The Republican-controlled House advanced uncertainly toward a vote on historic Medicare prescription drug legislation early Saturday after a day-and-night struggle punctuated by presidential lobbying calls from Air Force One.

Medicare "can't sustain itself. Add a new benefit and modernize," said California Rep. Bill Thomas, a principal architect of the plan to make the most sweeping changes in the health care program for 40 million seniors and disabled Americans since its creation in 1965.

Democrats, pressured by their leaders to combat the bill and its supporters, did so with gusto. "We're faced tonight with people who want to destroy Medicare. They'll lie to us, they'll lie to seniors for the pure purpose of their own messianic desires," said Rep. Fortney "Pete" Stark.

At its heart, the legislation would create a new prescription drug benefit for 40 million Americans, at the same time it would usher in a new era of private health coverage for seniors who choose it over traditional Medicare. The measure carried a price tag of $395 billion, just under the $400 billion cap set by the president and congressional Republicans.

Bush made his calls on the trip home from a state visit to England as Republican leaders worked to hand him a legislative and political victory and Democrats dug in to defeat the measure.

GOP vote counters reported progress in rounding up support as they aimed for a middle-of-the-night vote. HHS Secretary Tommy Thompson traveled to the Capitol to help with the lobbying, yet Bush's intervention was a sign that additional help was needed.

At least one lawmaker who took a presidential phone call was unmoved.

"I basically said it was a matter of principle, that I came to Washington not to ratify and to expand Great Society programs," said Rep. Tom Feeney, R-Fla. "He wasn't happy to hear that," the first-term lawmaker added of the president.

Two other first-term lawmakers, Reps. Marsha Blackburn of Tennessee and Trent Franks of Arizona, got the presidential pitch, as well. Neither would disclose how they intended to vote.

Facing defections, Republicans conceded they would likely need a handful of Democrats to prevail. House Democratic Leader Nancy Pelosi labored to prevent that, having called opposition a "party position."

Approval of the bill would send it to the Senate, where the path to passage seemed far easier — in part because of the decision of a growing number of Democrats to support the measure.

The bill's scope was vast.

Beginning next year, seniors would be able to purchase discount drug cards that the Bush administration estimates would yield savings of between 15 percent and 25 percent. The card program would expire in 2006, when beneficiaries would gain access to a prescription drug benefit for the first time.

The bill also encourages private insurance companies to establish new managed care plans for seniors, either as preferred provider organizations or HMOs. While Medicare currently includes an option for private coverage, most beneficiaries currently receive their health care as a standard, government-defined benefit that does not vary from one region of the country to another.

For the first time, the legislation would also require seniors with annual incomes over $80,000 to pay higher premiums under Medicare Part B, which covers services outside the hospital. Also, it would establish new tax-preferred health accounts, open to individuals with high-deductible insurance policies.

The measure also included billions of dollars to discourage companies from reducing coverage for their retirees. At the same time, it would retain the existing ban on the importation of lower-cost prescription drugs from Canada, unless the FDA (news - web sites) certified their safety.

The tax provision and requirement for higher premiums were part of an effort to appeal to conservatives who favor transforming Medicare and restraining its cost, yet find creation of the new prescription drug benefit distasteful.

Many Democrats argued that some of the conservative-backed elements of the bill were too dear a price to pay for the drug benefit, in particular a provision creating a limited experiment in direct competition between private plans and traditional Medicare beginning in 2010.

"This is a defining issue," said Rep. Jim McGovern, D-Mass, as he made the case for rejecting the measure. "This bill is a huge giveaway to the prescription drug companies. And worst of all, this bill shoves Medicare down that path toward privatization."

But Republican supporters said the legislation would provide better health care for seniors. "I think this bill has a great chance of injecting competition into the system," said Wisconsin Rep. Paul Ryan.

Support for the measure appeared to be building in the Senate. John Cornyn, R-Texas, who voted against a bill that cleared the Senate in June, said he would support the revised version. The previous measure, he said, lacked "the incentive for private plans to develop their coverage."

Senate Democratic Leader Tom Daschle said he would not support a filibuster if opponents launched one, and some rank-and-file members of his party announced their backing for the bill.

Sen. Kent Conrad was one, citing the presence of $25 billion in funding to help rural hospitals and health care providers as one reason. In addition, the North Dakota Democrat said he had received assurances of help to change a situation under which Medicare pays hospitals in Bismarck less money than facilities in Fargo, not quite 200 miles away.

Republicans staged a campaign-style event in the Capitol to stress the benefits of the legislation, and gave a prominent spot to William D. Novelli, CEO of the AARP. The organization's decision to endorse the bill marked a pivotal moment in the GOP effort to forge a House-Senate compromise. The AARP's heavy advertising campaign also gives powerful political support on an issue long-favored by Democrats.

Close

Today's Top News		Top International News
+Taiwan separatists target Olympics ( 2003-11-21) +Showtime arrives for foreign investors ( 2003-11-21) +Unregulated `green' labelling blackballed ( 2003-11-21) +China summons US ambassador over textiles quota ( 2003-11-21) +Building a sound economy ( 2003-11-22)		+GOP presses for vote on medicare overhaul ( 2003-11-22) +Bush's 2004 election campaign ad. condemned ( 2003-11-22) +Boeing may continue layoffs into 2004 ( 2003-11-22) +Guerrillas fire rockets at fortified Baghdad sites ( 2003-11-22) +Republicans running first Bush Ad in Iowa ( 2003-11-22)