Healthy Skepticism Library item: 1334

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Publication type: news

Pear R.
Democrats Lay Down Lines for Looming Medicare Fight
The New York Times 2003 Jul 8
http://www.nytimes.com/2003/07/09/us/democrats-lay-down-lines-for-looming-medicare-fight.html

Full text:

Senate Democrats set the stage today for a possible showdown with conservative House Republicans over legislation adding prescription drug benefits to Medicare.

In a letter to President Bush, many Senate Democrats laid out a half-dozen conditions for support of any compromise that might emerge from negotiations between the two chambers on the shape of a final bill.

The letter was initiated by Senators Edward M. Kennedy of Massachusetts and Tom Daschle of South Dakota, the Senate minority leader. It was signed by at least 35 other senators.

The Senate and the House have passed different versions of the legislation, which authorizes the biggest expansion of Medicare since the program was created in 1965. Drug benefits under the two bills are somewhat similar, but the measures differ in many ways that highlight ideological divides between liberals and conservatives over the role of government.

With the Senate majority leader, Bill Frist of Tennessee, committed to passing bipartisan legislation, Senate Democrats expect to have some influence over a conference committee dominated by Republicans.

In their letter, the Democrats objected to several provisions of the House bill, including one that encourages people to establish tax-free savings accounts to help pay medical expenses. Conservatives favor such accounts as a way for people to take more responsibility for their own health care.

But the tax breaks are estimated to cost the Treasury $174 billion over the next 10 years, in addition to the $400 billion allocated for prescription drug benefits. If the extra money is available, Democrats wrote in their letter, it should be used to provide more comprehensive drug benefits.

The letter also says it would be “wrong to legislate a vast social experiment” that could raise premiums for people who stay in the traditional Medicare program. Mr. Kennedy said this was an allusion to a provision of the House bill that calls for competitive bidding and direct price competition between Medicare and private health plans, starting in 2010.

Senate Democrats said the letter was an effort to lay down political markers for what they expect to be difficult negotiations between the Senate and the House.

Lawmakers of both parties said the outcome of those negotiations would depend, to a large degree, on President Bush. Mr. Bush has said repeatedly that he wants to sign a Medicare drug bill. But on many of the most divisive issues, he and his aides have not said whether they will side with conservatives, push for a bipartisan compromise or simply leave the details up to Congress.

One of the leading House conservatives, Representative Tom DeLay, Republican of Texas, the majority leader, said it was too early to make demands.

“People are taking partisan shots and drawing partisan lines in the sand before we even go to conference,” Mr. DeLay said.

Senator Charles E. Grassley, Republican of Iowa, a principal architect of the Senate bill, said he hoped the conference committee could finish its work by mid-September so it would not be caught up in the politics of the presidential campaign.

Mr. Grassley endorsed one point in the letter from the Senate Democrats. He said he supported a provision of the Senate bill under which the government would directly provide drug benefits if private insurance companies did not offer drug coverage to Medicare beneficiaries in rural areas or other parts of the country.

The House bill has no such backup mechanism. The White House has criticized the Senate provision, saying it could lead to “a government-run delivery system” and “government pricing of individual drugs.”

The Senate has named nine conferees, five Republicans and four Democrats. The Republicans, besides Mr. Grassley and Dr. Frist, are Orrin G. Hatch of Utah, Jon Kyl of Arizona, and Don Nickles of Oklahoma. The Democrats are Mr. Daschle, Max Baucus of Montana, John B. Breaux of Louisiana and John D. Rockefeller IV of West Virginia.

All the Senate conferees voted for the Senate bill except Mr. Nickles, who said it was too costly, and Mr. Rockefeller, who said the benefits were inadequate.

The Senate version of the Medicare bill was approved 76 to 21. But Mr. Daschle said, “Don’t be deceived by the overwhelming margin.” If the conferees move to the right of the Senate bill, he said, the fragile bipartisan coalition could collapse.

By voice vote, the House today passed a separate bill to protect the prescription drug benefits available to retired federal workers under the Federal Employees Health Benefits Program.

Federal employee unions and retirees lobbied for the legislation, saying they feared they might otherwise be forced to accept inferior coverage under Medicare.

Representative Jo Ann Davis, Republican of Virginia, said the bill “protects the health benefits of our valued federal employees.”

But Representative Henry A. Waxman, Democrat of California, said the measure confirmed his view that the drug benefits in the House Medicare bill were completely inadequate.