With the independent commission he headed unable to reach consensus on Medicare, Sen. John Breaux (D-La.) plans to carry his proposal to save the health program for the elderly to Capitol Hill.
The National Bipartisan Commission on the Future of Medicare defeated Breaux's plan by a vote of 10 to 7, one vote shy of the 11 required to make final recommendations. The commission was required to report to the president and Congress by March 1, but when it failed to reach consensus, it disbanded.
Despite the commission's efforts to eliminate partisanship from the debate, only one other Democrat, Sen. J. Robert Kerrey of Nebraska, voted for the plan.
"Partisanship is what killed it," says David Kendall, senior analyst for health policy at the centrist Progressive Policy Institute in Washington. The proposal, he explains, failed to muster enough Democratic support after President Clinton criticized it.
Under Breaux's proposal, Medicare enrollees would receive funds from the federal government, which they would use to buy private-sector coverage. The plan would increase the eligibility age to 67 from 65 and raise premiums for those with higher incomes. In addition, HCFA would no longer set reimbursement rates.
Rather, an outside Medicare board would oversee private-sector health plans that treat Medicare patients and negotiate with private plans and government-run fee-for-service plans.
"The president didn't want to deal" with the proposal, Kendall says. "He didn't engage his appointees in the commission and didn't make his views known until the very last minute."
As a result, Democrats and Republicans are going their separate ways with little time to compromise and hammer out legislation, given the upcoming presidential elections in 2000. After the March 16 vote, leading Republicans joined Breaux in advocating that the plan be brought before Congress.
In a prepared statement, Sen. Phil Gramm (R-Texas) said he will join three other senators on the commission -- Breaux, Kerrey and Sen. Bill Frist (R-Tenn.) -- in introducing the plan as a bill.
"I believe this legislation can win broad approval in the Senate Finance Committee and on the floor of the Senate, despite President Clinton's lack of support," said Gramm, who voted for the plan. Gramm decries Clinton's lack of action, questioning "why he continues to squander the power and authority of the White House by holding himself aloof."
Indeed, hearings on the Breaux plan already have been scheduled in the Senate Finance Committee and in the House Ways and Means Committee.
Democrats will look to the White House for guidance on how to proceed. Shortly before the commission vote, Clinton said he had instructed his advisers to draft a plan that strengthens Medicare.
The president said he couldn't agree with Breaux's plan because it did not include a provision to set aside 15% of the federal budget surplus for Medicare.
He also objected to the plan's higher eligibility age for Medicare and lack of comprehensive drug coverage, which is a concern for many low-income seniors.
"We must find agreement this year," Clinton said. "Medicare is too important to let partisan politics stand in the way of vital progress."
The commission was created last year to find ways to keep Medicare afloat when baby boomers, now in their early 50s, reach retirement age. But projections of a large federal surplus have led the Congressional Budget Office to forecast that the program will not run out of money until 2012. Since this is several years later than the CBO originally projected, legislators feel less immediate pressure to revamp Medicare.
Agreement on what to do about Medicare, much less actual legislation, is a long shot, Kendall says.
"The prospects are very dim, but there is a small hope if the president wants to grab the opportunity that's still there," Kendall says. He added that if Clinton works hard and tries not to politicize Medicare, there could be some genuine movement. If he uses the issue as a weapon against Republicans in campaigning for Vice President Al Gore and other Democrats, Kendall says, no resolution will be likely until after the elections.
