Chances of Final Passage of Medicare Legislation Are 50-50, Some Observers Say

With members of the conference committee charged with reconciling the House and Senate Medicare bills (HR 1 and S 1) scheduled to meet today for the first time since July, some key lawmakers and lobbyists have said the chance of passing a final compromise bill may be only 50-50, the Los Angeles Times reports. The coming negotiations for the conference committee are "littered with land mines" and "[e]ven the small issues have loomed large," according to the Times (Kemper, Los Angeles Times, 9/9). A disagreement between Senate Finance Committee Chair Charles Grassley (R-Iowa) and conference committee Chair Rep. Bill Thomas (R-Calif.) has not yet been resolved (Rovner, CongressDaily, 9/8). Grassley has said that aides to Thomas, who as head of the conference committee sets the conference committee's agenda, told Senate staffers they are not permitted to discuss provisions in both Medicare bills that would allocate at least $25 billion to increase payments to rural Medicare providers (California Healthline, 9/5). Meanwhile, Senate Republicans have disagreed with House Republicans over several issues and some Democrats have said they feel "left out" of the negotiations, the Los Angeles Times reports. "It's difficult to see how Democrats are going to vote for the bill if they haven't had any voice in the process," a Democratic staffer said. The "most contentious issue" is a provision in the House bill to inject market competition into traditional Medicare, according to the Los Angeles Times (Los Angeles Times, 9/9). The provision would call for private health plans to compete directly with fee-for-service Medicare beginning in 2010 (California Healthline, 9/8). Many Republicans have said they will not vote for a final Medicare bill unless it contains the competition provision, which they say is the only way to control rising Medicare spending. However, many Democrats have said they will vote against any bill that includes such a provision (Los Angeles Times, 9/9). The full conference committee is scheduled meet this afternoon, and congressional aides say negotiators likely will ratify several agreements reached by staffers over the August recess but that it is unclear what other issues will be addressed. Thomas said last week that he might ask the committee to vote on some "overall parameters" for a final bill, CongressDaily reports. Several congressional staffers addressing the media yesterday agreed that there is "virtually no chance" a final bill will emerge from conference committee by the end of this month, as some lawmakers have urged, but they also agreed that there is "little chance" of passing a Medicare bill if negotiations continue into 2004, CongressDaily reports (CongressDaily, 9/8).

A request by President Bush for Congress to approve $87 billion for next year to fund military operations in Afghanistan and Iraq could jeopardize the chances of Congress' passing a final Medicare bill, the New York Times reports. Some lawmakers yesterday said that Congress is likely to approve Bush's military funding request but that it could increase pressure on nonmilitary programs, including the proposal to add a prescription drug benefit to Medicare. Rep. William Thornberry (R-Texas) said the size of the military funding request could make some lawmakers "far more reluctant" to approve a final Medicare compromise or other large proposals, the New York Times reports (Firestone, New York Times, 9/9). The Wall Street Journal reports that the "deteriorating budget situation" could cost President Bush the support of "some moderates worried about health care" (McKinnon/Ip, Wall Street Journal, 9/9). According to the New York Times, adding $87 billion to the 2004 budget would raise the government's projected deficit to $550 billion (New York Times, 9/9).