Clinton administration officials emerged Wednesday from their first meeting to discuss the unified House-Senate GOP position on the spending parts of the budget reconciliation bill complaining that the list of differences, rather than being shortened, has actually grown.
For example, on welfare, Office of Management and Budget Director Franklin Raines told reporters, "Rather than moving towards the administration, there was an effort to move as far away as the House and Senate bills would permit." Continued Raines, "Based on the presentations we heard today, there are more issues than there were the last time we talked."
Raines' comments were in marked contrast to those of House Budget Chairman John Kasich, R-Ohio, and Senate Budget Chairman Pete Domenici, R-N.M. "The number of issues left clearly makes this doable," Domenici told reporters after the afternoon meeting, designed to explain to Democrats and administration officials the details of the plan Republicans hammered out in a series of closed meetings dating back to last week. "Once we start meeting we can do it in a couple of days," Domenici speculated.
Kasich added that progress was already under way from the first meeting. "We sank a lot of three-foot putts," he said.
Raines did agree that in some areas, a deal is in sight. On food stamps, for example, "we made enormous progress," he said. Similarly, while some major issues remain to be resolved on Medicare, Raines added, "We ought to be able to close that out."
Apparently off the table on Medicare, at least until leaders sit down at the very end to close the deal, are two of the three controversial beneficiary provisions passed by the Senate. One would gradually raise the eligibility age from 65 to 67 and the other would institute a $5-per-visit copayment for home health services. Still in play, although still opposed by House Republicans wary of potential electoral fallout, is whether to increase Part B premiums for high-income seniors.
The administration opposes the Senate plan to have the HHS collect the premiums, complaining that would entail creation of a huge new bureaucracy and allow high levels of evasion.
However, Republicans have balked at allowing the Treasury Department to collect the payments, even if the payments do not actually physically go to the IRS, complaining it looks too much like a tax.
The administration and Republicans also disagree over several other key Medicare provisions.
For example, the GOP plan would allow 500,000 beneficiaries to open tax-preferred medical savings accounts.
The administration wants the number of participants pared back even further from the Senate-passed level of 100,000.
The administration also opposes Senate-passed provisions allowing beneficiaries to join private fee-for-service plans that would not require physicians to abide by the usual Medicare limits on fees or beneficiary cost-sharing, and that would permit private contracts between physicians and patients for services that would otherwise be covered by Medicare.
In both cases, the administration says, doctors could end up coercing patients to pay more than Medicare allows.
Supporters of the provisions contend they are needed to prevent Medicare from becoming a program that rations health care.
A major financial sticking point is how fast to transfer Medicare's fast-growing home health program from Part A, where it is a major factor in the dwindling finances of the Hospital Insurance trust fund, to Part B.
The Republican proposal would phase in the transfer gradually, which the administration contends would not only cost the trust fund two years of solvency, but would violate the budget agreement reached in May.
"All sides clearly understood that the reallocation would be immediate," said the administration's July 2 views on the House- and Senate-passed bills.
On the table as well is the makeup of a commission that will be charged with examining options to reform Medicare to keep it solvent when the massive Baby Boom generation reaches retirement age beginning around the year 2010.
The consensus GOP plan calls for the House speaker and Senate majority leader each to appoint 6 members, no more than four of whom may be from the same party, and the president to appoint three members, likely producing an 8-7 GOP majority.
Attendees at the meeting ran out of time without reaching the children's health issue.
But that, too, is likely to prove a sticking point.
President Clinton Wednesday pointedly endorsed the Senate- passed version of the plan, particularly the extra $8 billion it would provide by increasing the cigarette tax by 20 cents per pack.
"I intend to fight to keep that money in the budget, and fight for our children," Clinton said during a child immunization event.
The consensus GOP plan reached no resolution on the tobacco tax issue, which was included in the Senate but not the House version of the tax bill, with the Senate stipulating that a portion of the proceeds be used for children's health insurance coverage.
Clinton also made a pitch for a comprehensive benefits package more inclusive than the choices included in the GOP plan.
"Some in Congress want a very watered-down package of benefits at a level well below that now provided by Medicaid and federal employee health plans," Clinton said.
The president added: "I think that would be a big mistake."
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