- The Washington Times - Tuesday, July 1, 2003

House Speaker J. Dennis Hastert has promised conservatives that the final Medicare prescription-drug bill will have a cost-containment provision to prevent the price tag from skyrocketing — a key commitment that allowed many Republicans to vote for the House bill last week.

Mr. Hastert, Illinois Republican, sent a letter to conservatives late last month committing himself to work with them to include “a provision that provides a mechanism to ensure that the cost of the prescription drug program added by the bill does not exceed the current annual estimated costs for the program” in the House-Senate conference bill.

“For those of us with concerns about this bill and who want to support the president, this is very important,” Rep. Sue Myrick, North Carolina Republican and chairman of the House Republican Study Committee, a caucus of more than 90 conservatives, said in a statement. “Without this commitment many of our group could not have supported this bill.”

Congress has set aside $400 billion over 10 years to reform Medicare and create a prescription-drug benefit for seniors, but conservatives worry that it will balloon beyond the initial price tag, as have other government programs.



In the end, 19 House Republicans opposed the House bill largely for that reason, and it passed by a razor-thin majority, 216-215.

But the assurances from Mr. Hastert on the cost of the proposed program and a few other key issues were enough for other House Republicans to support the bill, and now they say they want to ensure that party leaders follow through.

“Conservatives have raised enough Cain with the White House and leadership that they’re either going to come out with a bill that provides choice and competition and cost control, or they’re going to have to have liberal Democrats pass their Medicare plan,” said Rep. Tom Feeney, Florida Republican.

For some Republicans who voted for the bill, the promise on cost control was a deciding factor.

“They’re committed to making sure that … indeed it is a $400 billion program,” said Rep. Jeb Hensarling, the Texas Republican who proposed the cost-containment idea. “By putting a cost containment on it … it’s not an open-ended invitation to the working man’s pocketbook.”

“What finally tipped it for me was the speaker’s commitment,” said Rep. Patrick J. Toomey, Pennsylvania Republican.

“I feel better about my leadership addressing some of my concerns,” said Rep. J. Gresham Barrett, South Carolina Republican, referring to the cost-containment issue as well as another promise made by the Republican leadership.

In that promise, Mr. Hastert told Republicans that he would fight to keep in the final bill a contentious House provision that would require traditional Medicare to compete against private health plans for seniors’ business, starting in 2010.

The Senate bill does not include this provision, and many Democrats oppose this. “It’s tough to imagine anything like that being able to get through the Senate,” said one Senate Democratic aide on the condition of anonymity.

But Mr. Barrett said if the provision is not in the final bill, that could jeopardize House passage.

Mr. Hastert’s June 26 letter on cost containment was sent to House conservatives, such as Mrs. Myrick and Mr. Hensarling.

Mr. Hensarling said the 2010 competition setup is designed to keep costs down, but conservatives wanted a backup plan to ensure this outcome. That is why he proposed adding a cost-containment mechanism to the bill in conference.

He presented the idea to President Bush in a meeting Wednesday that also included concerned conservatives, and Mr. Bush directed Health and Human Services Secretary Tommy G. Thompson to look into various cost-containment mechanisms. The details are being worked out.

“I wouldn’t say there was a firm commitment there,” Mr. Hensarling said of the president. “But I think he thinks it’s an idea that has a lot of merit and deserves to be explored.”

Senate leaders said it was too early to comment on cost-containment proposals.

“We’d just need to see what they have in mind before we can respond more specifically,” said Jill Gerber, spokeswoman for Senate Finance Committee Chairman Charles E. Grassley, Iowa Republican and crafter of the Senate bill. “We’ll be glad to look at whatever they propose.”

Jay Carson, spokesman for Senate Minority Leader Tom Daschle, South Dakota Democrat, said getting the support of his boss would depend on what the cost-containment mechanism is.

He said if Republicans want to find ways to cut drug costs “that’s something Democrats would be fully supportive of.” But Mr. Carson said that “given the Republicans’ track record on this issue, they’re probably talking about cutting drug benefits to seniors, which is unacceptable.”

Meanwhile, even Mr. Barrett and other House conservatives who voted for the bill said they did so just to move the process along, with the commitment from leaders that the conference will improve the legislation. Many were not enthusiastic about the bill.

“We really just voted for it to move the process along,” said Rep. Joe Pitts, Pennsylvania Republican. “We were faced with the Senate bill, which is much worse, and we were assured by the leaders that if we didn’t move our bill, they wouldn’t be able to stop the Senate bill” from coming to the House floor.

Some conservatives, however, opposed the bill, saying it is beyond improvement because it creates a costly new entitlement that cannot be controlled.

“It’s clearly an entitlement that will be out of the hands of Congress to control the spending,” said Rep. Charlie Norwood, a Georgia Republican who voted no.

But Mr. Norwood said that even if House Republicans oppose the final conference report, it will ultimately pass the House because enough Democrats will vote for it. “They won’t want to go home without voting for a Medicare bill,” he said of the Democrats, most of whom have strongly opposed the House bill. Mr. Norwood predicted that House Republican leaders will pass the conference report “one way or the other.”

Mr. Hensarling disagreed, noting that before the House vote last week, some were saying that conservative votes were not needed because there were enough Democratic votes to pass the bill. The bill, however, ended up squeaking through by one vote, Mr. Hensarling said, “so I don’t know if those rumors are accurate.”

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