WASHINGTON – Republicans pushed Medicare prescription drug legislation through a weary House early Friday, rejecting Democratic claims the bill was an election-year gimmick that would do little to help senior citizens.
The 221-208 vote fell largely along party lines, and sent the measure to an uncertain fate in the Senate.
"This bill is a giant step forward for seniors in America," said Rep. Nancy Johnson, R-Conn. "This is the greatest leap forward for women in health care since the founding of Medicare."
In a debate that stretched well past midnight, Democrats countered the legislation marked the latest in a long string of GOP attacks on a program created in 1965. "There's no assured benefits and there's no set premiums because the Republicans are privatizing Medicare," said Rep. James McDermott, D-Wash. "They are giving this whole benefit to the private insurance companies."
The legislation provides $320 billion over the next decade to establish a system of Medicare prescription drug coverage through the private insurance industry. The program would begin in 2005.
Costs would be heavily subsidized for low-income Medicare beneficiaries. Under a typical plan, others would pay a monthly premium of roughly $33 and an annual deductible of about $250.
The government would pay 80 percent of the next $1,000 of drug costs and 50 percent of the subsequent $1,000.
All beneficiaries — low-income included — would have to pick up the tab beyond that, until they reached $3,700 in out-of-pocket expenses, at which time all additional costs would be covered.
The measure also provides billions of dollars in increased Medicare payments to hospitals, doctors and nursing facilities.
Democrats said the Republican bill was more loophole than coverage — focusing principally on the gap between $2,000 and $3,700.
"They are so intent on trickery and deception and illusion," Rep. Dick Gephardt of Missouri said of the Republicans.
"They are so interested in politics and the next election rather than doing simply what is right for the American people," the Democratic leader added at a news conference hours before the debate began.
Democrats prepared a far more costly alternative that would offer a new government-run prescription drug benefit under Medicare. It included a $25 monthly premium, a $100 deductible and no gap in coverage.
Cost estimates ranged from $800 billion to $1 trillion or more for the plan, but no official figures were available.
In the end, the bill had the support of 212 Republicans, eight Democrats and one independent. Opposed were 199 Democrats, eight Republicans and one independent.
The vote was prelude to an election-year battle on an issue of paramount concern to senior citizens, a group that votes in disproportionately large numbers in midterm elections.
Republican strategists said passage of the bill through the House would help their candidates blunt the inevitable Democratic campaign commercial attacks. Polling shows that Democrats are heavily favored over Republicans in their handling of the issue — 48 percent to 31 percent in one private GOP poll.
But if the 2000 campaign is any guide, Republicans will be ready with their own commercials, trumpeting passage of a plan offering prescription drug coverage to 39 million Americans on Medicare.
Democrats argued that the GOP measure, as written, would mean huge profits for the pharmaceutical industry and would lead the way to privatizing the health care program established in 1965.
There was little doubt that the drug industry favored the measure. The Pharmaceutical Research and Manufacturers of America, the industry's trade group, has spent millions of dollars helping finance television commercials in scattered locations to support the measure.
Republicans said their approach would give senior citizens access to prescription drug coverage through the private insurance market. They circulated an estimate from the Congressional Budget Office that 89 percent of all beneficiaries enrolled in Medicare would participate in the prescription drug program. Another 7 percent of all beneficiaries have other coverage, the CBO said.
In the run-up to the vote, GOP leaders sought to win the support of several Republicans seeking changes or additions to the measure.
Some conservatives objected to the creation of a new government benefit program that was guaranteed for all seniors, while others objected to the price tag.
Others sought inclusion of provisions to bring down the cost of prescription drugs, such as importation of U.S.-made pharmaceuticals sold more cheaply abroad and revised patent rules to make low-cost generic drugs more available.