GOP-Led House approves Medicare Bill, Republican-controlled House approves sweeping Medicare Prescription Drug Bill by 220-215 vote

The vote capped an extraordinary roll call that began at 3 a.m. and dragged on for nearly three hours before the GOP leadership could overcome a rebellion by conservatives in their own ranks and the overwhelming opposition of Democrats.

The vote sent the measure to the Senate, where supporters expressed growing confidence they also would prevail. President Bush is eager to sign the bill, which would give 40 million seniors and disabled Americans a prescription drug benefit and a new option for private health care coverage.

"After this legislation goes into effect, low-income seniors will never be confronted with the choice of putting food on the table or paying for life-saving prescription drugs," Speaker Dennis Hastert said well after midnight, just before the lights dimmed in the chamber to signal the beginning of the longest roll call in the history of the House.

But House Democratic Leader Nancy Pelosi said seniors know that her party gave birth to Medicare during the Great Society, adding, "we want to protect it and strengthen it. America's seniors have also known where Republicans stand, for four decades they have waged war on Medicare."

The bill represented a political compromise of sorts the new prescription drug benefit, coupled with federal subsidies designed to give private insurance companies incentives to establish new managed care plans around the country.

Republicans said these new plans, either preferred provider organizations or HMOs, would modernize Medicare, providing better coverage at lower cost. Democrats expressed skepticism, saying they marked the first step on the road toward privatization.

Dozens of lawmakers, participants and spectators both, waited out the drama of the middle-of-the-night roll call, as Hastert, his lieutenants and Department of Health and Human Service Secretary Tommy Thompson shuttled from one GOP holdout to another seeking enough votes to prevail.

Nearly 20 hours earlier, Republicans projected confidence, even bravado. "I look forward to the presidential signing ceremony," said California Rep. Bill Thomas, a key architect of a measure making the most sweeping changes in Medicare since the program's creation in 1965.

But that was before the near-solid wall of Democratic opposition, the stubborn refusal of conservatives to bend, the hours of debate, the behind-the-scenes lobbying, the presidential phone calls from Air Force One and the still-undisclosed deals made to secure passage.

"You'd think we were talking about different bills from the rhetoric we've heard this evening," said Rep. Deborah Pryce, R-Ohio, as the debate unfolded Friday night.

There was no disputing that.

"This is a defining issue," said Rep. Jim McGovern, D-Mass, as he made a case for rejecting the measure. "This bill is a huge giveaway to the prescription drug companies. And worst of all, this bill shoves Medicare down that path toward privatization."

"This bill is really all about a fair deal," countered Thomas, the chairman of the House Ways and Means Committee. "Modernize Medicare with prescription drugs, but put Medicare back on a sound financial basis as well."

As written, the legislation would virtually remake Medicare.

For the first time, seniors earning more than $80,000 a year would be required to pay a higher premium for their Part B non-hospital coverage under Medicare.

For the first time, the legislation would also require seniors with annual incomes over $80,000 to pay higher premiums under Medicare Part B, which covers services outside the hospital. Additionally, it would establish new tax-preferred health accounts, open to individuals with high-deductible insurance policies.

The tax provision and the requirement for higher premiums were part of an effort to appeal to conservatives who favor transforming Medicare and restraining its cost, yet find creation of the new prescription drug benefit distasteful.

Many Democrats argued that some of the conservative-backed elements of the bill were too dear a price to pay for the drug benefit particularly a provision creating a limited experiment in direct competition between private plans and traditional Medicare beginning in 2010.

Conservatives said just the opposite.

Rep. Tom Feeney, R-Fla., fielded an afternoon phone call from Bush, who was flying home from England aboard Air Force One. "I basically said it was a matter of principle, that I came to Washington not to ratify and to expand Great Society programs," said the first-term lawmaker. "He wasn't happy to hear that."