02-03-2001

WHITE HOUSE: A Different Tack With Congress

When Bill Clinton took office in 1993, he quickly went to work on a
signature issue of his presidential campaign-health care reform. He tapped
first lady Hillary Rodham Clinton and White House adviser Ira Magaziner to
head a 500-person task force that ended up sending a detailed 1,300-page
bill to Congress for consideration.


Members of Congress weren't welcomed into the decision-making process -not
even Democrats. And they didn't appreciate the snub.


"I was taken aback by how angry many members of Congress were about
the presumptiveness of the Clinton Administration," said Gail
Wilensky, a Bush adviser who chairs the Medicare Payment Advisory
Committee, which advises Congress on Medicare policies. "It was a
complete lack of understanding about how Congress works, and the rights
Congress believes is theirs, which is passing domestic
policy."


Although it's far too early to draw any conclusions, George W. Bush seems
to be getting off to a much different start. Like Clinton, Bush is making
a health care initiative one of his first priorities-in this case a
prescription drug benefit for seniors. Unlike Clinton, he appears willing
to let Congress play a prominent role in shaping the legislation, even if
it means backing off some proposals he pushed on the campaign trail.
Indeed, Bush's prescription drug plan was not in the form of legislation,
but a five-page conceptual proposal.


The plan, which Bush sent to Congress on Jan. 29, is intended to provide
temporary help to seniors facing rising prescription drug costs while a
more permanent solution is devised. The "immediate helping hand"
proposal would send block grants to the states to cover the full cost of
drug coverage for low-income elderly who are not eligible for Medicaid or
retiree benefits. Individuals with incomes up to $11,600 and married
couples with incomes up to $15,700 would be eligible. Under the plan,
there would be no premium, and co-payments would be
"nominal."


Single seniors with incomes up to $15,000 and couples with incomes up to
$20,300 would receive a subsidy for at least 50 percent of the premium for
coverage. And any Medicare beneficiary whose out-of-pocket spending for
prescription drugs exceeded $6,000 a year would be eligible for a state
program, with no premium. The federal government would pick up the full
cost.


Bush's plan drew quick criticism from Democrats, as well as from some
Republicans, in Congress. "While it is well-intentioned, it is not a
good one," said Sen. John Breaux, D-La. About half of all states
already have prescription assistance programs for seniors in place, and
proposals are pending in many others. Critics argue that by the time
states get programs up and running, the four-year timetable envisioned for
Bush's "helping hand" would have expired.


Even so, members of Congress are giving Bush more slack than they gave
Clinton. One reason why is that Bush did not send up his proposal as the
Administration's final word on the matter.


White House spokesman Ari Fleischer conveyed the White House's
conciliatory tone: "He [Bush] is aware that there are some important
people in the Congress who have expressed reservations about it moving as
a separate bill, and we'll be pleased to work with them," Fleischer
said. "Any proposal that anybody makes on Medicare, whether it's
giving prescription drugs to seniors or whether it's structural reforms
that involve Part A, Part B, all need to be explored in a fashion that
brings Democrats and Republicans together."


Health policy analysts see potential in the Administration's approach.
"In engendering a feeling of cooperation, where [Bush] said, `I
outline the principles and you outline the details,' it sets the correct
tone of cooperation," said Edward F. Howard, executive vice president
of the Alliance for Health Reform, a nonpartisan organization that
promotes health insurance reform. "The President said, `Look, I'm
interested in the outcome and not in the exact dimensions of the
process....' It's the focus on results that seems consistent and is the
sort of message that a lot of lawmakers from both parties like to
hear."


Bush said during the presidential campaign that, after he sent his
"helping hand" proposal to Congress, he would establish an
Administration task force to decide what to do about broader Medicare
reforms. Bush now appears to be backing off on that proposal, and says
he's open to allowing Congress to have more of a role.


Before Bush sent his prescription drug plan to Capitol Hill, he met
privately with Senate Finance Committee Chairman Charles Grassley, R-Iowa,
and House Ways and Means Committee Chairman Bill Thomas, R-Calif., and
said he wasn't wedded to the task-force idea, Grassley said. "He had
the feeling it might needlessly slow things up," Grassley said.
"We consider this pressure on Congress to do something." Bush
met later in the day with nine Republican and seven Democratic Senators to
discuss Medicare and other issues.


But whether this cooperation will persist-and carry over to other policy
debates-remains to be seen. For starters, Congress hasn't yet begun
working on Bush's prescription drug proposal. Moreover, Bush could take a
harder-line approach in policy areas where he has invested more energy,
such as education and taxes.


Marilyn Werber Serafini

National Journal