Will Medicare Issues be Resolved?

by David Tamasi

WASHINGTON - They are almost all Republicans, meeting behind closed doors in an effort to resolve their differences. But time is running out for Congress to complete its work on what would be the most significant overhaul to Medicare in 40 years.

"I've always thought failure was not an option," said Massachusetts Senator Edward M. Kennedy. "But we are in the last moments of the final inning."

Republican congressional leaders have said they wish to recess this month, but first they'd like to pass a Medicare bill that is a domestic priority for them and for President Bush. But one moderate Republican whose support is considered crucial to ultimate passage is not so sure the issue will be resolved.

"I am pessimistic that a bill will get finished," said Sen. Lincoln Chafee, R-Rhode Island.

Last summer, both the House and Senate approved a $400 billion, 10-year package that would revamp the health care system for seniors and, for the first time, provide them a prescription drug benefit. Yet the bill has been hamstrung by differences between House and Senate versions, particularly a House provision that would allow direct competition between private-sector plans and Medicare.

Democrats say such competition would eventually leave seniors without care. Republicans, prodded by conservatives in the House, have insisted that private plans be allowed to compete.

In June, the House passed its Medicare bill 216-215 amid last-minute arm-twisting by House GOP leaders. With only a one-vote margin, the House leadership is keenly aware of the value of every Republican vote. Therefore, various coalitions that emerge on the legislation can hold disproportionate sway over negotiations. For example, 42 House conservatives have threatened to oppose any bill that does not contain the provision for private competition.

In the Senate, Republicans must placate the concerns of moderate Senate Democrats and the liberal Kennedy, who long has been a leader on Medicare and who is the senior Democrat on the Senate Health, Education, Labor and Pensions Committee. Kennedy supported the Senate version of Medicare, bringing with him Democrats who might otherwise have voted against the measure. As a result, his continued support is vital to the life of the bill.

"They need to keep the Senate Democrats happy and the House Republicans happy," said Congressman Martin Meehan, D-Lowell.

The two Republicans attempting to bridge the gaps are House Ways and Means chairman Bill Thomas of California and Senate Finance Committee chairman Charles Grassley of Iowa. They have engaged in several public disputes over the last few months, which has done little to inspire confidence that compromise can be reached.

"The disagreements between Thomas and Grassley are issues affecting who they represent and not between them personally," Chafee said.

Grassley reportedly wants to ensure that $25 billion goes to Medicare payments for rural states. Thomas is said to oppose that provision.

Democrats, meanwhile, have protested the fact that only two of their members--Senators John Breaux of Louisiana and Max Baucus of Montana--have been allowed to participate in the negotiations,. Last week, Congressman Charles Rangel, D-New York, attempted to join the Medicare discussions but was not permitted, Meehan said.

"There is a long way to go," he said. "To get the biggest issues resolved, you need to get Democrats a seat at the table."

It is likely to take congressional aides six to eight days to draft legislative language once an agreement has been reached. In addition, the Congressional Budget Office must review the bill to ensure it does not exceed its limit of $400 billion.

Many Congress members and advocates for senior citizens worry that if a Medicare bill is not completed this year, it will fall victim to presidential politics in 2004. But Congressman John Tierney, D-Salem, said he does not necessarily think that will be the case.

"It will be harder to get a bill next year in an election year," Tierney said. But, he said, "I don't know why that has to be a matter of course."

Tierney said that it was "politically imperative" for the President to get a Medicare bill but questioned whether the bill would contain enough for Senate Democrats to support it.

The Bush administration reportedly has agreed with House Republicans to seek possible cutbacks in Medicare benefits, including the prescription drug plan, if the program's costs exceed $400 billion.

House and Senate negotiators are scheduled to continue their daily negotiations until at least Veterans Day, Nov. 11.