GOP's Medicare plan starts on tough path


WASHINGTON -- The House Democratic leader, Rep. Richard A. Gephardt, said yesterday that Democrats would do "everything we can" to slow down Republican legislation to make vast changes in Medicare, the federal health insurance program for the elderly and the disabled.

Republican leaders say they will unveil their Medicare proposals in the next few days and take the legislation to the House floor early next month, as part of a sweeping bill to balance the federal budget and prevent Medicare's Hospital Insurance Trust Fund from going bankrupt.

The bill would slow the growth of Medicare spending and create incentives for elderly people to join health maintenance organizations and other private health insurance plans.

The bill is supposed to cut projected Medicare spending by $270 billion, or 14 percent, over seven years. The Republicans have said they will include a mechanism to make automatic cuts in payments to doctors, hospitals and health plans if Medicare does not achieve enough savings in other ways, such as increased use of health maintenance organizations.

The Republicans have not disclosed how the mechanism would work, and the Congressional Budget Office is having difficulty computing the amounts of money that would be saved through use of such a mechanism. In the past, the budget office has assumed that such cost controls would be "reasonably but not totally effective," and it has been willing to recognize the savings only if the legislation described the cost controls in some detail.

On behalf of the House Democratic Caucus, Rep. John D. Dingell of Michigan yesterday introduced a resolution demanding at least four weeks of hearings on the Republicans' Medicare proposals.

Mr. Gephardt said: "We are going to do everything we can to slow this process down so the American people have a chance to know what's happening." Moreover, he said, "We think it's an outrage, an absolute outrage, that the Republicans are bringing these proposals" to the floor with little opportunity for public scrutiny.

Republican Speaker Newt Gingrich of Georgia said he welcomed the Democrats' demands as "a positive first step" showing that they might be constructively engaged in formulating changes in Medicare policy.

"We are going to have hearings on this," Mr. Gingrich said. "People will have a chance to look at it, and we will accept modifications. It would be wonderful if the Democrats changed their negative tactics and decided they would like to participate."

Rep. Bill Archer, a Texas Republican who heads the Ways and Means Committee, said: "It is unfortunate that the Democrats would rather delay and obstruct our efforts to save Medicare than offer a plan of their own. But I suppose when you have no plan of your own to offer, your alternative is to be misleadingly critical of others."

Mr. Archer said his committee had held 26 hearings on Medicare and would hold one more, on Sept. 21.

House Republican leaders will brief Republican lawmakers on the Medicare proposals at a four-hour session today. Mr. Gingrich will discuss the proposals tomorrow at a forum sponsored by the U.S. Chamber of Commerce. Ross Perot, who is considering running again for president as an independent, is scheduled to attend.

The Senate Finance Committee is working on a Medicare plan similar to the one being drafted by House Republicans. But its efforts have been disrupted by the sudden departure of its chairman, Republican Sen. Bob Packwood of Oregon.

Mr. Packwood stepped down as chairman last week and announced that he was resigning from the Senate after the Ethics Committee recommended his expulsion on charges of personal and official misconduct.

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