Spending: Difficult Talks Loom

House and Senate budget leaders stopped to pat themselves on the back Wednesday night after both chambers passed the spending portions of budget reconciliation, trimming Medicare spending by $115 billion and making other changes to Medicaid, agriculture, education, welfare and telecommunications policy.

But nearly everyone involved in the process concedes the heavy lifting has only just begun, and that the real dealmaking will have to take place in conference.

Politically, the bills are on two very different tracks.

The Senate passed its bill with broad bipartisan support by a vote of 73-27, with Democrats splitting nearly evenly on the measure, 21 voting for it and 24 against. The House, on the other hand, gave a more partisan performance.

Despite a last-minute plea from President Clinton urging Democrats to work together "to advance, not oppose, this significant achievement," only 51 House Democrats voted for the bill, while 154 voted against it, including Minority Leader Gephardt.

Among the largest substantive differences between the two bills are their treatment of Medicare beneficiaries.

The Senate bill would ask far more of current and future recipients, including imposing a $5 co-payment for home health visits, higher premiums for individuals with incomes over $50,000, and for future beneficiaries, and a boost in the Medicare eligibility age from 65 to 67.

The House bill, on the other hand, would provide beneficiaries with more in the way of new preventive benefits, and many more consumer protections, such as barring "gag clauses" in managed care contracts that limit what doctors may tell patients about specialists or services not covered by their plan.

House leaders, however, struck from the bill a Commerce Committee amendment that would have left decisions about lengths of hospital stays for Medicaid patients solely in the hands of doctors and patients, after the CBO said it would cost $800 million over five years.

Another simmering dispute that could crop up is over abortion.

Both the House and Senate bills include permanent abortion bans, allowing exceptions only for rape, incest and life endangerment, in the new program providing funds to states to help insure children through age 18.

That would represent the first time Congress has written into permanent law provisions of the "Hyde amendment" carried in each year's Labor-HHS appropriation. An amendment by Sen. Bob Kerrey, D-Neb., to strike the language failed on a vote of 61-39.

While the abortion ban would apply only to the children's health funds, not to Medicaid and other federal health programs, the Senate bill also would redefine the phrase "medically necessary" so as not to include abortion.

That, say abortion-rights backers, would have essentially the same effect as writing the Hyde language into permanent law.

"They did it in a sneaky, back-door way, but the full consequence is to say that abortion is not medically necessary, so the states would no longer have to provide this service" if the Hyde amendment were removed from the appropriations bill, said House Government Reform ranking member Henry Waxman, D- Calif.

Abortion opponents insist revision of the definition of medical necessity would not be tantamount to a ban, but would merely make abortion optional in the absence of other restrictions.

Regardless, 71 abortion rights advocates in the House Wednesday sent Clinton a letter urging him to make removal of all the abortion riders a condition of signing the bill.

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