House Approves Medicare Bill After Republicans, Including President Bush, Gather Enough Votes To Support Legislation

After the "longest roll call in House history," the House early Saturday morning approved the Medicare bill (HR 1) in a 220-215 vote largely along party lines, the Washington Post reports (Broder, Washington Post, 11/23). The bill's passage came after an "extraordinary bout of Republican arm-twisting to muster a majority" that prolonged the normal 15-minute roll-call vote to nearly three hours, the New York Times reports. For most of the three hours of voting, the bill appeared likely to fail (Pear/Toner, New York Times, 11/23). The legislation, which is a compromise of the separate House and Senate Medicare bills passed in June, would prompt the "biggest single change in Medicare" since its creation in 1965, according to the Washington Post. The legislation would add a prescription drug benefit for Medicare beneficiaries, create subsidies for employers that continue to provide drug coverage to retirees after the Medicare drug benefit takes effect, give more federal money to rural providers, allow the creation of tax-preferred health savings accounts for individuals and create a pilot project in six metropolitan areas under which traditional, fee-for-service Medicare would compete with private health plans (Dewar/Goldstein, Washington Post, 11/23). The bill now moves to the Senate, where a vote is expected Monday (Lytle, Orlando Sentinel, 11/23). Sen. John Breaux (D-La.) and Senate Majority Leader Bill Frist (R-Tenn.) predicted that the legislation would have a "strong bipartisan vote" in the Senate, adding that support will be broader in the Senate than in the House, according to the Washington Times (Fagan/Dinan, Washington Times, 11/23).

Details of Roll-Call Vote
The final vote on the bill came at about 6 a.m. Saturday after Republican leaders and Bush administration officials successfully "quell[ed] a conservative rebellion," the New York Times reports (Pear/Toner, New York Times, 11/23). According to the Los Angeles Times, many lawmakers came to the roll call on Friday night unsure of how they would vote. Republican leaders said they called for a vote, despite knowing they were "a few votes short," the Los Angeles Times reports. According to Stuart Roy, a spokesperson for House Majority Leader Tom DeLay (R-Texas), "The reality of the bill actually being on the floor pushes people from the undecided column into the yes column" (Hook/Kemper, Los Angeles Times, 11/23). House Speaker Dennis Hastert (R-Ill.) said, "People came into this thing unpersuaded, and it takes time to" convince them to support the bill (Ragan/Dinan, Washington Times, 11/23). For much of the roll-call vote, the tally stayed at 216-218 against the bill, according to CongressDaily (Wegner et al., CongressDaily, 11/24). In a "rare appearance by a Cabinet official on the House floor," HHS Secretary Tommy Thompson tried to persuade reluctant conservatives to support the bill, the Los Angeles Times reports (Hook/Kemper, Los Angeles Times, 11/23). According to the Post, several times Hastert and his aides were "on the verge of conceding defeat and moving to reconsider the issue later." At one point, they considered having DeLay switch his vote to "no," which if the bill had failed would allow him to immediately move to reconsider the result. The Post reports that there were rumors that if the bill was defeated, some Democrats would try to revive their Medicare bill or the original bill approved by the Senate, which is more liberal than the House version. Republican leaders reached a "breakthrough" when seven lawmakers who initially voted "no" met with the Republican leadership (Broder, Washington Post, 11/23). Two Republicans, Reps. C.L. Otter (Idaho) and Trent Franks (Ariz.) switched their votes from "no" to "yes" after speaking with President Bush, who was awakened to call Republican "defectors" and urge them to vote for the bill, according to CongressDaily (Wegner et al., CongressDaily, 11/24). According to White House spokesperson Suzy DeFrancis, Bush discussed with lawmakers "the benefits of the bill and urgent need to vote yes and keep their commitment to seniors." She said, "He was willing to do what he could to get it across the finish line" (Hook/Kemper, Los Angeles Times, 11/23). Otter said, "The President was working all of the votes very hard. I was reminded that I did vote for the budget, which included the $400 billion [over 10 years set aside by Congress for Medicare] in it" (Wegner et al., CongressDaily, 11/24). He added, "I did not want to vote for this bill. But I was persuaded that if this bill went down, we would end up with a bigger, more expensive alternative with much less reform" (Orlando Sentinel, 11/23). Rep. Dana Rohrabacher (R-Calif.), another conservative who initially was against the bill, "vehemently opposed" a $1 billion provision that would reimburse hospitals along the U.S.-Mexico border for treating undocumented immigrants, according to the Orange County Register. He switched his vote to "yes" after Hastert agreed to allow Congress to address a piece of legislation requiring hospitals to give the Border Patrol the name of illegal immigrants they treat within two hours of treatment (Bunis, Orange County Register, 11/23). Twenty-five Republicans voted against the bill, and 16 Democrats voted for the legislation (Orlando Sentinel, 11/23). Most of the Republicans who voted against the legislation "resisted the plea that GOP unity demanded that they support a vital piece of President Bush's program," CongressDaily reports (Cohen, CongressDaily, 11/24).

