Nov. 22 (Bloomberg) -- The U.S. House of Representatives approved a $395 billion Medicare bill to help the elderly afford prescription drugs, after Republican leaders spent three hours mustering the votes needed to overhaul the federal health plan.

House Speaker Dennis Hastert persuaded Republicans who supported three tax cuts to back more Medicare spending, winning a 220-215 vote. The House maneuvering prompted Senator Ted Kennedy to say he would try to block the Senate from voting on the bill with a filibuster. That requires 60 votes to overcome.

The House vote, which should have taken only 15 minutes, is a victory for President George W. Bush, who may take credit for helping senior citizens pay for prescription drugs during his re- election bid next year. Debate began in the Senate this morning.

House Republicans ``got it, and because they got it, someone like me has to say, `No, no way is this a good deal for the seniors of this country,' '' Senator Debbie Stabenow of Michigan, who leads the Democrats' task force on prescription-drug issues, said in a speech on the Senate floor.

The Senate may vote on the legislation to revamp the federal health insurance for the elderly and disabled as soon as Monday, Senate Majority Leader Bill Frist told reporters at the Capitol today. Without a filibuster, Frist would only have to muster 51 votes to send the most sweeping change in Medicare's history to Bush's desk.

Fallout After Vote

The measure would spend billions of dollars over the next decade to pick up much of the cost of prescription medicines that seniors buy at pharmacies, expanding sales for drugmakers including Pfizer Inc. and Merck & Co. The program now pays for medicines administered by doctors such as chemotherapy. The bill would also raise hospital payments and cut fees for doctors and other services.

The legislation ``would represent the greatest improvement in senior health care since Medicare was enacted in 1965,'' Bush said today in his weekly radio address. ``Seniors would have more choices of health care coverage.''

Kennedy told reporters on Capitol Hill that the predawn House vote reminded him of the outcome of the 2000 presidential election in Florida. He said he plans to seek supporters for a filibuster to block the Senate from voting.

``What happened in the House of Representatives in the dead of the night was Florida 2000 all over again,'' Kennedy said. ``It was a rigged vote.''

Winners, Losers

The House battle centered on costs and a measure to test competition between Medicare and private insurers such as UnitedHealth Group Inc. and Aetna Inc., which Democrats oppose. Some Republicans say it doesn't go far enough.

The nonpartisan Congressional Budget Office estimated the government would spend $410 billion over the next decade on prescription drugs for Medicare patients. The bill includes another $14 billion for Aetna, PacifiCare Health Systems Inc. and other private insurers to encourage them to offer broader coverage to seniors.

Health Management Associates Inc. and other rural hospital chains would benefit from about $20 billion in Medicare raises for health-care providers in sparsely populated areas.

The government would save money through measures including reducing reimbursements for inhalation drugs by $4.2 billion, other medicines by $12 billion and durable medical equipment such as canes by $6.8 billion. A provision allowing cheaper copies of medicines to get to market more quickly would save the government $600 million, the budget office estimated.

Shares of Apria Healthcare Group Inc., the biggest U.S. provider of home-health care services, and rival Lincare Holdings Inc. fell after Wachovia Securities analyst William Bonello said the Medicare cuts would hurt profit.

Wrangling on the Floor

During the three hours of wrangling on the House floor, Hastert convinced fellow Republicans Trent Franks of Arizona and Butch Otter of Idaho changed their votes, which was all he needed. When it was clear the bill would pass, moderate Democrat Dooley of California and a few other lawmakers switched their votes from no to yes.

``It was an extraordinary display of power politics and given what was at stake, you would have expected this to happen,'' said Paul Heldman, a health policy analyst with Schwab Washington Research Group. ``This was taken to an extreme, but given that it was the largest expansion of health-care benefits since the creation of Medicare and Medicaid in 1965, it was to be expected.''

Bush Lobbies Lawmakers

Bush made a dozen calls last night and this morning to lawmakers, White House spokeswoman Suzy Defrancis said. Calls were made aboard Air Force One as Bush flew home from London, and before 5 a.m. Washington time. Health and Human Services Secretary Tommy Thompson also lobbied lawmakers on the issue. ``It was a team effort,'' Defrancis said.

Sixteen Democrats, including Representatives Earl Pomeroy and Cal Dooley, joined Republicans in voting for the bill, while 25 Republicans and 189 Democrats voted against it.

Any lingering acrimony over the House vote will probably be insufficient to interfere with the Senate's passage, Heldman said. Senators Olympia Snowe, a Maine Republican, and South Dakota Democrat Kent Conrad have said they support the bill. Senate Minority Leader Tom Daschle, who opposes passage, has said he won't filibuster, Heldman said.

``There was a sense among the Democrats that this brought up memories of Florida in 2000,'' he said. ``That may rile up the Democrats a little bit. Still, at the end of the day, this becomes law. There's enough support in the Senate that it will go through by Monday or Tuesday.''

Predawn Vote

Both sides agreed that several health-care industries would prosper under the bill.

``Most industries are beneficiaries in this,'' said Ira Loss, an analyst with Washington Analysis who has followed health policy for three decades. ``The big winners are the managed-care companies. They'll get generous increases in their premiums.''

House Democrats decried Republican tactics in rounding up support during the predawn vote.

``The whole time that members were on the floor, there were overtures to members of Congress saying, `What do you want? What do you need?''' said House Democratic Leader Nancy Pelosi, of California. ``They spent billions of dollars of the taxpayers' money to win this vote on the floor.''

``Now it is time for the Senate to act,'' Bush said in a statement today. ``I urge the Senate to pass this good piece of legislation so that I can sign it into law.''

Democrats seeking their party's nomination to run against Bush next year issued statements blasting the measure. Representative Dick Gephardt said it ``takes dangerous steps toward privatization by forcing millions of seniors into HMOs.'' Former Vermont governor Howard Dean said Republicans ``strong- armed through the House a special-interest boondoggle,'' and urged the Senate to defeat it.

(The Medicare legislation is posted on the House Ways and Means Committee Web site at: http://waysandmeans.house.gov. The full House vote tally can be found at: http://clerkweb.house.gov/cgibin/vote.exe?year=2003&rollnumber=669 .)

Last Updated: November 22, 2003 18:44 EST