WASHINGTON, July 15 — House and Senate
negotiators met today for the first time in an effort to work out major
differences on legislation to add prescription drug benefits to
Medicare.
Representative Bill Thomas, Republican of California, who was
elected chairman of the House-Senate conference, and Senator Charles E.
Grassley, Republican of Iowa, said they were confident that the group
would reach an agreement.
But one negotiator, Representative John D.
Dingell, Democrat of Michigan, said, "I enter this with some feelings of
trepidation."
The House bill, written almost exclusively by
Republicans, and the bipartisan Senate bill both offer prescription drug
benefits to the elderly and disabled and give private health plans a big
new role in Medicare.
"If we get legislation out of this conference,
which we will, it will be a victory for America's seniors," said Mr.
Grassley, a principal architect of the Senate bill.
But Mr. Dingell,
whose father helped write the original Medicare law in 1965, said, "The
House bill helps insurance companies more than it helps seniors."
Mr.
Thomas, the chairman of the Ways and Means Committee, said Medicare was
already going bankrupt. "We want to meet the needs of seniors in a way
that does not exacerbate the chance of going bankrupt," he
said.
Lawmakers of both parties said they saw a political imperative to
provide drug benefits to the elderly, an influential voting bloc.
President Bush, who promised in the 2000 campaign to provide Medicare drug
benefits, is urging Congress to send him a bill as soon as possible. But
he postponed a White House session today at which he was to have given a
pep talk to the negotiators.
Earlier today, one of the House Republican
negotiators, Representative Tom DeLay of Texas, the majority leader, said
the conference committee must preserve elements of the House bill intended
to "hold down costs by introducing competition and choice for seniors."
"I can't see a bill coming out of conference that has less than that,"
Mr. DeLay said.
Republicans control the House and the Senate. Five of
the nine Senate conferees and five of the eight House conferees are
Republicans.
Senator Max Baucus, Democrat of Montana, a co-author of
the Senate bill, appealed to the Republicans to seek a compromise that
could win bipartisan support.
"If it passes narrowly, if it's a 51
percent strategy," Mr. Baucus said, "chances are that the follow-up will
not work very well."
AARP, the big lobby for older Americans, issued a detailed commentary
on the legislation today, and it objected to many provisions of the House
bill.
William D. Novelli, executive director of AARP, urged Congress to
"produce a better bill" than the measures approved by the Senate and the
House on June 27. If a final agreement emerges from the conference
committee but does not "correct serious problems that exist in both
bills," Mr. Novelli said, "we will not hesitate to oppose it."
That
statement, which could be read as a threat, was strong language for the
cautious AARP.
Mr. Novelli urged the conferees to drop a provision of
the House bill that would require traditional Medicare to compete with
private health plans, starting in 2010.
Mr. Novelli said such
competition could destabilize Medicare and significantly raise costs for
older and sicker beneficiaries, who, he said, were more likely to remain
in the traditional fee-for-service program. Moreover, he said, the
negotiators should adopt a provision of the Senate bill, authorizing the
government to provide drug benefits directly if insurance companies do not
do so.
"The Senate provision is the minimum necessary to ensure coverage in
all parts of the country," Mr. Novelli said.
Under both House and
Senate bills, Medicare would pay subsidies to insurance companies to
induce them to offer coverage for the drug costs of Medicare
beneficiaries.
But Mr. Novelli said, "Stand-alone drug plans generally
do not exist in the private market, and it is still unclear whether the
insurance industry will view stand-alone plans as an attractive business
opportunity."
AARP also criticized a provision of the House bill that would require
beneficiaries with incomes exceeding $60,000 a year to spend more of their
own money before they could qualify for protection against very high drug
expenses.