The specter of protests against Medicare prescription drug legislation will shadow lawmakers over the next few months as negotiators struggle to reconcile two different proposals.

Liberal activists plan to stage a series of rallies through September aimed at pressuring Congress to provide a more generous drug benefit in the complex Medicare legislation (HR 1) that negotiators hope to finalize this year. The lobbyists hope to simulate the events that forced Congress to repeal a different prescription drug law (PL 100-360) more than a decade ago.

Some 20 to 30 protests are planned, with sit-ins expected to generate arrests of seniors. The first target is House Speaker J. Dennis Hastert, R-Ill., whose Batavia, Ill., office is to be the site of a demonstration Monday.

The protests are meant to counter advertising by the drug industry that would encourage Congress to act on the issue this year and praise House members for supporting the partisan version that narrowly passed, 216-215. Groups such as the Seniors Coalition and the conservative 60 Plus Association are supplementing the drug industry's efforts by lobbying for the more partisan House bill. Think tanks such as the Heritage Foundation also are pushing for a more conservative approach than the Senate bill by allowing a stronger role for private-sector insurers in Medicare.

The House bill would inject more competition into Medicare, which Democrats say could undermine the traditional program.

Passage of the House measure came only after GOP leaders won votes from skeptical holdouts by pledging a range of benefits to members, including campaign fundraising assistance, support for spending projects, and a promised vote on other legislation, such as a drug importation measure (HR 2427) the House is expected to debate this week. That bill would let consumers buy U.S.-made drugs that sell for lower prices in other nations.

Rep. Jan Schakowsky, D-Ill., is advising the liberal activists, the advocates said. Schakowsky helped organize the famous town hall meeting protest that featured seniors booing then-Ways and Means Committee Chairman Dan Rostenkowski, D-Ill., because he had supported the 1988 law that provided benefits for drugs and catastrophic illnesses but required seniors to help shoulder the costs. In the face of protests, Congress overturned that law in 1989.

Effective Activism

Tough grass-roots campaigns spearheaded by liberal activists have affected at least two other issues this year.

Fierce opposition from liberal activists on a reauthorization (HR 2210) of the Head Start program delayed action on the bill last week.

Republicans' difficulty was reminiscent of their problems in gathering support for a measure (HR 1119) that would have granted employers the ability to compensate employees who work overtime with time off rather than extra pay. A vote on that bill was postponed just after Memorial Day in the face of criticism by organized labor.

The Medicare rallies by groups calling for more generous benefits are being organized by the Coalition to Save Medicare, a group leveraging efforts by the AFL-CIO, the Alliance for Retired Americans, the consumers' group USAction and the Campaign for America's Future.

The groups are coordinating with organizations representing people with disabilities and veterans, as well as Democrats who plan to hold a series of town hall meetings in August on Medicare, said Roger Hickey, co-director of Campaign for America's Future.

"Different groups involved have different positions on the legislation," Hickey said. "Some believe it should just be stopped. Many feel it doesn't hurt to use extreme examples of what's wrong with the bills to put pressure on [lawmakers] to hold firm about refusing to vote for a bad bill."

Seniors plan to dump prescription pill boxes on the doorsteps of congressional district offices. In some areas, groups may run advertising, but it probably will be limited.

The AARP is not directly involved, but has been communicating with the group, sending a letter last week restating its concerns with the bills.

AARP officials are emphasizing their reservations about the coverage gaps in both bills. They also are pushing for the Senate provision that would require the government to offer a "fallback" plan if at least two private plans do not offer benefits in an area. The House does not have a similar provision.

Final Negotiations

The lobbying comes as negotiators work to reconcile the $400 billion House and Senate bills. Senate leaders have been meeting with health care industry lobbyists who have questions about provisions in the bill.

Both bills would offer benefits for seniors, either through stand-alone drug plans, the traditional fee-for-service program, or new private managed care networks. While the framework of the legislation probably will remain intact, provisions affecting funds for providers are up for negotiation, as are the details of how the program would work.

The influence of the lobbying groups on both sides of the issue remains to be seen. Lawmakers say it will be hard to appease both the drug and health insurance industries, which are pushing to open Medicare up to more private-sector competition, and the liberal activists, who want to preserve the rights of seniors in the traditional system.

"This is going to take a lot of effort," said Sen. Charles E. Grassley, R-Iowa. He is chairman of the Finance Committee, which wrote the Senate bill.

The House is expected to vote on HR 2427 the week of July 21.