House rejects Medicare drug plan means-testing

House conservatives sought unsuccessfully this week to convince the House to endorse cutting the cost of a Medicare prescription-drug benefit by requiring wealthy seniors to pay more of their own drug costs.

The House on Tuesday defeated, on a 234-161 vote, a Republican motion that would have asked House and Senate negotiators to include “means-testing” as part of the new Medicare prescription-drug benefit Congress is trying to create.

Allowing the symbolic vote was a way for House Republican leaders to try to appease their conservative wing, many of whom oppose the idea of creating a costly new prescription-drug entitlement that would be available to all seniors regardless of their wealth.

Rep. Jeff Flake, the Arizona Republican who offered the motion, says the only way to hold down costs is for means-testing to exclude the wealthiest seniors from the new drug benefit altogether.

“There is no reason in the world why we ought to be paying the prescription-drug benefits for the wealthiest in society, the Bill Gates, the Barbra Streisands, the Ted Turners, the Warren Buffetts,” he said.

Tuesday’s vote “sends a signal to conservatives that they have more work to do to convince the majority members in the House that this is a position worth fighting for,” said one House Republican leadership aide.

Many Democrats strongly oppose any means-testing. Sen. Edward M. Kennedy, Massachusetts Democrat, has threatened in the past to filibuster any final Medicare drug bill that includes it.

Kennedy spokesman Jim Manley said the fact that 51 House Republicans voted against the broad idea of means-testing on Tuesday indicates a lack of support for the Medicare reforms that conservatives want in a final bill.

“It suggests that a lot of Republicans are going to have trouble swallowing the radical reforms being proposed,” Mr. Manley said. He said it also shows Republicans may be wavering on other contentious issues in the plan, including the House bill’s provision requiring traditional Medicare to compete directly against private health plans.

The Kennedy spokesman said it “demonstrates that there is a will in the House for a bipartisan approach” to the Medicare bill.

Those crafting the final bill are discussing a weaker form of means-testing — whether to require wealthier seniors to pay higher Medicare premiums for general doctor visits, Republican aides said. This idea has garnered the support of some Democrats in the past.

And House Republican leadership aides said the failure of Mr. Flake’s motion in no way weakens his party’s ability to push for means-testing.

They said leaders will continue fighting for the final bill to require wealthier seniors to pay more out of their own pocket before government would cover their drug costs for catastrophic illnesses. This limited means-testing provision was part of the House-passed Medicare drug bill.

Mr. Flake said that had his motion passed, it would have “upset the apple cart in conference, and I’ve said all along if I can upset the apple cart, I would.”

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