House and Senate leaders now face what could be a long and difficult conference to iron out differences between the two Medicare prescription-drug bills that passed each chamber early yesterday morning.
House Speaker J. Dennis Hastert, Illinois Republican, called the House bill a “landmark piece of legislation.” But he also cautioned that there should not be a rush through conference to get a bill signed. “We need to take our time. We need to get the policy right,” he said.
And Senate Majority Leader Bill Frist, Tennessee Republican, left open the possibility the conference could spill over into the fall.
President Bush praised both chambers’ action but pushed for speed.
“The sooner the job is done, the sooner Americans will get the health care they deserve,” he said yesterday at a fund-raiser in California.
Both House and Senate bills — set to cost about $400 billion over 10 years — would provide seniors with prescription-drug benefits either through private drug-only plans for those who stay in traditional Medicare, or through a new Medicare option that would use private health groups to deliver comprehensive health coverage.
One key difference is that the House bill would go further in reforming Medicare, forcing traditional Medicare to compete directly against the private plans starting in 2010. The House bill also would institute a means test, requiring seniors who make more than $60,000 to pay for part of their catastrophic-drug costs instead of having the government pick up the full tab.
While some Democratic forces will be pushing against these provisions in conference, conservative forces from the House and Senate will push for such provisions to be strengthened, and for more Medicare reforms to be added. Conservatives also want to see cost controls so that the new drug benefit doesn’t balloon out of control years from now.
Rep. Jim DeMint, South Carolina Republican, was one of 19 Republicans who voted against the House bill yesterday because he thought it was creating a costly government entitlement and did not have enough Medicare reform. He said Mr. Bush promised him and other wavering Republicans last week before the vote that the White House is committed to making the bill more acceptable to conservatives in conference.
“He is going to try to push as far as he can and still get something passed,” Mr. DeMint said.
Mr. DeMint would like to see the House’s 2010 competition model instituted sooner. And he would like to reduce Medicare regulations on doctors and hospitals, freeing them to compete with each other and to find new ways of delivering services cost-effectively.
He said conservatives “realize that we’re not going to get everything we want,” but he added that “the carrot of prescription drugs is something that can pull through more reforms than what we’ve got in this bill. We think we can get more reforms in there and still have it pass the Senate when it comes out of conference.”
Mr. Hastert did not say whether he would push to get more reform in the bill, but he did say he would defend the House’s 2010 competition model.
“It’s my commitment to try to keep it in,” Mr. Hastert said at a briefing yesterday with reporters.
Rep. Paul D. Ryan, Wisconsin Republican, said if the 2010 model is stripped from the bill it will be a “showstopper” for many House Republicans who supported the measure. If it is kept in, however, the final bill will lose the support of Senate Democrats.
Mr. Frist thinks there will be some form of means testing in the final bill as well.
The Senate tried to add its own means-testing provision to its bill immediately before final passage, but Sen. Edward M. Kennedy, Massachusetts Democrat and key supporter of the Senate bill, threatened to derail the bill’s passage if that happened. The amendment — which the majority of senators supported — would have required seniors with higher incomes to pay for more of their doctor bills under Medicare. Mr. Kennedy and other Democrats oppose this means testing.
Ultimately, the Senate bill passed 76-21, with 10 Republicans and 11 Democrats voting against it. The Senate bill — which represents a delicate balance between the two parties there — garnered the support of Senate Minority Leader Tom Daschle, South Dakota Democrat, and Mr. Kennedy.
The House bill, in contrast, had a much more partisan vote. It passed, 216-215, with Republicans losing 19 of their own, but gaining the support of nine Democrats. Many conservative Republicans such as Mr. DeMint opposed the bill.
The vote stalled for about an hour as Republican leaders cajoled wayward members to get the votes needed to pass it. Mr. Hastert said there was a “long period of arm twisting on both sides.” In the end, two Republican “no” votes switched to “yes” — Reps. Jo Ann Emerson of Missouri and C.L. “Butch” Otter of Idaho. There were a handful of other “no” votes who probably could have been convinced to vote “yes” as well, but when leaders got enough votes, they stopped trying to sway opponents of the measure, Mr. Hastert said.
Mrs. Emerson was part of a group that is pushing for the government to allow American-made drugs to be reimported from Canada and other countries. The Senate bill contains reimportation language and House Republican leaders included some language in their bill allowing drug reimportation from Canada, after certain safety regulations are met. But that wasn’t enough to satisfy some members of the drug-reimportation group, and Mrs. Emerson initially voted against the bill. But she was cajoled personally by Mr. Hastert and other leaders to change her mind.
Mr. Hastert promised the reimportation group that he would allow a House floor vote on a stand-alone drug-reimportation measure. He said the vote will determine the will of the House on that issue and then leaders will know whether to push for such language in the Medicare conference.
Meanwhile, Mr. Hastert said he respects the conservatives’ fiscal concerns but disagrees with them. He said the bill does not create a huge government program and will save money by keeping seniors healthier longer with prescription drugs.
And he added: “It’s my responsibility to move that legislation through. Sometimes it’s pretty, sometimes it ain’t.”