GOP leaders coax their own conservative lawmakers to support Medicare bill

<br>WASHINGTON (AP) _ House Republicans sought a quick victory Friday on the massive Medicare prescription drug bill that was finalized only a day earlier. <br><br>Increasingly confident of House passage,

Friday, November 21st 2003, 12:00 am

By: News On 6

WASHINGTON (AP) _ House Republicans sought a quick victory Friday on the massive Medicare prescription drug bill that was finalized only a day earlier.

Increasingly confident of House passage, Republicans brushed aside Democratic complaints that the plan violated a commitment Speaker Dennis Hastert made to give lawmakers three days to review the final legislation before voting.

``We were shut out of these negotiations ... and what we have here now is an evisceration of Medicare,'' said Rep. Alcee Hastings, D-Fla., adding haste to the Democrats' list of grievances.

House and Senate negotiators formally sealed their agreement on the legislation Thursday. Stuart Roy, spokesman for House Majority Leader Tom DeLay of Texas, said the House would vote Friday.

The Senate also hopes to finish its work on the $395 billion bill before Thanksgiving and send it to President Bush, who has pledged to sign it.

The legislation represents a grand bargain of sorts, struck between congressional Republicans and Democratic Sens. John Breaux of Louisiana and Max Baucus of Montana. It would provide a new prescription drug benefit for 40 million Americans, with hefty federal subsidies for the poor. At the same time, it includes billions of dollars in subsidies as incentives for insurance companies to offer seniors an alternative to their traditional government-run health coverage.

It also would offer $25 billion to rural doctors and hospitals.

But some congressional conservatives have little faith that the Medicare prescription drug bill can be held to its projected cost over 10 years.

Sen. Don Nickles, R-Okla., who helped negotiate the proposal, said, ``I will predict right now. It will come out double that.''

Undecided about the bill, Nickles said the legislation also would rely too heavily on government. ``I think we're falling short of a market-oriented approach,'' said Nickles, who is Senate Budget Committee chairman.

Citing a history of underestimating the cost of health-care legislation, Nickles said chances are good in the years ahead that lawmakers will close the gap in drug coverage contained in the proposal and relieve states of their share of health-care costs for poorer seniors.

``Take those two things together and the cost will explode,'' he said.

House conservatives were hearing a decidedly different story from their leaders.

The message to conservatives was that cost-control measures and health-related tax breaks should outweigh discomfort at creating a new government benefit for 40 million Americans.

``If you have to be pure you can't accomplish anything on the left or the right ... and you can't govern,'' said Majority Leader DeLay, arguing that the legislation would provide the most comprehensive reform of the program since its creation in 1965.

Rep. David Dreier, R-Calif., part of the orchestrated effort to line up support for the bill, said, ``No one will be able to describe this as the traditional, massive, open-ended'' program lacking financial accountability.

That legislation appeared to find favor in the Senate. Despite attacks on the bill by Democratic leader Tom Daschle and Sen. Edward M. Kennedy, several Democrats have signaled support. In addition, the party's second-in-command, Sen. Harry Reid of Nevada, said he has yet to make up his mind.

The political equation is far different in the House, where Democratic leader Nancy Pelosi has sought to unify her rank-and-file against the bill. ``This fight is no longer about prescription drugs, it's about saving Medicare from its enemies,'' charged Michigan Rep. John Dingell, one of five Democratic negotiators who were excluded from the closed-door talks where the compromise was put together over several months.

With Republicans unsure about how many Democrats will vote their way, the GOP lobbying effort has been aimed at lawmakers like Rep. Paul Ryan of Wisconsin.

A third-term conservative, he said he would support it if he concluded it contained enough incentives for private insurance plans to take root around the country beginning in 2006.

He added he approved of the cost-control steps included in the bill, the tax-preferred health savings accounts for individuals with high-deductible insurance plans and a portion of the bill that would charge higher-paid seniors more for their coverage under Medicare Part B.

And unlike many conservatives, he dismissed a controversy over a plan for limited direct competition between private plans and traditional Medicare in 2010. Private insurance companies ``aren't going to make their decision on entering the market'' based on that, he said.

Rep. Joseph Pitts, R-Pa., said he, too, remained on the fence. ``I wasn't sent here to create huge new'' benefit programs, he said. At the same time, he approvingly cited both the health-related accounts and the higher premiums for seniors with annual earnings of $80,000 or more.