House pushes ahead with GOP Medicare legislation

WASHINGTON - Tending to a vital election-year issue, House Republicans forced committee approval for their Medicare prescription drug legislation Wednesday night over the implacable opposition of Democrats.

The 23-14 vote was strictly along party lines on the bill, which envisions a blend of free-market insurance plans and government subsidies to spread coverage nationwide.

The vote set the stage for what is likely to be a tough struggle next week on the House floor on a measure Republicans have been warned by a GOP pollster is a ''political imperative'' for the coming campaign.

Shortly before final passage, Republicans held ranks and rejected a Democratic alternative calling for a uniform government-defined prescription drug benefit, also to be available nationwide.

''Clearly, now is the time to add prescription drug coverage to Medicare,'' said Rep. Bill Archer, R-Texas, as he gaveled the House Ways and Means Committee into session.

''There is no public office or election that is more important than the safety and well-being of senior citizens,'' he added, stressing the bill offered special help for those with low incomes or facing catastrophic costs.

But Democrats, armed with their own alternative plan to provide drug coverage, criticized the Republican measure as a rerun of old GOP attacks on the giant health care program for the elderly. ''It's not Medicare,'' said Rep. Pete Stark, D-Calif., of the GOP proposal, which relies on private insurance companies, aided by government subsidies, to offer coverage.

''Normally, the lobbyists are heaping money on us hoping we'll vote one way or another,'' he said. ''This bill heaps money on the lobbyists' clients, hoping they might write an insurance policy that might provide some Medicare members'' with insurance.

Passage was a certainty in the committee, although Democrats spent hours pressing amendments and their own alternative. Approval would set the stage for what is likely to be a tougher struggle next week on the House floor on the measure, which one Republican pollster has warned the GOP is a ''political imperative'' for the coming campaign.

Republicans sought to blunt one Democratic charge - that private insurance companies would not offer policies for sale. Rep. Bill Thomas, R-Calif., the chief architect of the bill, circulated a letter from a top official at Merck-Medco, a provider of pharmaceutical benefits to health plans. ''We would work to develop a prescription drug-only plan ... nationwide in competition with others in what we expect will be a highly competitive market,'' it said.

Republican demonstrated firm control of the committee proceedings, rejecting Democratic attempts to make fundamental changes in the bill. Among them was a proposal by Rep. Ban Cardin, D-Md., to give the government authority to offer an insurance plan.

Under the GOP measure, insurance companies - subsidized by the government - would offer approved prescription drug plans, with all seniors guaranteed a choice of at least two. The government ''would be the insurer of last resort.''

Deductibles, co-payments and other out of pocket charges would vary. Under a draft standard policy, officials estimated monthly premiums of $35 to $40 and a $250 annual deductible. Policyholders would pay half the cost of each prescription, until they reach a $1,050 annual benefit limit. Coverage would then stop, but any costs over $6,000 would be covered in full.

Subsidies would be available for those with low incomes, eliminating or defraying premiums and deductibles. Their co-payments would also be reduced.

In contrast, a Democratic alternative envisions a standard prescription drug benefit, including monthly premiums starting at $26, no deductibles and a 50 percent co-payment for each prescription. Policyholders would pay half the cost of each prescription, with an annual benefit limit of $1,000. Democrats also would provide financial assistance to those with low incomes. They have promised to add catastrophic coverage, but are still working on details.

The House panel met while a quiet struggle unfolded outside the committee room, fueled by President Clinton's proposal to add $21 billion over five years in Medicare payments to hospitals and other providers.

Republicans, too, were making plans to allocate more money to Medicare providers.

Several congressional sources, who spoke on condition of anonymity, said White House officials had been on the phone with provider organizations, urging them not to back the GOP prescription drug plan and pledging the additional payments later in the year.

Republicans, too, were on the phone, these sources added, urging the same groups not to attack their plan, and offering a similar incentive.