Seniors' drug bill survives in House

WASHINGTON -- After an extraordinary overnight session of arm-twisting and parliamentary tricks, House Republican leaders narrowly staved off defeat yesterday and passed a Medicare prescription drug benefit that represented the most sweeping overhaul of the program in its 38-year history.

The measure would provide nearly $400 billion in prescription drug aid to seniors, and for the first time, allow private health care firms to offer Medicare services long guaranteed by the federal government. Its passage spared President Bush a political embarrassment over one of his top priorities as the administration fought to push through his agenda in the waning days of the legislative session.

The 220-to-215 vote was reached after a marathon lobbying campaign by Republican leaders and Bush, who was awakened before dawn yesterday to call Republicans who had already cast votes against the bill and persuade them to change their votes. While Democrats and other foes of the Medicare bill initially seemed to have won, 216 to 218, Republicans used their power as the gavel-controlling majority to hold the roll call open a record three hours while they worked on changing the minds of skeptical colleagues.

Arriving after a day in which Bush's energy bill all but died in the Senate, the hard-fought victory on Medicare displayed the difficulty Bush is having in promoting his agenda through an increasingly partisan and narrowly divided Congress. Legislators already have moved to reverse a Bush administration directive on media mergers and might deny the president an overhaul of overtime rules for workers. Both houses of Congress also approved loosening the embargo against Cuba, although the White House ultimately killed that legislation by threatening a veto.

Bush called the Medicare bill "historic" and said it "brings seniors one step closer to a modern Medicare system, one that includes prescription drugs and choices for seniors." The Senate is expected to take up final passage of the bill tomorrow.

The measure would provide prescription drug assistance for the first time to Medicare patients, paying 75 percent of costs up to $2,250 a year. The package includes a $250 deductible, with no coverage for out-of-pocket costs beyond $2,250 but below $3,600. After patients spend $3,600 on prescription drugs, they would be eligible for additional coverage.

No coverage would kick in until 2006, although next year seniors would be eligible for a drug discount card, which the Department of Health and Human Services estimates would provide patients with discounts of 15 to 25 percent.

To avoid a loss over the politically potent Medicare issue, the White House had to sway conservatives who balked at giving Bush a domestic policy prize. Health and Human Services Secretary Tommy Thompson was on the floor talking to legislators as Republican leaders frantically traversed the aisles, pleading with colleagues for support.

Shortly after 6 a.m., Republicans produced two legislators who switched their votes and helped the White House win its battle. A few Democrats then quickly changed their votes to align themselves with a bill endorsed by the AARP, a powerful seniors' group.

"I did not want to vote for this bill," said Representative Butch Otter, a Republican of Idaho who switched his vote. But he said his party's leaders warned him that if he helped kill the package, Democrats would come back with a more generous prescription drug package that did not include the reforms Republicans had wanted in Medicare, which provides health care for 40 million elderly and disabled enrollees.

Otter said he did not win money for a project in his district in exchange for his vote, and John Feehery, a spokesman for House speaker Dennis Hastert, Republican of Illinois, said he was unaware of any quid pro quo offered to any member of Congress in exchange for a vote.

"Lots of people said: `What do you want? What do you want?' " Otter said. "I said I wanted us to pay for this" so that the $395 billion in spending does not add to the budget deficit, projected to be $500 billion this year. Otter said Republican leaders, not Bush, convinced him.

Furious Democrats accused Republicans of misusing their procedural power. While Republican leaders fiercely enforce the 15-minute voting rule when an issue is going their way, Democrats said, they refused to slam the gavel down yesterday until they got what they wanted.

"We had hoped the Republicans would want to win this vote fair and square. They didn't," said House minority leader Nancy Pelosi, Democrat of California. "We won it fair and square, so they stole it by hook or crook."

The vote puts pressure on the Senate, which appeared headed toward a vote tomorrow approving the package. Some Democrats, including Senator Edward M. Kennedy of Massachusetts, still hope to stop the bill from becoming law, saying the legislation would raise seniors' Medicare premiums and threaten the future of the Great Society program.

"What happened in the House of Representatives in the dead of night was Florida 2000 all over again," Kennedy said, referring to the contested presidential election. "It was a rigged vote. Republicans are playing politics with Medicare, and our seniors will pay the price."

Kennedy said he would drop his filibuster threat in the Senate on Medicare if the House gives the matter a "fair vote."

The debate put House Republican leaders in the politically odd position of fighting for the creation of a new entitlement under Medicare. While many Republicans cringed at the 10-year, $395 billion cost, they hope the reforms they inserted in the package would encourage more private-sector competition. The measure would allow limited competition from private health care plans for Medicare patients, and greatly expand a program to give Americans tax breaks to save for their health care costs during retirement.

But those changes worried Democrats, who contend that the reforms would undermine the universal nature of Medicare and raise premiums for those who decided to eschew private plans for traditional Medicare. Under the proposal, patients' premiums would be tied in part to what private health companies could offer. Because those plans could "cherry-pick" their patients, older and sicker Medicare retirees would be left with traditional Medicare, and forced to pay more for the privilege, Kennedy said.

Kennedy's efforts to defeat the latest version of the bill began to falter after the AARP endorsed the package, calling it flawed but a good start toward providing drug coverage for their members. Democratic Senators John F. Kerry of Massachusetts and John Edwards of North Carolina planned to leave the presidential campaign trail to return to Washington and bolster opposition to the Medicare bill. But thin hopes of filibustering the bill in the Senate dwindled last week, when Senate minority leader Tom Daschle of South Dakota said he would not support a filibuster, and wavering Senators Olympia Snowe and Susan Collins, both Republicans of Maine, said they would support the package.

In addition to the prescription drug benefit, the measure also allows private health care plans, for the first time, to compete with Medicare for clients. While the experimental program would be limited to six metropolitan areas, Kennedy warned that the idea is the first step toward privatizing Medicare and taking away what has been a guaranteed benefit for all retirees, regardless of occupation or income.