26 — In public, members of Congress have spent hundreds of hours debating the future of Medicare and the need for a
national energy policy. Behind the scenes, they have spent even more time working on little-known provisions of the legislation
that would benefit specific health care providers and energy companies.
Tucked inside the Medicare bill is an assortment of provisions that have nothing to do with providing prescription drug
benefits to the elderly. The energy bill and the annual spending bills for federal agencies are also stuffed with pet projects,
intended to win votes for the legislation.
Congress gave final approval to the Medicare bill on Tuesday, but is still wrestling with the energy measure.
The two bills — top priorities for President Bush and the Republican leaders of Congress — provided convenient
vehicles for spending narrowly focused on special interests. Hundreds of health care providers and colleges now receive such
largess, and the numbers have soared in recent years.
A provision benefiting a specific hospital in Tennessee was added to the Medicare bill at the last minute in an effort
to get the vote of Representative Harold E. Ford Jr., Democrat of Tennessee.
The hospital was not named in the bill, but was described in terms that apply to only one hospital in the United States,
the Regional Medical Center at Memphis. Mr. Ford's father, a former congressman, is a lobbyist for the hospital.
In the end, Mr. Ford voted against the bill. Bush administration officials now say they will probably not provide any extra
money, even though the Senate majority leader, Bill Frist, Republican of Tennessee, is urging them to do so because the hospital
is in his state.
"We are the largest charity hospital in Tennessee," said Dr. Bruce W. Steinhauer, the hospital president. "We also provide
millions of dollars worth of care to poor people from Mississippi and Arkansas."
The Medicare bill also increases payments for doctors in Alaska for a cancer treatment known as brachytherapy and for health
maintenance organizations that have been dropping out of the Medicare market.
The energy bill includes $1 billion for a new nuclear reactor in Idaho, $800 million in federal loan guarantees for a coal
gasification plant in Minnesota and tens of millions of dollars in subsidies for timber companies to log national forests
for energy production.
Senator John McCain, Republican of Arizona, said "parochial projects" were siphoning money away from higher priorities
at many agencies.
Timothy M. Westmoreland, a professor at Georgetown University Law Center, said: "Big bills become larded with whatever
bait it takes to get a majority vote. A lot of money in the Medicare bill is spent on things that have nothing to do with
a prescription drug benefit."
For decades, it has been common practice for lawmakers to designate money for specific military bases, post offices and
waterways. In recent years, they have funneled increasing amounts to specific hospitals, medical schools and health care projects.
Data collected by The Chronicle of Higher Education shows that spending on pork barrel projects at colleges and universities
topped $2 billion this year for the first time. In a recent report, the Democratic staff of the House Appropriations Committee
said the number of projects designated for assistance under the health and education spending bill nearly quadrupled, to 1,850,
in the last three years.
Frank Clemente, director of Public Citizen's Congress Watch, a consumer group founded by Ralph Nader, said, "The Medicare
bill is a grab bag of special interest provisions benefiting a large number of industries."
Public interest groups criticize pork barrel projects as shameful. But lawmakers often take credit for their handiwork
Just before the Senate gave final approval to the Medicare bill on Tuesday, Dr. Frist displayed a chart listing 358 organizations
that supported it.
Members of many of those groups stand to benefit from the bill and participated in a lobbying campaign coordinated by Susan
B. Hirschmann, a former chief of staff to Tom DeLay of Texas, now the House Republican leader.
The push for special interest provisions to ensure passage of the Medicare and energy bills led, in some cases, to new
variations on the traditional relationships between lobbyists and lawmakers.
Lobbyists have long tried to influence members of Congress. But increasingly members of Congress have put pressure on lobbyists
to support their legislative priorities. E-mail messages obtained from recipients provide details of such reverse lobbying.
On Sept. 12, Senator Charles E. Grassley, Republican of Iowa, the chairman of the Finance Committee, sent a "wake-up call"
to hospital executives around the country, asking for their help in fighting cuts proposed by the House.
"I met with Washington representatives from the American Hospital Association, the Federation of American Hospitals, the
Catholic Health Association, the Association of American Medical Colleges and the National Association of Public Hospitals,"
Mr. Grassley wrote. "I asked them to stand with me in opposing these cuts."
Senator Grassley was successful. Hospitals were spared, and rural hospitals received substantial increases in payments.
Representative Bill Thomas, Republican of California, the main author of the Medicare bill, tried to minimize the number
of special interest provisions. But lobbyists say those provisions are sometimes needed to increase access to lifesaving medical
The Medicare bill establishes a "special payment for brachytherapy," a procedure that uses radioactive "seeds" to treat
a wide array of cancers. The bill stipulates that Medicare will pay for the seeds, in addition to the procedure required to
Two Georgia Republicans, Senator Saxby Chambliss and Representative Nathan Deal, proposed the new method of payment. Theragenics,
which produces and sells seeds for use in brachytherapy, is based in Buford, Ga. It led a coalition of manufacturers and doctors
who lobbied for the change, noting that some patients were more costly than others because they needed more seeds.
In the last week, Congress also agreed to a proposal to help a Missouri company, Briggs & Stratton, one of the world's
largest producers of gasoline engines for lawn mowers and other outdoor equipment.
The provision was added to a catch-all spending bill by Senator Christopher S. Bond, Republican of Missouri. He wanted
to prevent states from adopting tough new air pollution standards for small engines of the type made by the company.
Mr. Bond said the legislation would avert the closing of two Missouri plants and save 22,000 jobs around the country.
But Senator McCain said it was "an egregious provision that would have detrimental effects on air quality in many states,
including my own."
The energy bill includes a section that would make it easier for a consortium of European and American companies, Louisiana
Energy Services, to build a $1.2 billion uranium processing plant for nuclear energy near Hobbs, N.M.
The provision would speed up a federal review of the environmental effects of the project and would allow the Energy Department
to transport radioactive waste from the plant to storage sites.
Senator McCain criticized the project as "the epitome of corporate welfare." The federal costs, he said, could reach $500
million to $1 billion. But a spokesman for the consortium, Marshall Cohen, said that it would pay for transporting the waste
and that taxpayers would not have to bear any of the costs.
State officials in New Mexico said the project came about through the efforts of Senator Pete V. Domenici, Republican of
New Mexico, who urged the consortium to build the plant there after local opposition blocked similar efforts in Tennessee
and Louisiana. Mr. Domenici said the plant could generate 600 jobs.