Monday, November 17, 2003

President Bush yesterday told Congress to pass a compromise Medicare agreement quickly and send it to the White House for his signature, as lawmakers released the first details of the plan, the result of months of negotiations.

“I know I will be actively pushing the bill because it conforms to the principles I laid out, of prescription drugs for our seniors, choice for seniors, accountability for the Medicare plan,” Mr. Bush told reporters at the White House after returning from a weekend at Camp David.

“On Medicare, it looks like there’s agreement in principle to provide our seniors with a modern Medicare plan, and that’s very positive news. I urge the members of the House and the Senate to take a look at it, vote it and get it to my desk as soon as possible,” Mr. Bush said.

However, Sen. Edward M. Kennedy, Massachusetts Democrat, said, “Republicans are committed to undermining Medicare” and predicted that the agreement would not pass the Senate. Some conservatives also expressed disappointment at the agreement.

Mr. Kennedy denied that he is under pressure by Democrats to block passage in order to rob Mr. Bush of a pre-election victory for giving the program its largest expansion since it was created in 1965.

“I think what the Democrats have to do is set the bar high … that’s why we’re in public life and why we’re in the Senate,” Mr. Kennedy said yesterday on the CBS talk show “Face the Nation.”

Capitol Hill negotiators released a six-page summary of the 10-year Medicare prescription-drug bill, which is required by this year’s budget law to cost no more than $400 billion. The key provision would give millions of seniors prescription-drug coverage for the first time for a premium of about $35 a month.

For those seniors who choose to stay with traditional Medicare, the drug benefit would be provided by private insurers. Or seniors could choose a new option under the Medicare law that would let private insurers provide comprehensive health insurance, including prescription drugs.

The bill would provide a “fallback” government-guaranteed drug benefit for seniors if two or more private plans did not enter an area — an idea of Senate Democrats.

The deal includes a watered-down version of a provision demanded by House conservatives to require Medicare to compete directly against private health plans starting in 2010, which they say will force Medicare to become more cost-efficient. The compromise reduces that to a six-year pilot program in six cities. This issue has held up the final bill because of opposition from Democrats and some Senate Republicans.

The proposal also contains several provisions demanded by House conservatives, including $6 billion for tax-preferred health-savings accounts for individuals.

It also would create a mechanism aimed at keeping the cost of Medicare in check and require wealthier seniors to pay more for their doctor visits under Medicare — two provisions absent from the original House bill that will enhance its appeal to House conservatives.

The final agreement was struck over the weekend by House Speaker J. Dennis Hastert, Illinois Republican, and Senate Majority Leader Bill Frist, Tennessee Republican, with the blessing of lead Medicare negotiator Rep. Bill Thomas, California Republican; lead Senate negotiator Sen. Charles E. Grassley, Iowa Republican; and two key Senate Democrats — John B. Breaux of Louisiana and Max Baucus of Montana.

The leaders, with support from the White House, will try to push the plan through Congress this week, although its fate in each chamber remains uncertain.

Mr. Frist said Congress is “on the final few steps of truly historic change” that will strengthen and improve Medicare and the lives of seniors.

“Congress has delivered, our government has delivered, the president has delivered.”

“While this is not a perfect bill, it is a good bill,” Mr. Baucus said, urging his fellow Democrats to support it and predicting that it can pass both chambers.

Appearing on “Fox News Sunday,” Senate Minority Leader Tom Daschle said it is too early to tell whether Democrats will filibuster the agreement.

“We want to have a chance, first, to look at it, talk with our caucus and come up with some plan for our own strategy,” Mr. Daschle said.

Mr. Kennedy said his main concern is that the private sector would handle healthy seniors, and the older and sicker seniors would be treated by Medicare.

“And the result of that, all of the premiums are going to be up, and it’s going to be more costly for our seniors. And that is the beginning of the end of the Medicare system as we know it,” Mr. Kennedy said.

The Massachusetts Democrat is leaving open the possibility of blocking the bill, aides said, although they added that no decision has been made.

Nor were complaints coming solely from liberals.

“I’m profoundly disappointed by the direction this has taken,” said Rep. Mike Pence, an Indiana Republican who voted against the initial House bill, adding that the scaled-down direct-competition model is “not going over well with conservative members of the House.”

“My guess is that most conservatives are disappointed,” said Rep. Jeb Hensarling, Texas Republican, who complained that the demonstration program will not be able to truly reform Medicare.

The pitch to House conservatives from Republican leaders this week will include arguments that the final bill has even more Medicare reforms than the original bill, which squeaked through the House in June by just one vote.

“There are a lot of good things in here for conservatives,” said John Feehery, a spokesman for Mr. Hastert.

But Mr. Kennedy and other Democrats complain that the bill would tilt the playing field toward the private sector by paying private plans more money to provide health coverage — something the secretary of Health and Human Services could do under the bill if private plans were not entering certain areas of the country.

Both parties have been concerned that once the new government drug benefit kicks in, employers will drop their retiree health benefits in order to save money, forcing retirees into the government plan.

To avoid that, the bill would subsidize employers for 28 percent of their retiree drug coverage and would make that payment tax-free. But Democrats such as Mr. Daschle say this will not be enough.

The administration urged lawmakers not to allow politics to scuttle the bill in its final moments.

“They have come up with a bipartisan bill, and we can’t let partisan politics derail this legislation,” Health and Human Services Secretary Tommy G. Thompson said in a statement.

Although an AARP statement yesterday withheld endorsement of the bill, the group said it was “encouraged by the conference committee members’ efforts,” citing particularly the moves to limit private-market competition.

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