More than two-thirds of the members of the House are pushing to increase outlays for Medicare providers even though the White House has shown reluctance to approve a huge provider spending package.

A letter sent Tuesday to House Speaker Dennis Hastert, R-Ill., and Minority Leader Nancy Pelosi, D-Calif., bore the signatures of 293 House members.

"We are seriously concerned that many Medicare beneficiaries in our districts are losing access to vitally important health care services due to the inadequacy of current Medicare payment rates," the letter said, citing problems for nursing homes, physicians, hospitals, HMOs and other providers. "Congress must take immediate action to address this urgent crisis."

Reps. Benjamin Cardin, D-Md., and Dave Camp, R-Mich., led the letter-writing effort.

The issue of payments to Medicare providers has been an issue on Capitol Hill for some time. Many lawmakers have said money is needed for providers because of reductions Congress made in Medicare allocations when it balanced the budget in 1997.

The Bush administration has resisted the pressure for additional money. White House budget chief Mitchell Daniels said in October that the nation could not afford another huge provider package and noted that lawmakers already have restored some of the money from the 1997 cuts.

Congress sent $32.7 billion to providers two years ago. Last year, the House included $30 billion for Medicare providers in a prescription drug bill, and several senators led an effort for a $43 billion provider package. Neither package made it to final passage.

Instead of advocating payments for all providers, the administration has said it agrees with lawmakers on the need to fix a formula that calculates Medicare reimbursements for doctors. The formula relies on the state of the economy, which is now struggling. Doctors' payments have been millions of dollars less than they had expected because of the problem.

A provision in a budget bill passed by the Senate last week would prevent a Medicare payment cut for doctors from taking effect in March as scheduled. The Senate bill also included money to increase payments to rural and small urban hospitals. The Senate and House must negotiate a compromise because that language is not in the House version of the bill.