Medicare overhaul bill moves closer to a vote

WASHINGTON — Landmark legislation to revamp Medicare headed Thursday toward final congressional votes, perhaps as early as today in the House, after negotiators slightly sweetened a proposed prescription drug benefit in hopes of winning over skeptical lawmakers.

With the outcome still in doubt and both sides stepping up their efforts to pick up votes, Republican leaders put the legislation — a top White House priority — on a fast track for approval in time for Congress to adjourn for the year before Thanksgiving.

The final push came as House and Senate negotiators prepared to give their formal nod to the measure, which had been whipped into final shape by a mostly Republican group of negotiators in four months of difficult bargaining that continued almost to the last minute. From speeches given at an afternoon meeting of the committee, it was clear the proposal would be approved, although many members said they wanted to study the fine print before signing the agreement.

"Seniors and taxpayers have been waiting a long time for this day," said House Ways and Means Committee Chairman William Thomas, R-Calif., chairman of the negotiating committee. Most of the Democrats were staunchly opposed but outnumbered. "This is a bad bill, the product of a bad process," said Rep. John Dingell, D-Mich., who criticized the exclusion of most Democrats from the drafting of the compromise.

It appeared that most if not all Republicans would sign the final agreement and that the only Democrats who would join them were Sens. Max Baucus, D-Mont., and John Breaux, D-La., who are also the only Democrats permitted to join negotiations on the final draft of the bill.

The legislation, marking the first major revamping of Medicare since it was created in 1965, would for the first time provide federal subsidies to help Medicare beneficiaries pay for prescription medicines, starting in 2006. It would also provide incentives for private health plans to compete with traditional fee-for-service Medicare for coverage of elderly Americans’ health costs.

A substantial number of House GOP conservatives say the bill is too costly and does not go far enough toward involving the private sector, although it was not clear how many of them would vote against the bill. Some reluctantly supported an earlier and more conservative version when it passed the House by one vote last summer.

In the Senate, Democrats have a very different complaint: that the bill goes too far toward privatization and may well ultimately doom "Medicare as we know it," as several senators put it.

In both houses, some lawmakers regard the drug benefit as too skimpy to overcome their other objections.

The drug-benefit incentives were included after the Congressional Budget Office calculated that the bill would cost about $5 billion less than the $400 billion Congress voted earlier to allow for the program over the next 10 years. The CBO’s exact figure was $394.8 billion.

This allowed the negotiators to cut the out-of-pocket costs of drug coverage for patients and expand coverage for those with high, but not catastrophic, drug costs, although the changes were modest. They reduced a patient’s annual deductible for coverage from $275 to $250. Also, under the earlier proposal, the legislation would have covered three-fourths of drug costs between $250 and $2,200 a year, with patients receiving no further assistance until their costs reached $3,600. The new version would raise the $2,200 limit to $2,250.

In the House, GOP leaders said they hoped to bring the bill to the floor today. Republicans said they were still trying to persuade some fellow party members to vote for the bill. They were optimistic, they said, but remained uncertain whether the bill would have the votes to pass.

The Senate plans to bring up the bill this weekend. Senate Republicans are encouraged that many Democratic moderates seem to be leaning toward supporting the bill but have stopped short of declaring victory.