Medicare drug bill accord seen as ‘on life-support’

Talks on a Medicare prescription-drug bill may be breaking down, as negotiators struggle to resolve tough sticking points and a key Senate Democrat yesterday declared the bill “on life-support.”

Sen. Edward M. Kennedy said Republican negotiators were catering to House Republicans on key issues as they craft a final bill to provide a Medicare prescription-drug benefit for seniors. He said a Republican-leaning bill will not pass the Senate.

“I believe it’s on life-support,” said Mr. Kennedy, the Massachusetts Democrat whose support is key to getting a final bill through the Senate. “Clearly, it’s in a free fall,” he said.

Late yesterday, however, a House Republican leadership aide said there had been “a lot of movement” on the bill and leaders were hopeful that there would be a compromise by the end of the week.

Negotiators emerged late last night without having resolved the remaining issues, but some disputed Mr. Kennedy’s assessment that the bill is on life-support.

Rep. Michael Bilirakis, Florida Republican, called Mr. Kennedy’s comment inaccurate. And top Senate Republican negotiator Charles E. Grassley of Iowa said no decision had been made on some of the issues Mr. Kennedy was complaining about and that he should reserve judgment until he sees the final product.

The toughest issue to resolve is a provision Republican negotiators were working to include in the final bill, which would require traditional Medicare to compete directly against private health plans starting in 2010. House conservatives have demanded that the provision be included, but Senate Democrats strongly oppose it.

“We have to be more creative and figure out a way around what appears to be an impasse,” Rep. Bill Thomas, the California Republican who is heading the negotiations, said earlier yesterday.

“It’s blink time,” said Sen. Max Baucus, a Montana Democrat who has been attending daily negotiations with Mr. Thomas and other Republicans trying to craft a final Medicare prescription-drug bill. “We’re trying to figure out who is going to blink.”

Mr. Grassley said a compromise was “still doable,” even on the 2010 competition issue. One option would be to enact a more limited version of the provision, instead of applying it nationwide, he said.

Republican negotiators were indeed looking at including a variation of the 2010 provision, but Mr. Kennedy said it wasn’t acceptable. Mr. Baucus said it would be “almost impossible” to get a bill through the Senate if it contains any variation of the 2010 provision.

Mr. Kennedy also complained that the final bill would likely have a cost-containment provision aimed at making sure Medicare costs don’t get too high. And he said Republican negotiators want to spend money creating tax-preferred health savings accounts under the bill, instead of using that money for other purposes, such as helping ensure employers don’t drop their retiree drug coverage once the government drug program kicks in. The final bill also will likely require wealthier seniors to pay more for their doctor visits under Medicare, which Mr. Kennedy doesn’t like.

Republican negotiators said the final bill must include Medicare reform in order to pass the House.

“We have at least as big a percentage on the House side who are concerned that if we add $400 billion to a Medicare program that is going bankrupt … that that will be catastrophic,” said Christin Tinsworth, spokeswoman for Mr. Thomas.

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