Medicare drug bill an uphill climb

Drug Store News,  Nov 3, 2003  by James Frederick

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WASHINGTON -- Not so fast. That was the message from Senate Democrats after word came last month that the House-Senate conference committee negotiating a Medicare drug benefit bill had made a compromise that could send legislation to the full House and Senate.

Despite reports of a tentative agreement on such issues as extending drug benefits to low-income, dual-eligible seniors who qualify for Medicaid, many Democratic senators remain opposed to major provisions of the bill endorsed by the White House and Republican lawmakers. In addition, both the Bush administration and the Senate leadership reiterated their opposition to any plan to cover dual-eligible, low-income seniors.

Among the major sticking points are issues of public versus private administration of drug benefits, the level of meaningful benefits that would be available and out-of-pocket expenses borne by seniors. Indeed, as currently envisioned in both the House and Senate plans, benefits would kick in only after an annual deductible of at least $250 and also would require seniors to pay roughly $35 in monthly premiums. What's more, coverage only would be good for up to about $2,100 in annual prescription costs, after which the beneficiary would pay out of pocket until exceeding a catastrophic level above $5,000.

"This coverage isn't that good," said one Capitol Hill regular. "You face a real possibility that someone could have expended their benefit by June. So you could have a lot of unhappy seniors ... and those who voted for the bill could be blamed."

Many Democrats also are miffed about attempts to force Medicare to compete with HMOs and other for-profit health plans. Differences also have arisen over attempts by some lawmakers to legalize the importation of drugs from Canada and other countries to cut program costs.

Throwing down a gauntlet, Senate Minority Leader Tom Daschle sent President Bush a letter Oct. 21 warning that time was "running out on this session of Congress" and that "prompt action to achieve a bipartisan compromise is essential." The letter was cosigned by 40 other Senators--all but two of them Democrats--and it served as a stark reminder that a gulf still separates the parties as they grapple with the future of Medicare and the role of private health plans in administering benefits.

That assistance--possibly in the form of tax breaks for companies that maintain retirement benefits--has become a contentious obstacle in the way of compromise. Said Larry Kocot, senior vice president of the National Association of Chain Drug Stores, "The [Congressional Budget Office] has estimated that as many as one-third of Medicare beneficiaries would lose their health coverage as a result of any prescription drug bill's passage."

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