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Bush May Back Medicare Rx Deal

President Bush may accept a new Medicare prescription drug benefit even if it does not mirror his own proposal to favor private plans over government-run insurance.

The Senate Finance Committee plans to vote this week on a $400 billion bill to add a drug benefit to Medicare, the nation's insurance program for the elderly and disabled.

The Senate proposal differs from the president's plan in that it gives equal coverage for drug costs to all enrollees who want them, regardless of whether they stay in traditional Medicare or join new, private-run plans created by the bill.

The president had wanted the private plans to offer greater drug benefits to encourage more seniors to switch out of the government-run plan.

Health and Human Services Secretary Tommy Thompson on Monday met with Mr. Bush and then told lawmakers the president's position. The secretary said the president was not seeking any change to the drug benefits proposal "at this point in time," The Times reports.

"The president is very high on the process we've got going here, without agreeing on every detail of what we're doing. I find this very helpful," Finance Committee chairman Sen. Charles Grassley, R-Iowa, told reporters afterward.

Asked whether Mr. Bush would sign the measure if it cleared Congress as drafted, Grassley replied, "I believe he would."

"There are differences to be worked out," said White House spokesman Ari Fleischer. But, he added, "the important thing is to keep the process moving."

Congress has for years discussed adding prescription drug coverage to Medicare, but in the past compromise has eluded them. Last summer, the Senate rejected no less than four proposals, with lawmakers divided over financing and eligibility.

By supporting the bill — even one that doesn't exactly match his request — the president could neutralize Democrats on an issue they have traditionally dominated, and show that the Republican-controlled Congress is capable of getting things done.

On Tuesday, the measure's sponsors were working to close gaps in coverage under the bill, using money freed up by new, favorable cost estimates.

A $400 billion measure is sought. An early draft was estimated to cost $359 billion over 10 years, and $8 billion less than that after taking unidentified offsetting provisions into account — meaning the bill's architects had tens of billions in additional funds to devote to the measure.

Grassley declined to say precisely how the bill would change, but several officials said they expected the available funds would be used in part to reduce the burden on seniors with high drug costs, and possibly to increase help for lower-income beneficiaries as well.

Pending overnight changes, aides have said that beneficiaries enrolled in traditional Medicare could purchase stand-alone drug coverage for a premium of roughly $35 a month.

The plan would carry a deductible of $275, after which the individual would be required to pay 50 percent of the bill until total costs reached $3,450.

From that point until costs reached $5,300, the individual would pay 100 percent of the bill. Beyond that level, insurance would pay 90 percent, and the individual 10 percent.

In addition to providing a prescription drug benefit, the legislation would establish a new managed care option for Medicare.

Seniors would be offered the chance to enroll in Preferred Provider Organizations that the administration says would help modernize the program while putting its finances on a stronger foundation.

Medicare enrollees can already choose between government- and private-administered fee-for-service plans and private, HMO plans.

The new PPO plans would offer preventive health coverage as well as protection against catastrophic health care expenses, neither of which is currently available under the government-run program.

Under PPOs, beneficiaries may see any physician for their care, but would pay higher costs — sometimes much higher — if the doctor were outside the insurance plan's network.

According to The Times, the Congressional Budget Offices told senators that if prescription benefits are equal, fewer than 10 percent of Medicare beneficiaries would switch to private plans. The White House thought as many as 28 percent might opt for private coverage.

While Baucus and a few Democrats support the measure, Senate Democratic leader Tom Daschle of South Dakota has been sharply critical of it. But Daschle has said repeatedly he doesn't expect to filibuster the proposal.

Currently, Medicare does not pay for most prescription drugs; exceptions include cancer medications and drugs administered during hospital stays.