Published on Saturday, November 22, 2003 by the New York Times
Divided House Approves Expansion of Medicare
by Robert Pear and Robin Toner
WASHINGTON, Nov. 22 - A divided House on Saturday approved the biggest expansion of Medicare since its creation, narrowly passing legislation that would help millions of elderly people buy prescription drugs while giving private health plans a huge new role in the program.
The vote came after a day of fast-paced developments on Capitol Hill, as opponents of the energy bill in the Senate blocked a final vote on the measure. Congress also struggled Friday to finish work on spending bills. Resolving one major issue snarling the spending measures, lawmakers said they had abandoned an effort to block new White House rules on overtime pay.
Mr. Bush immediately plunged into the Congressional debate upon his return from Britain on Friday afternoon. In a brief exchange with reporters after stepping off his helicopter, Mr. Bush urged lawmakers to accept the Medicare plan and, he blamed a ``minority of senators'' for holding up the energy measure.
``For the sake of our national security and economic security, the Senate's got to pass this bill,'' Mr. Bush said of the energy initiative.
Most House Republicans voted for the Medicare bill and most Democrats opposed it.
Final debate in the House began with Representative Deborah Pryce, Republican of Ohio, who declared, ``For those who are telling us to slow down, I say, seniors have been waiting for too long.'' Representative Bill Thomas, Republican of California, the chief architect of the bill, asked, ``If we are trying to destroy Medicare, why is the AARP supporting us?''
But Democrats asserted that Republican leaders were pushing through a bad bill in the middle of the night. The measure, they said, was laden with giveaways to insurers and drug companies and would shortchange the elderly people it was supposed to help.
Representative John Lewis, Democrat of Georgia, said: ``If this bill is passed, it would be a dagger in the heart of Medicare as we know it. This bill is a backdoor attempt by the Republican Party to privatize Medicare.''
At stake was a vast effort to remake the program that provides health insurance for 40 million elderly and disabled Americans.
The 678-page bill opens the traditional government-run Medicare program to new competition from private health plans, a goal long sought by conservatives. It also would add coverage for prescription drugs to the basic Medicare benefit, a goal of Democrats and Republicans alike.
In the Senate, the legislation also was moving quickly to a final vote, with more senators announcing support for the measure on Friday. Senator Tom Daschle of South Dakota, the Democratic leader, said he would not support any effort to block the bill by a filibuster, although he strongly opposes the legislation.
To the very end, House Republican leaders struggled to overcome the qualms of conservatives who complained that the bill would authorize a big increase in federal spending. Mr. Bush lobbied some House conservatives in phone calls from Air Force One. House Democratic leaders pleaded with members of their party to vote against the bill, which they said would undermine and privatize Medicare.
At a news conference earlier on Friday, Republican leaders including Bill Frist of Tennessee and J. Dennis Hastert of Illinois, joined by elderly Americans and the head of AARP, which endorsed the measure this week, asserted that the bill was the last, best chance to provide long-promised drug benefits.
Representative Tom DeLay, Republican of Texas, the House majority leader, argued, ``We must forget about ideological absolutes.''
But conservatives were restless, and Democrats were furious that the legislation, written in closed-door meetings without Democrat representation from the House, was being pushed through that chamber with little debate, just a day after the text was made public.
The bill's first tangible benefit would be available next spring, when elderly people could get Medicare-approved discount cards to help them secure lower drug prices.
Beginning in 2006, Medicare would offer a full-fledged drug benefit. After a person paid a $250 deductible, Medicare would cover 75 percent of the drug costs from $251 to $2,250 a year. Coverage would then be suspended until the beneficiary had spent $3,600 out of pocket. After that, Medicare would cover 95 percent of the cost of each prescription.
The bill offers billions of dollars in federal subsidies to private health plans to induce them to enter Medicare markets around the country. The most hotly debated provision would require the government-run Medicare program to compete with private health plans in six metropolitan areas beginning in 2010.
The political implications of the legislation were considered vast but largely unpredictable.
Copyright 2003 The New York Times Company