After months of deliberations between the House and Senate, conferees reached an agreement late last week on the Medicare Prescription Drug bill. Republican leaders intervened last week in order to get the measure cleared by both chambers before the November 21 target adjournment.

A six-page summary of the conference approved agreement can be seen at the House Ways and Means Committee website.

Republican leaders are embarking on a campaign with the White House to sell their plan to a public and Congress that are divided on the issue.

The agreement would make the most significant changes to Medicare in its 38-year history and create a new government paid drug benefit for the program’s more than 40 million beneficiaries. It also would expand the role private health plans play in delivering benefits.

The deal scales back some of the most contentious proposals urged by conservatives, including “premium support” that would force the traditional Medicare program to compete with private health plans on price. Lawmakers also agreed on a way to encourage employers not to drop drug coverage for their retirees and offered more assistance for low-income seniors.

The outcome of this week’s floor votes is likely to influence the 2004 elections. Should an overhaul bill plan pass, Republicans are likely to seek credit for both helping seniors cope with rising drug costs and for rescuing an entitlement program. However, the risks are significant because there is not enough money to pay for drug coverage for every level of medical need. This means that some seniors will incur significant out-of-pocket expenses.

During conference negotiations, conservatives had to drastically scale back a proposal to force the new Medicare drug plans to compete with private plans in local markets. Negotiators agreed to drop the regional test and implement the pilot in six metropolitan areas only. Leaders also thwarted efforts of conservatives to limit government spending on Medicare. The new deal contains a provision calling for Congress to examine the program again if costs rise too quickly, but stops short of the more binding measures conservatives were advocating. Tax-free savings accounts, known as health savings accounts, were included.

Despite the backing of Senators Baucus of Montana, the ranking member of the Senate Finance Committee and John Breaux of Louisiana, the only two Democratic conferees permitted to attend the negotiating sessions, Democratic support will be difficult to secure. And with the Senate divided politically 51-48 with one independent, the leaders would have to make up for any moderate GOP defections with votes from a handful of Democrats, who may not see it in their political interest to vote for the legislation.

Senate Majority Leader Frist predicted floor votes before the targeted adjournment date of November 21.