Hopes for a bipartisan Medicare-reform compromise appeared to be evaporating last week in the rising partisan heat of an election year.
Only four or five conservative Democrats are supporting an agreement between Reps. William Thomas (R-Calif.), chairman of the House Ways and Means health subcommittee, and Collin Peterson (D-Minn.) that would seek about $168 billion in Medicare savings between now and 2002.
The House Republican leadership wants to hold a vote on such a proposal to protect some of its freshmen who had gone out on a limb to support an earlier balanced-budget bill with $270 billion in Medicare savings.
Democratic leaders, meanwhile, may be trying to prevent such a vote from happening so that they can use the Republicans' support of higher Medicare savings as a campaign issue.
The conservative House Democrats known on Capitol Hill as the "Blue Dogs," who have been working with Thomas, complain that the $168 billion in Medicare savings is too high. Although they proposed that savings total as part of a balanced-budget plan last fall, subsequent estimates by the Congressional Budget Office said the Blue Dogs' plan would trim only $152 billion.
With the current fiscal year ending in October, and thus only six years to balance the budget by 2002 instead of the seven the conservative Democratic proposal originally called for, the Blue Dogs want lower savings of $145 billion during that period.
"What they've got now hasn't moved forward enough to get Democratic votes," said a staff member for one of the Blue Dogs.
Republicans said the conservative Democrats already have agreed to the $168 billion figure and contend that $145 billion is insufficient.
A Thomas spokesman said negotiations are continuing.
The conservative Democrats also wanted provider savings to be more equitably distributed. The Democratic staff aide said they wanted more savings from physician payments than the $12.6 billion called for in the Thomas-Peterson compromise and less than the $16.1 billion from home health agencies included in the plan.
They also want to eliminate the budget "fail-safe" that the Republicans sought, which would impose mandatory across-the-board cuts in fee-for-service reimbursement if budget caps are exceeded.
Republicans, meanwhile, also are insisting that the Medicare program include a private medical savings account insurance option. In a letter sent Feb. 9, 140 Republicans, including Thomas, urged President Clinton to support a Medicare MSA option.
But the Blue Dogs have called for only an MSA demonstration project, and they point to a Congressional Budget Office estimate that a full-scale MSA option would cost $4.5 billion.