WASHINGTON, Friday, June 27 ? After a severe test of President Bush's influence on Capitol Hill, the Senate and the House today approved the biggest expansion of Medicare since its creation nearly four decades ago, passing legislation to provide prescription drug benefits to the elderly and give private health plans a much larger role in the program.

The House vote was 216 to 215 in a dramatic roll-call that lasted more than 40 minutes, with the "nays" outnumbering the "yeas," until several Republicans switched their votes. Conservative Republicans joined most House Democrats in voting against the bill in a setback for the Republican leadership and for President Bush, who had lobbied intensely for the measure for months.

… In an effort to secure conservative support for the Medicare bill, House Republican leaders combined it, at the last minute, with a separate bill encouraging people of all ages to set up two types of tax-exempt personal savings accounts to help pay medical expenses. By a vote of 237 to 191, the House on Thursday approved the new savings accounts, estimated to cost the Treasury $174 billion in lost revenue over the next decade.