A contentious health and education spending bill squeaked through the House on its second try yesterday, but a broader Republican effort to cut some mandatory domestic programs continued to falter.

The $142.5 billion package, which would fund the departments of Health and Human Services, Education, and Labor for fiscal 2006, was approved 215 to 213. The House rejected a similar bill 224 to 209 last month. Lawmakers from both parties protested a broad squeeze on popular programs, such as low-income heating assistance and the National Institutes of Health. House and Senate Republican negotiators were forced to make minor adjustments to push the giant bill through the House.

Their struggle reflects a deeper problem that GOP congressional leaders are confronting as they try to wrap up the legislative year, possibly by Saturday. Eager to restore their fiscal credibility after several years of spending growth and rising deficits, Republicans are attempting to tighten the federal belt, both through leaner spending bills, and through separate budget cuts that target mandatory programs such as Medicaid and food stamps.

The House's struggle to pass the health and education bill illustrated how difficult many lawmakers are finding it to actually wield the ax. "I recognize that we had limited resources," said Rep. Ralph Regula (R-Ohio), who negotiated the House package.

Regula won most of the needed votes, all Republican, by adding $90 million for rural health programs. He picked up at least one key ally by restoring $90 million in Medicare prescription drug coverage.

President Bush signed into law earlier this year a bill that would bar federal coverage of such drugs as Viagra, but it does not take effect for Medicare until 2007. Regula's bill had included a provision to accelerate the ban to 2006, but Ways and Means Committee Chairman Bill Thomas (R-Calif.) strongly protested the move, explaining that next year's contracts with coverage providers have already been negotiated.

The new money was shifted from Medicare administrative accounts and from a pandemic flu program. Congress is expected to approve about $3.5 billion in new flu preparedness funding in the fiscal 2006 defense spending bill, likely to come before the House and Senate tomorrow.

Overall, the health and education bill came in about $1.5 billion smaller than last year's version. Numerous programs were trimmed, frozen or granted modest increases, including Meals on Wheels, Head Start and heating assistance for low-income people. The widely supported National Institutes of Health received its smallest funding increase since 1970.

The legislation is expected to narrowly pass the Senate as early as today, although Sen. Arlen Specter (R-Pa.) said he would "cast a protest vote" against it, if his support is not needed for passage.

Meanwhile, House and Senate negotiators remained at loggerheads over legislation to trim the growth of mandatory spending in programs such as food stamps, Medicaid, student loans and agricultural subsidies over five years.
 Senate Majority Leader Bill Frist (R-Tenn.) said the main sticking point remains a Senate-passed provision to open Alaska's Arctic National Wildlife Refuge to oil drilling, a measure that the House was unable to approve in the face of opposition from moderate Republicans.

House and Senate negotiators were considering breaking the wildlife refuge provision out of the budget bill and passing it on a different bill, most likely the defense spending bill. But that would subject the defense bill to a possible filibuster.

Another possible hurdle for the defense bill is an across-the-board cut to discretionary spending that House Republicans are seeking, as an additional cost-cutting measure. The cut, likely 1 percent, is expected to apply even to defense and homeland security programs, said House Appropriations Committee Chairman Jerry Lewis (R-Calif.). But Lewis opposes the idea, and in the Senate, some Republicans -- including Specter -- are raising objections.
In other negotiations, the House appeared to be moving toward the Senate on cuts to programs for the poor. Senate aides said they were confident they would hold down savings from Medicaid to about $6 billion over five years, mostly by squeezing savings from prescription drug providers. Negotiators appear to have abandoned House-passed cuts to the food stamp program. And moderate Republicans in the Senate are holding firm against deep cuts to federal child-support enforcement approved by the House.

Negotiators also dropped a provision that would have allowed the sale of hundreds of thousands of acres of federal land adjacent to mining claims.

Those changes would lower the budget savings from the $50 billion mark secured by the House to about $44 billion -- or closer to $41 billion if the Arctic provision is dropped and anticipated oil-leasing revenues are lost, budget negotiators said.

But other problems remain. Negotiators have not decided how to stop a 4 percent cut to physician reimbursements under Medicare that is scheduled to take effect next year. The Senate has approved a measure stopping that cut and replacing it with a 1 percent increase, at a cost of $18 billion. Negotiators are looking at holding payments steady for two years, but they cannot agree on how to pay the cost, as much as $11 billion.

Negotiators are also wrangling over whether to extend farm price supports, as the Senate wants.

House Republican leaders have said this week that a final deal on the budget bill is not necessary before Congress adjourns for the year. But at a closed meeting of House Republicans, conservatives adamantly maintained that lawmakers should be willing to work through the weekend, or even return after Christmas, to complete the budget-cutting measure. They suggested they would be willing to accept more modest cuts to entitlement spending, without hits to Medicaid or food stamps, if the House Republican leadership makes good on the across-the-board cut.