Senate fight on Medicare bill heats up


WASHINGTON - Senate Democrats are mounting an intense effort this week to kill a sweeping Medicare overhaul measure that would add prescription drug benefits to the 38-year-old program, hoping to derail Republican leaders' plan to send the bill to President Bush by Thanksgiving.

But several Democrats have come out in favor of the bill or are leaning toward supporting it, and their leaders acknowledge that they do not have the 60 votes they would need to block it. They expect to fail today in their efforts to prevent the Senate from going forward with the legislation, which would be the broadest expansion of Medicare since its creation in 1965.

"We don't have the votes right now" to halt the bill outright through a filibuster, Minority Leader Tom Daschle of South Dakota said yesterday on NBC's Meet the Press. Daschle has said he will not support efforts to block a final vote.

Majority Leader Bill Frist, a Tennessee Republican, expressed confidence yesterday that the Democrats' stalling tactics would not succeed. "They simply can't obstruct," he told CNN.

But Democrats are preparing to raise several objections to the bill - some of them based on its effect on the federal budget, which is projected to face a deficit next year of about $480 billion - and to force votes on them. "We're going to fight this bill with all we've got," Daschle said.

Final approval of the legislation would hand Bush an important victory that could boost his re-election chances next year. The measure would set aside $400 billion over the next decade to add prescription drug benefits to Medicare and would give private insurers a new role in covering senior citizens and the disabled.

The House narrowly approved the measure early Saturday morning after the longest vote in the chamber's history. Republican leaders spent three hours pressuring conservatives who opposed the bill to switch their votes and back it. The final vote was 220-215.

Those tactics moved Sen. Edward M. Kennedy, a Massachusetts Democrat who had voiced fierce opposition to the bill, to threaten Saturday that he would filibuster it. Sen. John Kerry, a Massachusetts Democrat who has been crisscrossing the country seeking his party's presidential nomination, returned to Washington to make a rare appearance on the Senate floor yesterday in support of the filibuster.

Sen. John Edwards of North Carolina, another Democratic presidential contender, also showed up to speak against the bill.

Still, many Democrats see political peril in blocking the Medicare measure because the idea of adding prescription drug benefits to the program is so popular among senior citizens, who vote in disproportionately large numbers. The stakes went up last week when the AARP, the powerful group representing 35 million seniors, strongly endorsed the bill. The group is spending millions of dollars on a TV advertising campaign urging Congress to approve it.

The measure would allow seniors to choose between staying in traditional government-run Medicare or joining private plans to receive health services and drug coverage.

Private companies would also offer the prescription drug coverage, starting in 2006. Seniors would pay a monthly premium of about $35 and have a $250 deductible before the government began covering 75 percent of their drug costs, up to $2,250. They would be responsible for all prescription costs between $2,251 and $3,600, after which the government would step in again and cover 95 percent of all remaining expenses. Low-income beneficiaries would receive more help.

Under the bill, seniors would also get a card next year allowing them to buy drugs at discounted prices until the drug benefit takes effect in 2006.

Democrats have voiced concern about the drug benefit, especially the gap in drug coverage between $2,251 and $3,600. They are also concerned about the role that private insurers would have. Though private plans would have to provide benefits equivalent to Medicare's, they wouldn't have to be exactly the same. And so some Democrats worry that that might open the door to reducing benefits.

The measure sets aside $12 billion for insurers to encourage them to cover Medicare beneficiaries. It would also create a test beginning in 2010 in six metropolitan areas where Medicare would compete with private companies to see which could cover senior citizens more cheaply. The government would then base its subsidy on those bids - a system many Democrats say would result in skyrocketing premiums for those who chose to stay in traditional Medicare.

The measure "is a right-wing program to privatize and voucherize Medicare," Kennedy said yesterday. "It asks the elderly to swallow unprecedented and destructive changes to the Medicare program in return for a limited, inadequate, small prescription drug benefit."

Conservative Republicans are as uncomfortable with the measure as many Democrats, although for different reasons. They oppose adding an entitlement to Medicare without adding substantial private-sector competition and other measures to help control the costs of the program.

Analysts have long said that the program will go broke if it keeps growing at its current rates, and several prominent conservatives - including former House Majority Leader Dick Armey, a Texas Republican - have said the measure recklessly piles more federal money on a program that is too big.

"We have an unhealthy foundation that we're building a brand new deck for," Sen. Don Nickles, an Oklahoma Republican and chairman of the Budget Committee, said yesterday. "We are not paying for these new benefits. We are saddling our future generations with enormous liabilities."

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