WASHINGTON – Seeking votes for a Medicare (search) prescription drug bill, House Republican leaders are likely to add a provision to speed the availability of lower-cost generic medicine, officials said Tuesday.
At the same time, the GOP leadership looked to President Bush to help shore up support from balky conservatives concerned that the measure does not go far enough to introduce free-market forces into the 38-year-old government program.
"I feel confident we will have the votes" to pass the bill, Rep. Roy Blunt (search), R-Mo., the House GOP whip, told reporters.
House Republican leaders worked to build support behind their bill while Democrats sought unsuccessfully to sweeten the drug benefit contained in a companion Senate measure. Proposals to eliminate a $1,300 gap in coverage, expand the group of seniors qualifying for low-income subsidies and have the program take effect in 2004 instead of 2006 all fell to a bipartisan coalition shepherding the bill toward passage later this week.
Key senators and the Bush administration worked toward agreement to spend $12 billion to showcase competing visions for Medicare. Under the emerging compromise, Republicans would satisfy their demand to have $6 billion spent testing the feasibility of health care plans run by private companies.
For their part, Democrats would meet their goal of $6 billion to gauge public reaction to an experimental program in which traditional Medicare would be expanded to include preventive care and selected other services.
While a relatively small amount of money was involved -- $12 billion out of $400 billion in the overall bill -- the issue took on outsized importance because it reflects the deep philosophical differences on Medicare between Democrats and Republicans.
"It seems to us to be a very reasonable compromise," said Tom Scully, head of the federal agency that runs the Medicare program.
Each of the rival bills in the House and Senate would create a new prescription drug benefit under Medicare, to be offered by private insurance companies and subsidized by the government.
In addition, they would create a new managed care option for older people, who could choose to receive health care from preferred provider organizations -- along the lines of coverage that millions of workers now have -- or from traditional, government-run Medicare.
Bush repeatedly has urged Congress to enact legislation this year. While he supports the new drug benefit, he also stresses a goal of a modernized Medicare that would give seniors more choices while shoring up the finances of the 38-year-old program.
The House and Senate bills are similar at their core, but wide differences remain. The House measure is almost exclusively a product of the Republicans, and thus is tilted more to satisfy conservatives with inclusion of provisions that Democrats argue would lead toward privatization.
Even so, conservatives have grumbled that it skimps on their goal of adding free-market competition to Medicare. Bush invited several lawmakers to the White House on Wednesday to try to reassure them.
While the Senate bill is a more bipartisan product, Democrats spent the day advancing proposals designed to underscore their differences with Republicans.
Sen. Barbara Boxer (search), D-Calif., led the fight to eliminate a feature of the bill that would deny coverage for drug costs between $4,500 and $5,800 annually. "We should not have a plan that stops and starts," she said, advocating an extra $60 billion to close the gap.
Sen. Rick Santorum, R-Pa., argued that the cost was excessive and would raise spending beyond the $400 billion allocated by Republicans for the next decade. The vote to kill the proposal was 54-42, with all 51 Republicans and three Democrats in opposition.
Also sent down to defeat was a proposal by Sen. Frank Lautenberg, D-N.J., to inaugurate the drug benefit on July 1, 2004, rather than 2006. The vote was 54-41. A third Democratic proposal that would have provided low-income subsidies for more seniors also fell on a vote of 54-41.
A proposal by Sen. Mark Dayton, D-Minn., to limit members of Congress to receiving the same prescription drug benefit that seniors receive under Medicare passed on a vote of 93-3. Republican aides said it would not be part of the final legislation that reaches Bush's desk.
Several sources said a generic drug proposal probably would be added in the House. A separate plan to permit the importation of brand name pharmaceuticals from Canada could also be added.
The Senate voted overwhelmingly last week in favor of plans to speed the entry of generic drugs to the marketplace and allow pharmacists to import brand-name drugs from Canada, where they are often less expensive.
No details were immediately available on the provisions that House leaders were considering, but a decision to include either one in the House bill would greatly increase the chance it would survive the final House-Senate negotiations and become part of the compromise that reaches Bush's desk.