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Prescription Drug Bill Hangs on Roll Call

Posted on: Saturday, 22 November 2003, 06:00 CST

Medicare prescription drug legislation hung on the outcome of a long, pre-dawn roll call early Saturday as House Republican leaders struggled to overcome defections by rebellious GOP conservatives and a near-solid wall of Democratic opposition.

With the customary 15-minute vote long expired, Speaker Dennis Hastert and other key GOP leaders cajoled and coaxed fellow Republicans to swing behind the measure and avert a crushing defeat for the party and President Bush.

Democrats worked just as intensely, hoping to hold their own defections to a minimum and triumph on an issue that their leader, California Rep. Nancy Pelosi, had made a matter of party principle.

At 4:20 a.m. EST, more than an hour after the roll call began, the vote stood at 216 to 218. As the majority party, Republicans control the gavel, and there was no indication they were ready to concede defeat.

At its heart, the legislation would create a new prescription drug benefit for 40 million Americans, at the same time it would usher in a new era of private health coverage for seniors who choose it over traditional Medicare. The measure also includes $25 billion in increased funding for rural hospitals and other health care providers, money designed to be a sweetener to attract support from Republicans and Democrats alike.

The bill carried a price tag of $395 billion, just under the $400 billion cap set by the president and congressional Republicans.

"Today we will pass this historic piece of legislation and tomorrow we will tell our nation's senior citizens that we have finally delivered a modernized Medicare system and a prescription drug benefit," Hastert predicted earlier.

Pelosi, who labored all week to unify her rank and file against the bill, said the GOP-backed bill was "not the beginning of a real prescription drug benefit under Medicare. On the contrary, this is the beginning of the end of Medicare as we know it."

Bush made his calls on the trip home from a state visit to England as Republican leaders worked to hand him a legislative and political victory and Democrats dug in to defeat the measure.

GOP vote counters reported progress in rounding up support as they aimed for a middle-of-the-night vote. HHS Secretary Tommy Thompson traveled to the Capitol to help with the lobbying, yet Bush's intervention was a sign that additional help was needed.

At least one lawmaker who took a presidential phone call was unmoved.

"I basically said it was a matter of principle, that I came to Washington not to ratify and to expand Great Society programs," said Rep. Tom Feeney, R-Fla. "He wasn't happy to hear that," the first-term lawmaker added of the president.

Two other first-term lawmakers, Reps. Marsha Blackburn of Tennessee and Trent Franks of Arizona, got the presidential pitch, as well. Neither would disclose how they intended to vote.

Facing defections, Republicans conceded they would likely need a handful of Democrats to prevail. Pelosi labored to prevent that, having called opposition a "party position."

Approval of the bill would send it to the Senate, where the path to passage seemed far easier - in part because of the decision of a growing number of Democrats to support the measure.

The bill's scope was vast.

Beginning next year, seniors would be able to purchase discount drug cards that the Bush administration estimates would yield savings of between 15 percent and 25 percent. The card program would expire in 2006, when beneficiaries would gain access to a prescription drug benefit for the first time.

The bill also encourages private insurance companies to establish new managed care plans for seniors, either as preferred provider organizations or HMOs. While Medicare currently includes an option for private coverage, most beneficiaries currently receive their health care as a standard, government-defined benefit that does not vary from one region of the country to another.

For the first time, the legislation would also require seniors with annual incomes over $80,000 to pay higher premiums under Medicare Part B, which covers services outside the hospital. Also, it would establish new tax-preferred health accounts, open to individuals with high-deductible insurance policies.

The measure also included billions of dollars to discourage companies from reducing coverage for their retirees. At the same time, it would retain the existing ban on the importation of lower-cost prescription drugs from Canada, unless the FDA certified their safety.

The tax provision and requirement for higher premiums were part of an effort to appeal to conservatives who favor transforming Medicare and restraining its cost, yet find creation of the new prescription drug benefit distasteful.

Many Democrats argued that some of the conservative-backed elements of the bill were too dear a price to pay for the drug benefit, in particular a provision creating a limited experiment in direct competition between private plans and traditional Medicare beginning in 2010.

"This is a defining issue," said Rep. Jim McGovern, D-Mass, as he made the case for rejecting the measure. "This bill is a huge giveaway to the prescription drug companies. And worst of all, this bill shoves Medicare down that path toward privatization."

But Republican supporters said the legislation would provide better health care for seniors. "I think this bill has a great chance of injecting competition into the system," said Wisconsin Rep. Paul Ryan.

Support for the measure appeared to be building in the Senate. John Cornyn, R-Texas, who voted against a bill that cleared the Senate in June, said he would support the revised version. The previous measure, he said, lacked "the incentive for private plans to develop their coverage."

Senate Democratic Leader Tom Daschle said he would not support a filibuster if opponents launched one, and some rank-and-file members of his party announced their backing for the bill.

Sen. Kent Conrad was one, citing the presence of $25 billion in funding to help rural hospitals and health care providers as one reason. In addition, the North Dakota Democrat said he had received assurances of help to change a situation under which Medicare pays hospitals in Bismarck less money than facilities in Fargo, not quite 200 miles away.

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