With a Senate showdown looming, the politically potent AARP rode to the rescue of Democrats on Wednesday, supporting $460 billion in Medicare cuts to help pay for landmark health care legislation.
As Republicans pressed to restore the cuts, AARP said Democrats merely were recommending elimination of waste and inefficiency within the giant health care program for seniors.
"Most importantly, the legislation does not reduce any guaranteed Medicare benefits," A. Barry Rand, the AARP's CEO, said in a letter to senators.
Republicans, led by Sen. John McCain, said seniors would lose some of their add-on benefits that are part of coverage under private insurance Medicare. "Above all, we must not use Medicare as a piggy bank" to pay for other programs, the Arizona Republican said.
Democrats, sensitive to the charges, rallied behind an alternative proposal by Sen. Michael Bennet (D-Colo.), saying the bill would cause no reduction in guaranteed Medicare benefits.
Votes were scheduled on the issue and a women's health care amendment. Both issues have dominated early debate on health care legislation that President Barack Obama has urged Congress to enact.
The two parties maneuvered for political advantage on women's health, as well, each backing a promise to provide new no-cost preventive procedures such as mammograms.
Republicans hastily rewrote theirs after an initial estimate from the Congressional Budget Office put the cost at $30 billion over a decade — a significant requirement on the insurance industry from a political party that has criticized Democrats for seeking a government takeover of health care.
Overall, the legislation is designed to extend health care to millions who now lack it, prohibit insurance companies from denying coverage on the basis of pre-existing medical conditions and generally slow the rate of growth in medical spending overall.
Most Americans would be required to carry insurance. While employers would not be obliged to provide it, big companies would face penalties if they did not and their workers received federal subsidies to help defray their personal insurance costs.
At its core, the bill would create new marketplaces, called exchanges, where consumers could shop for insurance that met government guidelines. The bill includes hundreds of billions of dollars in federal subsidies to help lower and middle-income individuals and families afford insurance.
The House passed its version of health care legislation last month, and Senate Majority Leader Harry Reid (D-Nev.) has vowed to clear a bill through his chamber by Christmas.
The early pace of debate has been exceedingly slow, and Democrats accused Republicans during the day of stalling.
"There's a lot of talk that if we have to be here until Christmas, we'll be here until Christmas," Sen. Tom Harkin (D-Iowa) said after a closed-door Democratic caucus meeting.
That seems unlikely.
Democrats command 60 seats, enough to end any delaying tactics if they are united. So far, they are not, and while debate unfolds on the Senate floor, Reid is working behind the scenes to resolve a small number of controversial issues.
Chief among them is a call by liberals for the government to sell insurance in competition with private industry. The legislation on the floor permits that, subject to approval from individual states. But an unknown number of moderate and conservative Democrats have demanded changes as the price for their support on the legislation.
AARP has played an influential role all year on health care, working with the Obama administration as well as Democratic leaders to help pass legislation.
The organization's Web site claims more than 40 million members in all 50 states, and describes AARP as "a nonprofit, nonpartisan membership organization that helps people 50 and over improve the quality of their lives."
Polls have shown the group enjoys a high degree of trust among seniors, a group that tends to vote in disproportionately high numbers, particularly in midterm elections. As a result, its endorsement is prized by both political parties.
When Republicans held power in Congress, AARP's decision to support a new prescription drug benefit under Medicare was a turning point in the drive to pass legislation.
Democrats were furious at the time. But now, in power, they have worked closely with the organization, and the political lines are reversed.
"Shame on AARP," McCain said earlier in the week as he pressed his case to restore the cuts Democrats wrote into their legislation. Sen. Lamar Alexander (R-Tenn.) accused Democrats repeatedly of seeking to cut "Grandma's Medicare" and use the money to finance other programs.
McCain and others recited the proposed cuts in future payments during days of debate, including private-insurance Medicare, payments to hospitals, hospices, home health agencies and others.
But Rand, in his letter, wrote, "AARP believes that savings can be found in Medicare through smart, targeted changes aimed at improving health care delivery, eliminating waste and inefficiency, and aggressively weeding out fraud and abuse."
The biggest cuts are aimed at the Medicare Advantage program, in which private companies provide coverage. Studies show the government pays 14 percent more a year for each beneficiary covered in a private plan, compared with traditional Medicare.
Critics say that money goes into high executive salaries and profits for the firms. But supporters say the plans use the funds to provide extra benefits, sometimes including vision or dental coverage or gym memberships.
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