Officials, Lawmakers look for Solution to Medicare Cost Hike

WASHINGTON – Senior Bush administration officials and lawmakers searched Monday for ways to control unexpectedly large future increases in the cost of Medicare (search), but one participant in the talks said no agreement was likely that would compel Congress (search) to act.

"There's going to be a fig leaf so people can say we're doing something to control costs," predicted Sen. Charles Grassley (search), R-Iowa, stressing that the description was his.

In comments to reporters, Grassley also said negotiators had made "great and satisfactory progress" on proposals to increase federal funding for rural health care providers under the Medicare bill. He offered no details, but other officials said at least $25 billion would be set aside for that purpose.

The closed-door discussions were the first since late last week, when Senate Democrats wrote President Bush to outline a series of conditions that Republicans would have to satisfy if Medicare legislation were to gain bipartisan support.

In their letter, Democrats were particularly sharp in their criticism of proposals to cap spending on Medicare, which has historically been a benefit program open to all who qualify. They also attacked Republican proposals to force traditional Medicare to compete directly with new private health plans.

Both the House and Senate passed legislation earlier this year to create a new prescription drug benefit as well as introduce private market competition into the government-run program that provides health care to 40 million disabled and older Americans.

Negotiations on a compromise have been intense in recent weeks, as a core group of lawmakers from the House and Senate struggled to resolve hundreds of large and small differences between the bills. While lawmakers have reported significant progress in recent days, the letter issued last week by Democrats underscored the difficulties still ahead.

"We've got a long way to go," Health and Human Services Secretary Tommy Thompson said after the first of Monday's two meetings.

At the same time, there were fresh indications that bargaining was nearing a conclusion.

Apart from the rural health care issues, Grassley said the House and Senate were near to agreement on controversial proposals to scale back payments to doctors who administer certain drugs to fight cancer and other diseases.

Senate Republicans scheduled a meeting for Tuesday to bring members of the rank and file to speed on negotiations. Such meetings are customarily held when leaders believe complex or controversial legislation is nearing completion.

Josh Bolton, the Bush administration's budget director, joined the talks for the first time in the afternoon as the discussion turned to GOP proposals to contain unexpectedly large costs in the future.

Efforts by House Republicans to force a vote in Congress in such circumstances appeared unlikely to succeed, largely because of a reluctance to abandon the Senate's cherished right of unlimited debate, according to several officials who spoke on condition of anonymity.

Under the Senate's rules, nearly all bills may be debated until supporters gain 60 votes, a supermajority that is difficult to achieve on contentious issues. As the minority party, Democrats have used such rules this year to prevent votes on some of the president's judicial nominations, for example.

In private talks, Democrats have refused to waive or dilute that right for future Medicare cost control legislation, fearing Republicans would have an easier time pushing through spending restrictions.

At the same time, according to GOP officials, conservative Republicans had second thoughts when they considered a future in which Democrats might hold power in the Senate and seek tax increases to increase funding for Medicare.