Both Parties Face Huge Risks In Prescription Drug Bill Fight
By Helen Dewar
Washington Post Staff Writer
Wednesday, June 11, 2003; Page A06
As legislation to add a prescription drug benefit to Medicare gathers momentum in Congress, both parties face difficult choices and political risks that may help shape next year's presidential and congressional elections.
President Bush and congressional Republicans probably would gain the most from a bill expanding benefits, especially if they can avoid getting bogged down in a divisive debate over whether the proposed changes will lead to a privatization of the government's popular but expensive program of health insurance for the elderly.
But Republicans have the most to lose if the legislation fails, because they control the White House and Congress, and they blunted the Democrats' advantage on the Medicare issue in the 2000 and 2002 elections by promising to enact a drug benefit of their own.
"If we can't pass it, that is a big problem for us," said Sen. Rick Santorum (Pa.), chairman of the Senate Republican Conference. "There's no question the responsibility falls on a Republican president and Senate and House Republicans, and that's why it won't fail."
For Democrats, the situation is different but nearly as perilous. If they try to block a plan they don't like, they could be accused of obstructionism by Republicans, who have portrayed Democrats as naysayers on several issues. But if they go along with a bill associated with the Republican Party, then Democrats could lose their grip on one of their signature issues.
Some Democratic lawmakers may try to split the difference by pushing to expand the prescription drug bill but voting for it even if they fail, promising to fight another day for broader benefits.
"They're going to try to convince seniors that we're the problem," said Sen. Jon S. Corzine (N.J.), chairman of the Democratic Senatorial Campaign Committee. But, Corzine said, "I think Americans trust Democrats more on health care issues, and they'll know when they're getting the short end of the stick."
Plans pending before both houses, including a bipartisan proposal likely to win the Senate Finance Committee's approval this week, would give Medicare beneficiaries a choice between staying in the traditional fee-for-service program or joining a private health plan. Both options would carry the same drug benefit.
The cost of the plan has been estimated to fall about $50 billion short of the 10-year, $400 billion limit Congress set earlier this year, providing some leeway for drafters to address criticisms by eliminating inequities and expanding benefits.
Democrats basically "owned" the Medicare issue until Republicans developed plans of their own, combining the proposed drug benefit with expanded opportunities for Medicare recipients to choose private health plans. By last year's elections, even though most polls continued to give Democrats a significant edge on health issues, Republicans had largely neutralized the drug benefit issue by criticizing Democrats for failing to deliver and vowing to do better.
This year, in rejecting Bush's proposal to encourage people to join private health plans by offering them a more generous drug benefit, Congress's GOP leaders dodged a bruising battle that could have painted them into an anti-Medicare corner. Democrats almost certainly would have accused them of trying to use the lure of a drug benefit to kill off the traditional Medicare program in favor of "privatizing" the whole system. Such allegations could resonate powerfully with older Americans nervous about switching to private managed-care plans.
"Bush's proposal would have upset many seniors if it were still on the table," said Robert J. Blendon, a Harvard professor of health policy and political analysis.
For Democrats, the biggest choice is whether to try to block a GOP-backed plan. Barring a fratricidal fight among Republicans, about the only major obstacle to enactment is a Democratic filibuster in the Senate, which would require 60 votes to break. Republicans hold 51 seats.
But Senate Minority Leader Thomas A. Daschle (D-S.D.) said Democrats do not intend to filibuster, even though he opposes the bill before the Senate. The Senate proposal, which stems largely from a plan developed last year by moderates of both parties, faces criticism from conservatives who want more privatization of Medicare, and criticism from liberals who want less. But many more Republicans than Democrats seem to be supporting the plan.
Some Democratic strategists believe that the plan likely to emerge from this Congress will fall so far short of what seniors thought they were promised that it will become an election year albatross for Republicans. Others wonder if seniors are so tired of waiting that they may welcome whatever they can get and continue pushing for more in future years.
For Democrats, there is another complexity: Sen. Edward M. Kennedy (D-Mass.). Probably no one has done more to push the drug benefits issue than Kennedy, and he is a powerful proponent of generous benefits. But the senator is also a political realist, and he wants a bill. So he praised the Senate Finance Committee proposal as a "major breakthrough," even while vowing to fight for expansions. As for the politics, he said, "there's more than enough credit to go around."
Some liberals are upset with Kennedy, but there is not much they can do. "Kennedy took the wind out of their sails," said Sen. John Breaux (D-La.), a key supporter of the Senate plan. Democrats may be reluctant to support what they regard as a flawed bill or to lose one of their favorite issues, said a Democratic strategist, "but I'm not sure they want to be seen as voting against a prescription drug bill that both Ted Kennedy and George Bush are for."
Rep. Fortney "Pete" Stark (Calif.), ranking Democrat on the House Ways and Means health subcommittee, has serious reservations about the Medicare proposals, but believes the issue will fade next year unless Republicans go overboard in trying to push people into private health plans. "If it's a blatant bribe to get people out of traditional Medicare and a subsidy to private insurers to keep their plans alive, then I couldn't support it," he said. "But if it's a uniform benefit for all, without paying extra to managed care, if it weren't too gimmicky, I would be hard-pressed to vote against it."
As Harvard's Blendon sees it, Democratic challengers would be the main losers if a drug benefit is enacted. Incumbents of both parties could claim credit as long as they voted for the bill, but challengers need big issues and sharp distinctions, which are not always in plentiful supply, he said.
Two political strategists -- Republican David Winston and Democrat Mark Mellman -- presented contrasting but not contradictory views.
"After 9/11, the American people saw the two parties come together, and so they know it's possible . . . they're saying, 'here's a problem, so go solve it,' " Winston said. But Congress's painful experience in the 1980s with the enactment of insurance for catastrophic illnesses under Medicare (financed by a fee on recipients) should remind lawmakers of the risks inherent in passing flawed legislation, Mellman said. After a rebellion by seniors, he noted, Congress repealed the law.
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