Giving his party an election-year issue, President Clinton last week joined congressional Democrats in introducing legislation allowing people ages 55 to 64 to purchase Medicare coverage.
First outlined in January, the proposal would allow early retirees ages 62 to 64 to purchase Medicare coverage at a monthly premium of about $300. After age 65, the current mark for eligibility, they also would pay a surcharge to cover their early entry.
The proposal also would allow workers ages 55 to 61 who lose their jobs to buy into Medicare at a monthly premium of $400.
Congressional Republicans responded to the legislation by calling for a delay on debate over the proposal until the National Bipartisan Commission on the Future of Medicare has made its recommendations.
"We need to fix the current shortfalls in Medicare and Social Security before we consider the president's proposal to increase government spending and expand yet another government program," said Rep. William Thomas (R-Calif.), chairman of the House Ways and Means health subcommittee.
Clinton, however, tried to extend an olive branch to the GOP.
"We ask the Republicans to come and help us on this," Clinton said at a rally last week unveiling the legislation. "Let's don't play election-year games on this. We don't want to, either."
To support his argument, Clinton pointed to a Congressional Budget Office estimate indicating the program would cost $1.4 billion from 1999 to 2003, less than the White House itself had estimated. Meanwhile, the CBO estimated about 408,000 people would take advantage of the proposal by 2003.
The Clinton administration has said the extra cost will be paid for through new anti-fraud measures.
But the proposal already is facing challenges.
For example, outlining its budget resolution for federal fiscal 1999, the Senate Budget Committee last week did not account for the extra cost of the Medicare buy-in proposal.
Although the budget blueprint does not specifically forbid the buy-in program, the omission of designated funding prompted the committee's senior Democrat, Sen. Frank Lautenberg of New Jersey, to say the budget "precludes the possibility" that Congress could authorize the buy-in.
"It largely ignores the agenda that President Clinton set out," Lautenberg said of the budget resolution.
The Senate Budget Committee, on a 12-10 vote last week, sent the fiscal 1999 budget resolution to the full Senate. The resolution assumes no changes in Medicare and Medicaid spending laid out under the Balanced Budget Act passed last year.
A separate measure added to the budget resolution affirms provisions in the balanced-budget law that blend national costs into local Medicare HMO capitation fee calculations.
The budget proposal also does not specifically bar Congress from imposing on providers some $659 million in new user fees in fiscal 1999 to fund expanded audits and certification surveys, as Clinton has proposed.