GOP leaders struggled to clinch Medicare deal
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WASHINGTON (AP) -- Republican congressional leaders struggled to clinch a deal on a Medicare prescription drug bill Saturday after reaching a tentative compromise on conservatives' demand for competition within the federal health program, officials said.
These officials said agreement remained elusive on a plan to discourage private companies from dropping existing health coverage for retirees once the new government drug benefit begins in 2006.
In his weekly radio address, Bush made another pitch for the legislation, which he wants by year's end. "Congress has an historic opportunity to give all our seniors prescription drug coverage, health care choices and a healthier, more secure retirement," Bush said.
The president said lawmakers "have already agreed to ... clear-cut improvements to Medicare."
The changes would give a drug benefit for Medicare's 40 million older and disabled Americans and encourage private insurance companies to offer the elderly the choice of health coverage under Medicare, managed care plans or new preferred provider organizations. Those organizations encourage patients to use doctors inside a network but allow them to see others physicians for an extra charge.
The president omitted any mention of direct competition between traditional Medicare and the new private plans, which critics contend would drive up premiums for people who opted to stay in traditional Medicare. The government-run program allows beneficiaries to choose their doctors and hospitals.
Democrats strongly oppose the competition. Even Republicans are divided over the extent of competition traditional Medicare should face.
Several officials said the tentative agreement on competition calls for a temporary program in six metropolitan areas. One of these sources said the program would include one of the largest cities, one of the smallest metropolitan areas and an urban center that crosses state lines.
Selection would be made among areas where a large percentage of Medicare beneficiaries is enrolled in managed-care plans, either existing health maintenance organizations or newly envisioned preferred provider organizations.
As GOP conservatives in the House pushed for as much competition as possible, several Republican senators voiced concerns.
Two senators are seeking to shelter their states from any competition plan, officials said Friday.
Sens. Gordon Smith of Oregon and Arlen Specter of Pennsylvania have lobbied GOP leaders about the impact back home, where some cities are candidates for tests of the proposed new system. Sen. Jon Kyl of Arizona also worried about the effect in his state, officials said.
Specter wrote top Republicans recently that Pittsburgh and Johnstown in his state meet the criteria for an experimental program under discussion and argued that people "who are negatively affected by this proposed demonstration must be indemnified."
Phoenix and Tucson, Arizona, as well as Portland, Oregon, also would be prime candidates for the proposed temporary program, which would last up to six years.
The heart of the legislation is drug coverage that older Americans could purchase for $35 a month beginning in 2006. Bush said the plan would cut "annual drug bills roughly in half" for the quarter of older Americans who lack insurance for prescriptions.
Beneficiaries would get a drug discount card in 2004 and 2005 that would offer discounts averaging 15 percent.
In both cases, the president said, "Seniors with the greatest need will get the most help," in the form of government subsidies on the drug card and drug coverage.
While agreeing to the largest expansion in Medicare's 38-year history -- the $400 billion prescription benefit -- Republicans have been keen to widen the role of private insurers.
GOP congressional leaders took over negotiations in recent days, resolving most questions.
But an earlier accord to spend at least $80 billion in an effort to discourage private companies from curtailing or dropping health coverage for their retirees has been reopened, several sources said.
Sen. Don Nickles, R-Oklahoma, one of the participants in months of talks, has complained that the pool of money is too large. Sen. Max Baucus, D-Montana, another negotiator, and AARP, the influential seniors' organization, are seeking to add even more money, officials said
To control costs, the president would propose, and Congress would consider, legislation in the future if Medicare spending should rise higher than expected.
Lawmakers also have agreed essentially to maintain a ban on importing cheaper prescription drugs from abroad, despite the issue's popularity across the country and in Congress.
Copyright 2003 The
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