Political will wanes on drug coverage

WASHINGTON -- Prescription drug coverage for the elderly, a Medicare benefit long sought by retirees facing escalating prescription costs, once looked like that rare piece of major legislation that members of both parties could embrace in this politically polarized climate.

But now, just four months after deals were reached amid fanfare in the House and Senate, plans for drug coverage are nearly doomed. And while lawmakers say they still hope to reach a compromise, they acknowledge that the grand plans of last spring ran into trouble in a classic Washington fashion -- a combination of overreaching, clashing priorities, diminishing political will, and intervention by an array of interest groups.

"It's not dead yet, but it's on life support," said Robert Moffit, a health policy analyst with the conservative Heritage Foundation.

Plans to add prescription drug coverage to Medicare drew bipartisan support because of the appeal to seniors, an influential voting bloc. But members of Congress returned to their districts over the summer to find that senior citizens weren't happy with the benefits and uncertain premiums in the competing House and Senate proposals.

Meanwhile, labor unions worried that employers would abandon more generous drug benefits negotiated during collective bargaining sessions. Conservatives protested that the program would create a massive and expensive new government entitlement.

Looming over all was a new era of swelling deficits -- and a realization by lawmakers of the difficulties and price of engineering the largest expansion of Medicare since its creation in 1965, costing $400 billion over the next decade.

Lawmakers are now deeply divided over how much the private sector should be involved, and the two parties have taken to holding separate meetings on what is supposed to be a bipartisan, bicameral negotiating session.

Neither bill would win majority support in the other chamber, lawmakers in both parties say, and the House bill -- which was approved by just one vote this summer -- probably wouldn't get a majority now in the House.

As disparate interest groups, including seniors' organizations, pick away at the details, some lawmakers are concluding that approving no bill would be better than one that didn't provide the benefits or reform they want.

"I'm one who believes in quality legislation as opposed to rushing through something that doesn't meet my standards," said Representative John Dingell, Democrat of Michigan and one of the conference committee negotiators.

But other supporters want to get the bill done this year, fearful that new demands for spending in Iraq and Afghanistan -- combined with existing budget shortfalls -- will make the task impossible in later years. "If we miss this opportunity, it's going to take another seven to 10 years" to get a Medicare prescription drug benefit, said Senator Edward M. Kennedy, Democrat of Massachusetts and a key architect of the Senate bill.

Lawmakers say the biggest obstacle is the tepid response from senior citizens. Representative John Tierney, Democrat of Salem, held several meetings with seniors in his district during the August recess, and learned that they were unhappy with the proposals on the table. "People very quickly understood that unless you were extremely poor or had extremely high catastrophic drug costs, there isn't a lot in there for you," Tierney said.

While Congress once felt a strong political imperative to get a prescription drug bill, members and lobbyists are now worried that seniors might stage a reprise of their behavior in 1989, when Congress was considering changing Medicare to include catastrophic coverage. Retirees unhappy with the costs the changes would impose on them chased Dan Rostenkowski, who was chairman of the House Ways and Means Committee, in his home district, calling the Illinois Democrat a "liar" and a "chicken" for refusing to face their questions. The change was quickly reversed.

This year, House conservatives want to use the prescription drug bill as a way of overhauling Medicare, alarming Democrats and seniors who worry that the plan would move toward privatizing a program that has always been a guaranteed government benefit.

The House package would require Medicare to compete with private plans after 2010. But since private insurers could tailor their plans to attract younger and healthier seniors, those stuck in Medicare could find their premiums soaring to fund the higher-risk group of beneficiaries, said JoAnn Volk of the AFL-CIO.

Both conservatives and labor unions are concerned about independent estimates that about one-third of employers who now provide drug coverage to retirees would drop it, sending those people into the government plan.

That might mean worse benefits for retired union members, who may have given up pay increases in exchange for prescription drug coverage, Volk said. Moffit, the health policy analyst, cautioned that the expected shift would throw more people into a government program, further increasing costs.

Critics in both parties say President Bush is not taking a strong enough leadership role in the talks, an intervention both Democrats and Republicans say would be necessary to get a deal.

Tom Scully, administrator of the federal Centers for Medicare and Medicaid Services, said Bush is closely involved in the negotiations. But lawmakers and lobbyists alike say Bush needs to expand his role, detailing what kind of bill he could sign and then personally appealing to Republican members of Congress to give him a needed legislative win.

While Bush appeared poised to take the prescription drug issue away from the Democrats this year, he may suffer if no bill is approved. "One thing we learned when we were in power is that when you're in power, everything's your fault -- whether it's your fault or not," said Representative Barney Frank, Democrat of Newton.

Representative Rahm Emanuel, Democrat of Illinois, said the bill might be scrapped in favor of one small but popular provision to allow Americans to buy lower-cost drugs in Canada and perhaps other foreign nations. "I don't see how Ted Kennedy and [House majority leader] Tom DeLay agree on a bill," Emanuel said.

The New York Times reported today that Senate and House negotiators were considering means testing, whereby wealthier Medicare patients would pay higher premiums. Critics say such a plan would undermine the basic tenet of Medicare -- that it provides the same benefits to all retirees.

Some lawmakers are also floating the idea of a drastically scaled-back bill to serve two categories of people: those with low incomes and those with catastrophic prescription drug costs. Senator Max Baucus, Democrat of North Dakota and a conferee on the bill, rejected the idea as expensive and too narrow. But other lawmakers believe it's the only proposal that could win.

"It's my feeling now that we don't have a bill that could pass both houses," said Representative Dan Burton, Republican of Indiana. "We need to come up with a plan to help the people who need help."

Susan Milligan can be reached at milligan@globe.com.