WASHINGTON (AP) – Talks to find a compromise on a Medicare prescription drug bill are so plagued by policy differences and personality clashes that Republican leaders are considering setting deadlines to prod bargainers toward a deal this fall.

More than two months of formal talks have yielded general agreement on items such as establishing an interim drug discount card program for Medicare clients. Even in some of these areas, however, critical details remain unresolved; for example, whether to make physician participation in a new electronic prescription program voluntary or mandatory.

Also, bargainers have yet to delve into more fundamental differences between House and Senate versions of the bill. Both are designed to provide a prescription drug benefit while injecting competition into the government’s health care program for older Americans.

“We’re considering setting a deadline,” said Rep. Roy Blunt, (R-Mo.), third-ranking member of the House GOP leadership.

Asked about the possibility, Senate Majority Leader Bill Frist said that decision has not yet been made. At the same time, the Tennessee Republican added, “I could see certain benchmarks being set” to hasten compromise.

Frist said he remains committed to passage this year of a “comprehensive bill, not scaled-back,” to cost $400 billion over a decade. House Speaker Dennis Hastert (R-Ill.) has told fellow Republicans he holds the same view.

At the White House, spokesman Scott McClellan said Friday that President Bush, too, wants a comprehensive bill this year.

Given the slow pace of the talks on a compromise bill, and the complaints that some lawmakers reported hearing over the summer that the legislation is not generous enough, possible alternatives are being floated.

Several cost-conscious conservatives wrote Hastert last week that if the broad compromise efforts falter, “we would support a basic drug subsidy for low-income seniors and a catastrophic coverage for middle-income seniors” rather than a “universal, unlimited” benefit for all.

While formal negotiations plod, Frist and several other top GOP senators meet regularly with Democratic Sens. Max Baucus of Montana and John Breaux of Louisiana. Thus far, they have focused on possible ground rules for a new era of competition between managed care plans and traditional Medicare.

Several sources, speaking on condition of anonymity, said options under discussion included using a blend of competitive bidding and a formula pegged to traditional Medicare to set the level of government payments for companies that establish managed care plans.

The objective, these sources said, is to set a payment level high enough to encourage companies to offer managed care coverage, yet low enough to begin restraining the growth in Medicare’s cost.

If the policy differences have yet to be fully discussed, the political gulf on Medicare has long been plain. In contrast to the Senate bill, which passed on a bipartisan vote in June, House Republicans tailored their bill to conservative specifications.

Asked recently to name the biggest hurdles blocking compromise on a final Medicare bill, Rep. John Dingell, (D-Mich.), responded: “Republicans, pharmaceutical houses and insurers.”

The senior Democrat in Congress and longtime supporter of Medicare, Dingell has never been viewed as a likely supporter of any GOP-engineered compromise.

But a day after he spoke, a group of GOP House conservatives whose votes were critical to passing the legislation in June sent Hastert a series of conditions for their continued support.

They included a requirement that traditional Medicare compete directly with new managed care plans beginning in 2010, which many Democrats say is a deal-breaker for them.

Some Republican aides have spoken up in recent weeks about trying to fashion a final bill that would pass the House with little Democratic help, then dare Democrats to filibuster it in the Senate.

On the other hand, Frist, Grassley and other Senate Republicans have long been on record saying they want a bipartisan bill. At the last public bargaining session, Baucus warned the GOP not to exclude his party from the talks.

“I’d rather have a good bill,” said Baucus, who worked closely this year with Republicans on a bill that passed the Senate with bipartisanship support. “But no bill is better than a bad bill.”

Another obstacle to progress has been the difficult relationship between two Republican committee chairmen leading their respective delegations at the talks, California Rep. Bill Thomas and Iowa Sen. Charles Grassley.

Thomas, chairman of the bargaining effort, has a history of dealing brusquely with members of both houses and both parties. For his part, Grassley openly expressed irritation with the treatment he had received at the hands of his fellow chairman during discussions this year on a tax bill.

The rift deepened when Grassley ordered his aides to stay away from staff-level Medicare talks this summer, protesting that Thomas wouldn’t discuss the Iowa senator’s key priority of providing more money for rural doctors and hospitals.

Last week, according to officials in both parties, when Thomas sought to arrange a small meeting with Frist and other key lawmakers, Grassley was not among them.

 

 

 

 

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