Reaction
Most Republicans praised the bill's passage, the New York Times reports. Sen. Olympia Snowe (R-Maine), who had opposed several aspects of the legislation, said the bill is the result of a decade of work "that will forever change the face of Medicare, providing every senior in America with a prescription drug benefit" (Pear/Toner, New York Times, 11/23). "What this bill does is it modernizes Medicare," Rep. Pete Sessions (R-Texas) said (Kuhnhenn, Philadelphia Inquirer, 11/23). According to the Los Angeles Times, Many Democrats said they were upset by the vote outcome and by what they called a "shameless abuse of power" by Republican leaders. "This vote was stolen from us by the Republicans," House Minority Leader Nancy Pelosi (D-Calif.) said (Hook/Kemper, Los Angeles Times, 11/23). Rep. Steny Hoyer (D-Md.) said that Republicans "stole" the bill's victory through "undemocratic subversion of the will of the House" (Broder, Washington Post, 11/23). Rep. Frank Pallone (D-N.J.) said, "I'm ashamed of what we're about to do. My constituents are calling ... because they're scared to death. They think Medicare is going to die, that Medicare is going to disappear" (Philadelphia Inquirer, 11/23). Sen. Edward Kennedy (D-Mass.), who has said he will filibuster the bill in the Senate, said, "It was a phony vote in the House of Representatives and now they are trying to jam us in the Senate of the United States" (Pear/Toner, New York Times, 11/23).

Bush's Involvement
To ensure that the bill passed in the House, Bush was in "constant contact" with congressional Republican leaders over the last few days, according to a White House official, CongressDaily reports (Koffler, CongressDaily, 11/21). Although Bush had some 20 meetings on Medicare with administration officials over the course of the year, he saved "the real push" on the bill until the final moments, the New York Times reports (Bumiller, New York Times, 11/23). In a radio address, Bush urged the Senate to pass the bill following the House vote, saying, "In the nearly 40 years since Medicare was launched, this is the most significant opportunity for any Congress to improve health coverage for our seniors" (Pear/Toner, New York Times, 11/23). Democrats, meanwhile, have said they would "attack the president" for pushing a bill that is "stuffed with giveaways to drug and insurance companies and that in the end would cut benefits to the old people it was designed to help," the New York Times reports. "This bill is a backdoor attempt by the Republican party to privatize Medicare," Rep. John Lewis (D-Ga.), said (Bumiller, New York Times, 11/23). The Post reports that the House vote could have "huge political ramifications" in the upcoming presidential campaign "and beyond" (Broder, Washington Post, 11/23). Passage of the Medicare bill -- in addition to the energy bill -- before the election has long been a goal of the Bush administration to allow the president to focus his campaign on national security and the economy. Bush also hopes the Medicare bill would boost his support among the elderly, a "crucial constituency," the New York Times reports (Bumiller, New York Times, 11/23).

Past Kaiser Daily Health Policy Report coverage of the Medicare legislation, including details of the bill, is available online.