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Barring changes, Dems 'unable to support' prescription drug bill

House plan requires Medicare to compete with private plans

From Steve Turnham
CNN Washington Bureau

Sen. Edward Kennedy, D-Massachusetts, and Senate Minority Leader Tom Daschle, D-South Dakota, during a news conference Thursday regarding a prescription drug bill.
Sen. Edward Kennedy, D-Massachusetts, and Senate Minority Leader Tom Daschle, D-South Dakota, during a news conference Thursday regarding a prescription drug bill.

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WASHINGTON (CNN) -- Forty-one senators, all but two Democrats, sent a letter to President Bush on Thursday, saying they would oppose a Medicare prescription drug bill -- unless some changes are made.

That number would be enough to block the bill in the Senate, although Democrats said they had not decided whether to filibuster the measure. The bill is currently being negotiated by a House-Senate conference committee.

"We are further away now than at any time since this conference began," said Sen. Edward Kennedy, D-Massachusetts. "It is at grave risk."

The letter -- signed by 39 Democrats, one Republican and one independent -- includes a long list of objections, but a House proposal that would require Medicare to compete against private health plans appears to be the killer issue for these senators.

"It is such an anathema to most people," said Senate Minority Leader Tom Daschle, D-South Dakota. "It really means the demise of Medicare as we know it."

The letter calls on President Bush to get involved before it's too late.

"If the conference report does not address the issues... we will be unable to support it," the senators wrote.

Senate Finance Committee Chairman Chuck Grassley, the lead Senate negotiator in the conference committee, said some form of competition will have to be in the bill, and the Democratic complaints are premature because the deal is still being worked out.

"There will not be a compromise until the end of this week or early next week and so there should not be anybody making any judgments of what's in a bill that does not exist yet," Grassley, R-Iowa, said.

And one of the two Democrats in the negotiating sessions, Sen. John Breaux of Louisiana, said he was optimistic that the bill would ultimately pass. Neither Breaux nor the other lead Democrat, Sen. Max Baucus of Montana, signed the letter.

House leaders have said they do not believe the bill can pass without the so-called "premium support" measure. Thirteen House conservatives have said they will vote against the bill if premium support is not in it.

Besides raising questions about competition, the 41 senators say more must be done to prevent private plans from dropping drug coverage once the government drug plan kicks in, and that the final bill must do more to contain costs by allowing more generic drugs into the system as well as the re-importation of cheaper drugs from Canada.

The lone Republican to sign the letter was Sen. Olympia Snowe of Maine, and the independent was Sen. James Jeffords of Vermont.

However, Daschle said there are other senators who didn't sign who would vote against the compromise bill as it's shaping up. Kennedy said he does not believe the proposal being circulated would even win majority support.

While the measures affecting the broader Medicare program are the most politically controversial, most of the bill's $400 billion price tag would be spent on prescription drug coverage.

According to briefing papers detailing the compromise plan, Medicare beneficiaries annually would pay the first $275 of drug costs and a quarter of the costs between $275 and $2,200 dollars.

After that, the patient would pay the entire cost up to about $5,000. At that point, catastrophic care would kick in, providing 95 percent coverage. For this benefit, Medicare recipients would be required to pay a $35 annual premium.

In total, patients would be required to pay about $3,600 out of their own pockets each year before the catastrophic coverage kicked in. For seniors with major health problems, the benefit could represent a significant savings.

The measure has additional benefits for poorer seniors. Seniors earning less than $12,123 a year would not have to pay the $275 deductible or the monthly premium. Instead they would pay a co-payment of between $2 to $5 for each drug purchase. Those earning between $12,123 and $13,470 a year would also get more generous benefits than wealthier seniors.

Overall, the benefits in the compromise under consideration by the conference are less generous than the bill passed earlier this year by the Senate, but more generous than those passed by the House.

Once the House-Senate conference committee hammers out the final details of the plan, the Congressional Budget Office would then have to check it to see if it fits under a $400 billion limit imposed by Congress. Both Houses would then have to vote on the final measure.

Wednesday night on CNN, Senate Majority Leader Bill Frist, R-Tennessee, said he expects the Medicare bill will hit the Senate floor in two to three weeks.


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