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Hobson’s Choice

GOP Member May Block Drug Bill Over Equipment Provision

Rep. David Hobson says he has been objecting for months, but no one has been listening.

So the seven-term Ohio Republican took a step he says he’s pretty uncomfortable taking — threatening to derail the House-Senate compromise on creating a prescription drug benefit under Medicare.

“I have not tried to stir up discontent on this bill,” Hobson said last week. “But unfortunately, nobody listened so I’ve been forced to do what I don’t like to do, which is take this position.”

At issue for Hobson is a relatively obscure provision in the House-passed Medicare bill that would allow competitive bidding for home health care equipment paid for by Medicare. It’s backed by House Ways and Means Chairman Bill Thomas (R-Calif.) but opposed by the Senate, which would freeze the cost of such medical equipment over the next several years.

Thomas’ approach, Hobson said, “will force a lot of small business people out of business.”

However, Thomas has argued that the provision will save Medicare money in the long run, and he has fought vigorously to keep his version in the final conference report.

Hobson said he voted for the original House bill with the provision included because “I was told there’d be a reasonable accord, but no one has talked to me about a reasonable accord.”

So now Hobson says he has “talked to everybody I can in the [House GOP] leadership” to tell them he will not vote a second time for a bill that contains the competitive bidding provision.

One House Member’s complaint on such a far-reaching measure might not be a big deal if the Medicare bill had passed by more than one vote in the House, or if more than nine Democrats had supported the bill’s initial passage.

But Hobson’s case is just one instance among many in the tremendous backlash House GOP leaders are getting from their trusty rank and file over the process and policy of the Medicare bill.

One House Republican leadership aide estimated that GOP leaders could count on only about 100 solid votes no matter what comes out of the conference committee. The other 118 they need to prevail will have to be cajoled out of Members whose concerns on the bill are like juggling “cats and dogs,” the aide said.

In some ways, it has become a situation much like the Senate faces every day — where the objections of one lawmaker can bring a bill to a screeching halt.

“They have a lot of leverage because these are guys who are Republicans who voted yes [on the Medicare bill] the first time,” noted one health care lobbyist involved in the talks on home health care supplies.

The problem is compounded because House Republicans decided to forgo input from all but two Senate Democrats during conference talks. Just last week, an angry Rep. Charlie Rangel (D-N.Y.), who is the ranking member on Ways and Means and was named a conferee on the bill, led 12 other Democrats into Thomas’ office to object to their exclusion from conference committee negotiations.

With most of the 205 Democrats and one affiliated Independent considering voting against the measure out of protest and policy differences, House GOP leaders appear to have given their own 229 Members much more power to influence the outcome of the bill.

Indeed, House Speaker Dennis Hastert (R-Ill.), Majority Leader Tom DeLay (R-Texas) and Majority Whip Roy Blunt (R-Mo.) have been getting an earful from their rank-and-file Members upset with specific provisions that have leaked out of negotiations as well as with their feeling that they still don’t know much about what agreements have already been made in the conference committee negotiations.

“There are not enough leaks out of conference committee,” said Rep. Joe Pitts (R-Pa.), who has been part of the vocal chorus of malcontents on the Medicare bill. “I would like to understand this issue before we are compelled to vote.”

So last Thursday, at a GOP Conference meeting that was called exclusively to update Members on the Medicare talks, Hastert assured his troops that they would now get regular briefings on the Medicare bill and would have a least three days to look over the conference report before having to vote on it, according to several Members who attended.

That concession — unusual for a House GOP leadership used to relying on the loyalty of the rank and file when they force conference reports to the floor within hours of agreement — demonstrates just how precarious House passage of the prescription drug bill could be and just how seriously Hastert is taking complaints among his rank and file.

“The Speaker wants to make sure that Members are comfortable making this historic change” to Medicare, said Hastert spokesman John Feehery.

The three-day review idea was first floated by freshman Rep. John Kline (R-Minn.), who got 41 fellow Republicans — from conservatives to moderates — to sign his letter to the leadership requesting such a review period.

Kline’s letter warned, “Allowing Members adequate time to properly evaluate the conference report will avoid a needless and difficult internal fight over the rule [for floor debate], and allow leadership to concentrate its efforts on final passage.”

After the Medicare briefing, Kline appeared buoyed by Hastert’s pledge to give Members time to look over the bill but indicated he was still looking for tangible results.

“This is an important step,” he said.

Indeed, even with Hastert’s assurances, many Members remain skeptical about the entire process and are worried their leaders might be trying to sell them a bill of goods.

“Every time we hear something out of that conference committee, it gets contradicted two hours later,” said Rep. Jeff Flake (R-Ariz.), who opposed the original House measure and vowed to vote against any conference report. “There are a lot of conservatives who have buyers remorse after voting for it the first time.”

Though many House conservatives like Flake are firmly against creating what they feel is a new entitlement program, even moderates who support the notion of crafting a prescription drug benefit under Medicare appear to be having second thoughts.

Rep. Johnny Isakson (R-Ga.) acknowledged that Members feel like they could be in a lose-lose situation on the Medicare bill, given that its impact may be unknown on a broad swath of regular voters — those 65 and older.

“Once this thing passes, you’ve got two sales to make” to your constituents, said Isakson, noting the effects of a badly crafted measure could negatively impact both seniors who already have private prescription drug coverage and those who have none.

“This would not be a bill to pass in haste,” added Isakson, who signed on to Kline’s letter.

But one senior House GOP aide said the leaders are asking Members to look beyond small issues in the bill and at the big-picture benefits to the Republican Party in enacting what Democrats have been campaigning on for years.

“As long as [the conference committee] brings something back that ensures Medicare is there for the future and won’t bankrupt the system, we’ll be in good shape,” the aide predicted.

So far, that approach doesn’t appear to be sinking in.

“I have tried to be a team player. I am a team player. But there comes a time when you’ve got to do what you’ve got to do,” Hobson said.

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