- The Washington Times - Tuesday, November 25, 2003

The Senate yesterday approved historic Medicare prescription-drug legislation, clearing the way for President Bush’s signature on the largest expansion of the government health program since its creation in 1965.

“Today is an extraordinary [day], it’s a fateful and a red-letter day for seniors and, indeed, for all Americans,” said Senate Majority Leader Bill Frist, Tennessee Republican, after the measure passed 54-44.

The bill — which spends an estimated $395 billion over 10 years to update Medicare, create a prescription-drug benefit for all seniors and give private health plans an expanded role in health care delivery — was pushed by Mr. Bush. Its passage gives Mr. Bush and Republicans a major victory on an issue that Democrats traditionally have claimed as their own.

“For the sake of our seniors, we’ve got something done,” Mr. Bush said after the measure passed the Senate on 54-44 vote, with 11 Democrats and one independent joining 42 Republicans in supporting it. Nine Republicans sided with 35 Democrats to oppose it.

Two Democratic presidential candidates, Sens. John Kerry of Massachusetts and Joe Lieberman of Connecticut, skipped the Medicare vote.

“I’m honored to put my signature on this historic piece of legislation,” Mr. Bush said.

But Democratic opponents pledged to continue fighting the legislation in Congress, at the grass-roots level and at the polls, predicting that seniors will rebel. Most Democrats say it provides a paltry drug benefit and undermines the government-run Medicare program by tilting too much in favor of private health plans.

“We will continue this battle,” said Sen. Edward M. Kennedy, Massachusetts Democrat. “At the end of the day, we will preserve the Medicare system, which is threatened seriously by this bill.”

Senate Minority Leader Tom Daschle, South Dakota Democrat, concurred.

“We will continue to see debate about this legislation for years and years to come,” he said. “Seniors are going to ask Congress to revisit this legislation very, very soon.”

Mr. Daschle said seniors oppose the bill “by an overwhelming margin,” so its passage could actually be a “cause for optimism for [Democrats], politically” in the next election.

“Seniors are a very significant block of voters,” he said.

Starting in 2006, seniors who choose to stay with traditional Medicare could access a new drug benefit, 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 also require Medicare to compete directly with private plans starting in 2010 in a six-year pilot program involving six cities — a concept pushed by conservatives but strongly opposed by most Democrats.

“[P]eople will have more control over their health care options, and health care plans will start competing for their business. And that’s positive,” Mr. Bush said of the bill.

But several Republicans who voted against the legislation yesterday — including Sens. Trent Lott of Mississippi and Don Nickles of Oklahoma — are concerned with the high cost of prescription-drug entitlements for all seniors, instead of a more targeted, less costly approach.

In the House, 25 conservatives ended up voting against the bill Saturday for many of the same reasons. It passed 220-215 only after Republican leaders persuaded two conservatives to change their vote and back it, a move that also kept other Democrats from withdrawing their support.

Senate passage of the bill capped off the tumultuous first session of the 108th Congress, which was marked by historic levels of spending, passage of a large tax-cut package and a half-dozen filibusters of federal judicial nominees.

Congress also passed a bill banning partial-birth abortion, which became law with Mr. Bush’s signature. A previous attempt during the Clinton administration failed because of a veto. Democrats and northeastern Republicans, however, did manage to block Mr. Bush’s energy package.

The chambers have not passed seven of the 13 fiscal 2004 appropriations bills, and House and Senate Republican leaders expect to return in December to try to pass an omnibus spending bill. House and Senate negotiators finalized the bill yesterday, but it contains a host of complicated and contentious provisions that could complicate the December session and prevent passage until next year.

For the first time since the 1950s, Republicans controlled the White House and both chambers of Congress for the whole year, and Mr. Daschle pronounced Congress “seriously off track” as it pursued the Republican agenda.

But Republicans pointed to the Medicare bill as an example of how their agenda has helped Americans.

A few skeptical Republicans, such as Sen. Wayne Allard of Colorado, supported the bill only because of its $6 billion for tax-preferred health savings accounts that encourage individuals of all ages to save for their medical costs instead of relying solely on government or insurance.

Meanwhile, the bill’s $25 billion package to boost Medicare payments to rural hospitals and doctors was key in securing the support of rural-state Democrats such as North Dakota Sens. Byron L. Dorgan and Kent Conrad.

Also key to the bill’s passage was the support of Democratic Sens. John B. Breaux of Louisiana and Max Baucus of Montana, who helped craft it. And the nation’s leading seniors advocacy group, AARP, played a major role by endorsing it. The group argued to lawmakers that while the measure is not perfect, the bill will help millions and an opportunity such as this might not come around again.

Seven Senate Republicans joined more than 30 Democrats a few weeks ago in urging leaders to strip the direct-competition idea from the final bill. Although the legislation still contains it, only two of the seven Republicans voted no yesterday. Sen. Olympia J. Snowe of Maine was one of the Republicans who signed the letter but voted for the final bill. She said she is satisfied that the direct-competition idea was sufficiently scaled down.


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