Medicare Rx proposals stay in spotlight

GOP leaders eye plans that would offer low-income seniors quick financial relief from drug costs while Democrats argue the ideas don't go far enough.

By Jane Cys, amednews staff. Sept. 25, 2000.

Washington -- With election-year pressures intensifying, some influential Republicans appear to be searching for short-term fixes that will offer low-income Medicare beneficiaries relief from hefty prescription drug bills.

Sen. William Roth (R, Del.), the chair of the Finance Committee, who is facing a tough election challenge by his state's Democratic governor, Thomas Carper, introduced two bills Sept. 7 that would create a temporary, state-based prescription drug benefit targeted at low-income Medicare beneficiaries. The measures are modeled after the State Children's Health Insurance Program.

"What this temporary legislation offers is an assurance to low-income seniors that they will be able to receive the help they need while Congress completes the larger task of overhauling [Medicare]," Roth said.

Key differences between the two Senate bills are cost and coverage. Roth estimated that one measure would cost $20 billion -- the amount the Senate agreed to spend earlier this year -- and that the second measure would cost $31 billion. The bill with the higher price tag would offer coverage to additional seniors by allowing more low-income seniors to qualify. It would also require a "supermajority," 60 votes, to pass because it exceeds the Senate's spending plan on prescription drugs, Roth said. Both plans have expiration dates -- one in December 2003 and one in December 2004 -- under the assumption that Medicare reform will be enacted by then.

The House passed a more comprehensive Medicare drug benefit earlier this year that doesn't appear to be making progress in the Senate. Rep. Bill Thomas (R, Calif.), chair of the House Ways and Means Committee's subcommittee on health, said he would consider Roth's proposals.

Roth's plan echoed many themes that Republican presidential nominee George W. Bush espoused when he released the details of his Medicare prescription drug benefit proposal in early September. The Texas governor would give $48 billion to state drug assistance programs to help seniors in the short term. His plan also would set aside $110 billion to use for the long-term goal of Medicare modernization.

According to the National Conference of State Legislatures, 23 states have either a senior drug assistance program in place or plans to start one. Several state legislatures also are still considering such programs.

The quick-fix proposals didn't sit well with Democrats. They argued that the state grant program would leave too many seniors without coverage, would give seniors more or less assistance based on where they live, and would take too long to implement for it to offer financial relief quickly.

Some health policy advocates expressed doubts that Congress would be able to get a drug bill passed this session given the limited amount of time left, the politically charged atmosphere and the political parties' wide philosophical differences.

"It's obvious [the Republicans are] trying to buy their way out of a political problem," said Jeff Lemieux, senior economist with the Progressive Policy Institute. Polls have shown that voters tend to trust Democrats more on the prescription drug issue.

Sen. John Breaux (D, La.), chair of the now-expired National Bipartisan Commission on the Future of Medicare, said Bush's plan appears to track the comprehensive Medicare reform bill he introduced last year with Sen. Bill Frist, MD (R, Tenn.). But he is concerned that Bush's tax cut and other spending promises won't leave enough money to enact his reform proposal. "In the end, we must move beyond using Medicare as just a political issue," Breaux said. "Our nation's seniors cannot use a political issue to buy their prescription drugs."