Bush To Sign Medicare Legislation; Democrats Strategize Changes

President Bush plans to sign the Medicare legislation (HR 1) passed by Congress last month in a ceremony on Monday, White House Press Secretary Scott McClellan announced on Tuesday, CongressDaily reports (CongressDaily, 12/2). The Senate passed the bill last Tuesday on a 55-44 vote, just three days after the House approved the legislation 220-215 in a three-hour roll call vote (California Healthline, 12/1). Some Democrats who oppose the Medicare bill have begun formulating a strategy to change the legislation's provisions, The Hill reports. The Democrats hope to secure a broad base of public support for their efforts to change the bill by illustrating what they believe are the legislation's shortcomings, according to The Hill. Changes Democrats hope to make include:

Reimportation: Democrats will likely seek to add language to the drug reimportation provision, which currently would allow U.S. residents to purchase medications from Canada only if the HHS secretary certifies the practice. Democrats have said that HHS Secretary Tommy Thompson is unlikely to do so because neither the current nor the previous presidential administrations supported the practice.
Prescription drug prices: Democrats also might seek to address prescription drug prices, in part by working to repeal a provision in the Medicare legislation that would prevent HHS from using its purchasing power to negotiate lower drug prices. Senate Minority Leader Tom Daschle (D-S.D.) has introduced legislation intended to give HHS the power to negotiate lower prices.
Drug benefit: Democrats hope to address the gap in prescription drug coverage (Marre, The Hill, 12/3). Under the bill, Medicare beneficiaries would pay an estimated average premium of $35 per month and an annual deductible of $250 for prescription drug coverage. Beneficiaries would have to pay for 25% of their annual prescription drug costs that do not exceed $2,250 and 100% of their costs between $2,250 and $5,100, and Medicare would cover 95% of their costs that exceed $5,100 (California Healthline, 11/25). Sen. Barbara Mikulski (D-Md.) said that she plans to work to "try to redirect these enormous subsidies that are going to insurance companies and put them back into where they should be."
Competition provision: Daschle has also introduced legislation that would eliminate the pilot project calling for traditional, fee-for-service Medicare to compete with private health plans in six areas.
Health savings accounts: Democrats also hope to eliminate the provision in the bill that allows the creation of tax-preferred health savings accounts.

Strategy

Sen. Edward Kennedy (D-Mass.) said that maintaining the current Medicare system is one of the bases of the Democratic strategy. "We are confident that seniors are going to ask the Congress to revisit this issue very soon," Daschle said. According to The Hill, Democrats will need help from AARP, which endorsed the legislation. According to John Rother, AARP's policy director, the group hopes to work with Democrats to improve the bill's cost-control mechanisms and fill the gap in prescription drug coverage. Democrats also are likely to receive help from Sen. Max Baucus (D-Mont.), one of the two Democrats who participated in the Medicare conference committee. Baucus supported the final bill but has said there is room for improvement, according to The Hill. Because Republicans are the majority party in both chambers of Congress, the chances of Democrats enacting meaningful changes to the bill are "slim," because the conservative Republicans who voted against the bill will be opposed to adding "costs to an entitlement they think is already too expensive," The Hill reports (The Hill, 12/3).

No Need for Retaliation, Conservative Opponents Say

Some conservative Republicans who voted against the Medicare legislation largely because of concerns that the addition of a $400 billion prescription drug benefit "violated the principle of limited government" are urging the Bush administration and congressional leaders "not to retaliate" against them for their "no" vote, the Washington Times reports. In total, nine Senate Republicans and 25 House Republicans opposed the Medicare bill. Sen. Lindsey Graham (R-S.C.), who voted against the bill, said, "The White House won, so it should see no need to retaliate -- it would be self-defeating." Rep. Mike Pence (R-Ind.), who voted against the bill, said, "My experience is that this [Republican] majority is interested in winning much more than in payback. All 25 of us ... took a principled stand without regard to our personal interests, and the leadership will very likely accept its victory and move on." Republican supporters and opponents both agreed that the "practical politics" of Bush's re-election campaign should dissuade party infighting, according to the Times. House Majority Leader Tom DeLay (R-Texas) said the Medicare legislation is a win for both conservative and moderate Republicans, adding, "We won an important political and policy victory for conservatives by passing the Medicare reform bill" (Hallow, Washington Times, 12/3).

Broadcast Coverage

The following broadcast programs reported on the Medicare legislation:

CNN's "Wolf Blitzer Reports": The segment examines the issue of uninsured U.S. residents, "a growing crisis that's largely ignored" in the midst of Medicare reform. The segment includes comments from Families USA Executive Director Ron Pollack (Rogers, "Wolf Blitzer Reports," CNN, 12/2). The full transcript is available online.
NPR's "All Things Considered": The segment examines the "low-key approach" of pharmaceutical companies and lobbyists, including the Pharmaceutical Research and Manufacturers of America, to Medicare reform. The segment includes comments from Senate Majority Leader Bill Frist (R-Tenn.) and Washington Analysis Corporation Executive Vice President Ira Loss (Overby, "All Things Considered," NPR, 12/2). The full segment is available online in RealPlayer.
NPR's "Tavis Smiley Show": Smiley interviews regular commentator Antonio Gonzalez about his "deep concerns" over the Medicare bill and the Congressional Hispanic Caucus' unanimous opposition to the legislation (Smiley, "Tavis Smiley Show," NPR, 12/2). The full segment is available online in RealPlayer.

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