House Passes Medicare Bill

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House Passes Medicare Bill

 

 

> House Passes Medicare Bill

>

> By Amy Goldstein, Helen Dewar and David Broder

> Washington Post Staff Writers

> Sunday, November 23, 2003; 7:48 AM

>

> A divided House, in a dramatic vote before dawn, approved the most

> fundamental transformation of Medicare in the program's history, adopting

> legislation that would add a prescription drug benefit and create a large

> new role for private health plans in caring for the nation's elderly.

>

> The measure had appeared destined for defeat, but passed on a vote of 220

> to 215 after the House's GOP leaders kept the roll call open for nearly

> three hours until shortly before 6 a.m. as they scoured for extra votes.

> Knots of senior House Republicans and Health and Human Services Secretary

> Tommy G. Thompson huddled repeatedly around several of the two dozen

> skeptical members who had initially voted against the bill -- with little

> apparent effect -- while their colleagues milled the floor and a few

napped.

>

> Through most of that time, the red lights on the voting board in the House

> chamber showed the tally at 216 for the measure and 218 against it.

> Finally, moments before 6 a.m., two Republican members, Rep. C.L. " Butch "

> Otter (Idaho) and Rep.Trent Franks (Ariz.) changed their minds, then

> another few colleagues followed suit.

>

> Several longtime lawmakers said the roll call was the longest in their

> memory. The cliff-hanger vote, and the arduous efforts to pry a victory

> from an apparent defeat, reflected the enormous political significance of

> the Medicare issue and the philosophical differences -- between the

> political parties and among factions of Republicans who hold the majority

> in both houses of Congress -- over the changes the legislation would bring

> to the program.

>

> The bill's passage, rocky as it was, vastly increases the chances that,

> after years of legislative struggle, the federal government will begin to

> offer the help in paying for medicine that has been a rallying cry among

> older Americans.It handed a substantial victory to the White House, which

> has sought to champion Medicare changes as a major domestic accomplishment

> for President Bush in his reelection campaign next year.

>

> Congressional Republicans and Democrats, however, were deeply divided over

> whether the legislation would prove helpful to the 40 million older and

> disabled Americans who get health insurance through the program.

>

> The slender margin resembled another cliff-hanger vote when the House

> passed a more conservative version of the Medicare legislation by a

> one-vote margin in June, following similar pressure by GOP leaders to win

> over skeptics. In that earlier vote, the GOP leadership extended the roll

> call by more than an hour to secure the final " yes " vote. Throughout

Friday

> and until voting began at 3 a.m., Republicans leaders scurried to overcome

> resistance from Democrats and some GOP conservatives who objected to

> elements of the biggest proposed change to the program since it began in

1965.

>

> The House took up the legislation one day after congressional negotiators

> completed work on a hard-fought compromise, produced largely by

> Republicans, that would inject heavy new market competition into the

> government health insurance program for the elderly and disabled. The

> compromise emerged from four months of negotiations over separate Medicare

> bills that the two chambers had passed.

>

> Many Republicans called the bill an unprecedented opportunity to help

older

> Americans with drug costs. " This is one of those times for great change, "

> said House Speaker J. Dennis Hastert (R-Ill.)

>

> Most Democrats condemned it as a handout to pharmaceutical and insurance

> companies and a threat to the program's existence. House Minority Leader

> Nancy Pelosi (D-Calif.) said the bill would offer too little help with

drug

> costs and lead to " the end of Medicare as we know it. "

>

> In the end, just 16 Democrats joined with the Republican majority to pass

> the bill. Twenty-five Republicans and one Independent voted with the rest

> of the Democrats against the measure.

>

> The conservative Republicans who switched their votes at the end said they

> did so because they were told that if this bill failed, Democrats planned

> to bring up an earlier, more liberal Senate version.

>

> Otter said he and Franks were among a group of seven conservatives who met

> with party leaders off the House floor. About an hour before the switch

> they were told the House Democrats were planning to introduce the Senate

> version of the Medicare prescription drug bill and bring it to the floor

> through a seldom used discharge petition that requires the signature of a

> majority of the members. The Senate bill was far more expensive and

> contained fewer reform elements, so Otter said he and Franks decided to

> change their votes.

>

> Otter said he received a call from Bush earlier urging him to vote for the

> bill but he told the president " I can't help you " because the bill would

> increase the national debt.

>

> After the vote, Rep. Steny Hoyer (D-Md.) blasted the GOP for forcing a

> rejection into a win. " Arms have been twisted and votes have been

changed, "

> said Hoyer, who said the process had been anti-democratic.

>

> The House vote is to be followed by action in the Senate, which planned to

> debate the legislation today and Sunday, with a vote possible by Monday.

> Yesterday, the bill continued to pick up support from senators of both

> parties. Democratic leader Thomas A. Daschle (S.D.), who has sharply

> criticized the bill, said he would not support a filibuster to block its

> passage because Democrats are split on the issue.

