The US House of Representatives narrowly approved a bill to overhaul the federal health program for the elderly on Saturday after an all-night struggle that was a hard-won victory for US President George W. Bush.
After House Republicans pushed the through the measure on the Medicare program by a 220-215 vote, the US Senate launched its own debate, aiming for a vote early next week.
The legislation would add a prescription drug benefit to Medicare and introduce free market-style changes and cost-containment measures that could reshape the 38-year-old program that serves 41 million Americans.
The Medicare bill gives Bush, who has seen his public support decline in recent opinion polls, an important domestic policy victory that could boost his re-election chances. The president had made early morning telephone calls to a few balky Republicans who saw the bill as a costly expansion of the government program. After the vote, he praised the house passage and urged the senate to do the same.
"In the nearly 40 years since Medicare was launched, this is the most significant opportunity for any congress to improve health coverage for our seniors," Bush said in his weekly radio address. "Now we're down to the final stages."
Senate Majority Leader Bill Frist, a Tennessee Republican, predicted the bill would win strong bipartisan approval in the senate. That would contrast sharply with the heated debate in the house on Friday night and into Saturday morning.
House Democrats overwhelming opposed the legislation, calling it a first step to privatizing Medicare while offering a skimpy drug benefit for the elderly.
The legislation is estimated to cost US$395 billion over the next 10 years, but many analysts say its costs could explode as the baby boom generation retires.
In the end, it took an extraordinary effort by house Republican leaders to round up the votes. Twenty-five Republicans broke with Bush to oppose the bill, while 16 Democrats broke ranks to back it.
The house began voting at 3am. It appeared for a while the measure would be defeated by opposition from conservative Republicans concerned about its costs and Democrats worried it would undermine traditional government-run Medicare. House Republican leaders kept the vote open for almost three hours instead of the customary 15 minutes while they struggled to get some Republicans to switch their votes. By 6am, they succeeded with the help of Bush.
"Arms have been twisted and votes changed," Maryland Republican Steny Hoyer, the Democratic whip, angrily declared as Democrats futilely challenged the vote.
House Democratic Leader Nancy Pelosi of California accused Republicans of an "abuse of power" and likened it to the contested 2000 presidential elections in Florida. "I guess it's in their DNA. They just can't play by the rules," she said.
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