Rural aid gives Medicare bill impetus

House and Senate backers of the Medicare prescription-drug bill are counting on the measure's $25 billion in funding for rural doctors and hospitals to win over lawmakers in both parties.

"I do not see how a senator can vote against this bill and deny rural residents of his or her state ... the tremendous increases in this bill for rural America," Sen. Max Baucus, Montana Democrat and key bill supporter, said yesterday.

"I'm here today to urge my colleagues, Republicans and Democrats who represent states like mine, to understand that this is the best thing rural America has ever seen," said Sen. Charles E. Grassley, the Iowa Republican who helped craft the bill.

Leaders were still modifying the bill's language to secure more votes late yesterday, and the Congressional Budget Office was waiting for the final version so it could provide a total cost estimate, a CBO spokeswoman said.

The bill would dedicate at least $25 billion to boost Medicare payments to rural doctors and hospitals, which often suffer financially compared with their suburban counterparts.

Mr. Baucus and fellow bill supporter Sen. John B. Breaux, Louisiana Democrat, met Tuesday with the conservative, rural House Democrats that compose the Blue Dog coalition. Mr. Breaux said some indicated their support.

Rep. Ralph M. Hall -- a Texas Democrat who voted for the initial bill last time with eight other Blue Dogs and will support the final bill as well -- predicted 10 to 16 House Democrats will vote yes.

"It's the only bill that's coming up, and it has some good provisions for rural areas," he said. "I don't think you can go home and say you voted against the only Medicare prescription-drug bill."

Fellow Blue Dog Rep. Collin C. Peterson, Minnesota Democrat, also predicted more than nine Democratic votes now that the measure has the backing of the AARP, the nation's largest senior citizens group.

The Blue Dogs are being lobbied heavily by both supporters and opponents of the bill. Most of the conservative Democrats are undecided.

Rep. Charles W. Stenholm, Texas Democrat, is still making up his mind, but said that "the rural component is a must for us and it is a very good package."

Meanwhile, House and Senate Democratic leaders continued their campaign to defeat the bill, saying it will undermine Medicare by giving private plans too great a role in delivering health care.

"Democrats will work day and night against this shameful Republican bill," House Minority Leader Nancy Pelosi, California Democrat, told a rally of seniors groups that was opposing the measure.

House Republican leaders said yesterday they'll have the votes to pass it.

"The dynamic is very good," said House Majority Whip Roy Blunt, Missouri Republican. "I believe we'll have it by Friday."

And in the Senate, Democrats still lacked the votes to filibuster the bill.

But House Republican leaders are trying to convince conservatives the measure does indeed contain ample Medicare reform. Nineteen House conservatives voted against the bill last time, and several who supported it are now complaining about the measure, saying key reforms have been weakened.

One opponent, Rep. Jeff Flake, Arizona Republican, said all 19 would vote no again and there are close to another 19 ready to vote no as well.

But a House Republican aide said the leadership would keep most of the conservatives in the end. Even a House Democratic aide who opposes the bill agreed Republican leaders would be able to pass the measure.