>

> Starting in 2006, the bill would allow everyone in Medicare to obtain

> federally subsidized drug coverage by buying a separate insurance policy

or

> by joining a private health plan that also provided the rest of their

care.

> Before those subsidies began, the government would, starting next spring,

> organize a network of drug discount cards sold by private companies that

> proponents predict could shave about 15 percent from the price of

> pharmaceuticals.

>

> The drug assistance, the most widely publicized part of the 678-page

> legislation, is less controversial than several other provisions. Some of

> those would try to nudge Medicare patients to join preferred provider

> organizations (PPOs), HMOs, and other private health plans. Nearly nine in

> 10 people on Medicare belong to the original " fee-for-service " version in

> which patients choose their doctors and essentially can get the care they

> request.

>

> Under a central compromise reached a week ago, the program would begin an

> experiment in which the traditional program would have to enter direct

> price competition for patients against private health plans. That six-year

> experiment in several metropolitan areas, to start in 2010, has drawn fire

> both from Democrats, who say it would begin to undermine Medicare, and

from

> conservatives, who favor such competition permanently and nationwide.

>

> For the first time, the plan calls for wealthier Medicare patients to pay

> more for doctors visits and other outpatient care. It provides for extra

> drug subsidies to low-income beneficiaries, although not to as many as

many

> Democrats would like.

>

> To get the drug benefit, patients would pay an average premium of $35 a

> month and a $250 annual deductible. After that, the government would pick

> up 75 percent of their drug expenses up to $2,250 a year. At that point,

> coverage would stop, except for a small number of patients wth extremely

> large pharmaceutical expenses who incur $3,600 in out-of-pocket costs. At

> that point, the government would pay 95 percent of the rest.

>

> Before last night's debate began, GOP House leaders spent the day racing

to

> cajole a skeptical core of conservatives and other party members who

> reluctantly supported the original Medicare legislation that passed the

> chamber. The White House, hoping to tout a new Medicare law in President

> Bush's campaign next year, applied similar pressure. Bush telephoned " more

> than a handful " of House members from Air Force One as he returned from

> Britain, a White House spokesman said. And Friday night, Health and Human

> Services Secretary Thompson came to the Capitol to lobby in person for the

> measure's passage.

>

> The House debate's intensely partisan tone, escalating all week, was

vivid.

> Early in the day, Pelosi (D-Calif.) made a rare appearance at the Rules

> Committee and complained that the bill was being brought to the floor

> without a standard three-day waiting period for such agreements between

the

> House and Senate. Rep. John D. Dingell (D-Mich.) called the measure " an

> unfair improper dangerous piece of legislation, conceived in darkness and

..

> . . slipped through over the heads of our senior citizens. " In a frequent

> theme, one Democrat denounced it as " a GOP drug company bonanza. " And Many

> Democrats criticized the AARP, the nation's largest organization of older

> Americans, for endorsing the plan.

>

> Rep. Gene Taylor (D-Miss), said: " This is nothing but an auction to the

> insurance companies and the pharmaceutical companies in this nation for

> campaign contributions to the Republican Party. "

>

> Republicans, trying to court skeptics in their own party, emphasized parts

> of the bill that embrace conservative goals. They include the expanded

> market competition in Medicare, steps toward limiting overall spending on

> the program, and new tax breaks for Americans of all ages who open special

> savings accounts for medical expenses.

>

> " This bill is really all about a fair deal, " said Ways and Means Committee

> Chairman Bill Thomas (R-Calif.), one of its main architects. " Modernize

> Medicare with prescription drugs, but put Medicare back on a sound

> financial basis, as well. "

>

> Thomas also countered Democratic efforts to demonize the AARP for its

> surprise decision to side with the GOP in support of the bill. " The AARP

> has not abandoned you. You've abandoned seniors, " he told the Democrats.

>

> In the 100-member Senate, Democratic foes of the Medicare bill may use

> parliamentary maneuvers to force Republicans to muster 60 votes to block a

> filibuster. But after a 90-minute Democratic caucus on the issue, Daschle

> said party members were " passionately " divided over the filibuster

strategy.

>

> " I don't believe a filibuster reflects the consensus of our caucus, " he

> said, adding that he would vote against such a delaying tactic.

>

> Despite some defections from their ranks, Senate Republicans said they

> believed they had enough votes for passage, even if they have to clear a

> 60-vote hurdle. During the past few days, wavering Democratic Sens. Kent

> Conrad (N.D.), Mary Landrieu (La.) and Blanche Lincoln (Ark.) said they

> would vote for the bill, as did a Republican skeptic, Sen. Olympia J.

Snowe

> (R-Maine). Sen. John Cornyn (R-Tex.), who voted against an earlier Senate

> version of the legislation in June, said he supports the new version.

>

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