GOP leaders coax conservatives for Medicare support

WASHINGTON -- House Republican leaders coaxed conservatives Thursday to support a sweeping Medicare drug bill, arguing that health-related tax breaks and measures to curb spending on health care 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 House Majority Leader Tom DeLay.

, arguing that the legislation would provide the most comprehensive reform of the program since its creation in 1965.

The stepped-up sales job came as congressional negotiators were formally clearing the way for quick floor action on the measure. "This fight is no longer about prescription drugs, it's about saving Medicare from its enemies," charged Michigan Rep. John Dingell, although neither he nor other Democratic critics sought to prolong the session.

The House and Senate are expected to vote before Thanksgiving, and President Bush has pledged to sign the measure.

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 coverage.

That bargain 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, and Republicans are working hard to bring their conservatives around.

That has made lawmakers like Rep. Paul Ryan of Wisconsin a prime candidate for the GOP lobbying effort.

A third-term conservative, conflicted about the bill, he said he will support it if he concludes it contains enough incentives for private insurance plans to take root around the country beginning in 2006.

He added he approves of the cost-control steps included in the bill, and he said, "I would have walked a long time ago" without the tax-preferred health savings accounts for individuals with high-deductible insurance plans.

Ryan also praised a portion of the bill that would charge higher-paid seniors more for their coverage under Medicare Part B, saying that would prompt individuals "to move into private plans."

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, echoing concerns of other Republicans. 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.

Ryan, Pitts and others have been targeted with a barrage of lobbying. Former Speaker Newt Gingrich appeared in the party's closed-door caucus on Wednesday, where he praised the legislation, particularly the tax proposals. At the same session, House Speaker Dennis Hastert told the rank-and-file he insisted that the tax provision be retained in the final bill.

The leadership looked to outside groups, as well. Several officials said they hoped that the National Right to Life Committee, whose principal concern is stopping abortion, could be persuasive with some conservatives. The organization told lawmakers the measure "enables older Americans to escape rationing of life-saving medical treatment."

DeLay attended a meeting Wednesday of the Republican Study Committee, a group that includes some of the bill's most vocal conservative critics. Participants in the meeting, speaking on condition of anonymity, said the Texas Republican engaged in an impromptu debate with Stuart Butler, the head of the Heritage Foundation. The conservative think tank advocates the bill's defeat.

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

Dreier played a role in developing a method to force Congress to consider legislation in the event Medicare spending rises higher than anticipated -- one of a series of sweeping changes in the bill. A vote in the House is guaranteed under the plan, although opponents can still mount a filibuster to derail any legislation in the Senate.

The tax provision fulfills a long-held goal of conservatives. It would permit individuals with high-deductible insurance policies to make tax-deductible deposits in a health savings account, and use the money on health care costs at a later date.

The bill also includes an estimated $25 billion for rural health care, provisions that appeal to Republicans and Democrats alike.