By Joanne Kenen
WASHINGTON (Reuters) - Senate backers of legislation to revamp Medicare on Monday narrowly beat back a challenge to the bill, removing one of the last hurdles before they can pass the White House-backed measure as early as Monday.
The mostly Democratic foes of the $400 billion, 10-year legislation, which would add a prescription drug benefit to the health program for the elderly and pump billions of dollars into expanding the role of private insurers, came surprisingly close to stopping the bill.
The legislation squeaked through the House before dawn on Saturday after intense White House lobbying during an unprecedented three-hour vote. President Bush has made the bill a domestic priority as he prepares to run for reelection.
Republicans beat back the challenge under budget rules by a 61-39 vote -- mustering one more vote than they needed.
Senate Majority Leader Bill Frist, a Tennessee doctor who has made Medicare a signature issue in his first year as Republican leader, said he hopes to pass it and send it to Bush later on Monday, although it could take until Tuesday.
"We're going to modernize Medicare. We're going to bring it up to date," said Frist, who has characterized it as a "life and death" bill for older Americans.
Congress has for several years grappled with how to add a drug benefit to Medicare but stalemated on the scope of the benefit, and the role of the private sector in delivering it.
This year, consensus grew around adding the drug benefit. Democrats and Republicans continued to spar about the specifics, but the huge battle that erupted centered not on the drugs but on all the other elements in the sweeping bill that could transform Medicare by adding more market competition, cost-containment and higher fees for the wealthy.
SENIOR CITIZENS
Facing likely defeat, critics of the bill led by Sen. Edward Kennedy of Massachusetts said they would come back next year to try to change the legislation to make sure that senior citizens still had the health safety net they have been able to count on since Medicare's creation in 1965.
Kennedy had angered some liberal colleagues last June when he shepherded an earlier version to a bipartisan victory in the Senate. Kennedy says the final version negotiated with the more conservative House threatens the very survival of Medicare.
Ironically it was former Senate Majority Leader Trent Lott of Mississippi, displaced by Frist after Lott made racially insensitive remarks, who gave Frist the 60th vote on the budget rule, even though he is among the small group of Republicans who think the price tag is too big and the reforms inadequate.
Earlier in the day bill supporters more easily won a vote to limit debate on the bill, 70-29. Democrats who did not want to risk being labeled obstructionist by filibustering it were more willing to block it using arcane budget rules. Republicans had used budget rules to kill Democratic Medicare legislation in 2002.
The three Senate Democrats running for their party's presidential nomination -- John Edwards of North Carolina, John Kerry of Massachusetts and Joseph Lieberman of Connecticut -- were in the Senate, not on the campaign trail, on Monday to vote to block it.
The bill also includes tax-preferred health savings accounts long championed by conservatives, and a pilot program to force Medicare in some parts of the country to begin competing head-to-head with private health plans in 2010. Health maintenance organization stocks rose on Monday on the prospect of its final passage.
The legislation also includes drug patent laws changes to make it easier for generic drugs to compete against brand names -- one of the few provisions where the big drug makers did not get what they wanted.
(Additional reporting by Donna Smith)