’t need most Democrats’ support in their chamber, Senate Republicans have said they want to pass something with bipartisan support in their chamber.

Senate Democrats said that means no competition provisions, and three dozen of them communicated that in a letter to Mr. Bush last week.

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