- The Washington Times - Monday, October 13, 2003

Republican lawmakers negotiating a final Medicare prescription-drug bill are rejecting President Bush’s ideas for key parts of the measure, which some say has put Mr. Bush in a difficult situation.

“The president has said he wants a bill. He also has strong opinions on some things, but we’re not doing any of those things,” said one Senate Republican aide. “So how excited is the president about the bill?”

The political stakes are high, with seniors demanding a Medicare prescription-drug benefit, and Mr. Bush and Congress vowing to deliver.

But the Republican-led conference crafting the bill differs from Mr. Bush in several areas. For instance, the administration wants to limit to three the number of private health plans that would compete in each region of the country to deliver the prescription-drug benefits. Congressional negotiators want to allow more plans per region, Senate Republican aides said.

Negotiators also are leaning toward a system of reimbursing the private health plans that differs from the system Mr. Bush wants, the aides said.

Mr. Bush recently stepped into negotiations for the first time about another issue where he was being told no.

The issue was whether low-income Medicare beneficiaries who receive drug coverage through Medicaid should be included under the new Medicare drug benefit. House Republican leaders, state governors and Democrats say they should be included, and negotiators had tentatively agreed to do so.

Shifting this group, known as “dual eligibles,” to the federal drug benefit would lower states’ Medicaid costs. But Mr. Bush and some Senate Republicans want them to remain in Medicaid.

The conference chairman, Rep. Bill Thomas, yelled at Health and Human Services Secretary Tommy G. Thompson about this during a closed-door negotiating session a few weeks ago, House and Senate aides said.

Mr. Thomas, California Republican, was “dressing down” Mr. Thompson over the policy issue and insinuating “the White House has not been a good partner … the White House doesn’t have any good ideas, meaningful ideas that can sell,” said one Senate Republican aide who was present.

Senate Majority Leader Bill Frist, Tennessee Republican, said on Thursday he and Mr. Bush have spoken regularly about Medicare issues, including dual-eligibles, which he said still is being discussed by conferees. He dismissed the Thomas-Thompson incident as “ancient history.”

He also said Mr. Bush is “not getting involved … in the weeds” of issues and is “satisfied with the progress being made.”

White House spokeswoman Claire Buchan wouldn’t comment on negotiations, but said Mr. Bush continues to push Congress to produce a good bill. “The process is ongoing,” she said.

But notably, while Mr. Bush intervened in the dual-eligible fight, he has remained silent on what is arguably the most contentious issue and the most important one to his conservative base: whether the final bill will require traditional Medicare to compete directly against private health plans starting in 2010.

House conservatives and conservative lobbying groups have made it clear that a final bill must contain this requirement. But this would have a difficult time getting through the Senate, and could complicate the bill’s passage.

Negotiators, who have set Oct. 17 as the goal for producing a final bill, are leaving this sticky issue until the end.

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