Copyright 2002 The Houston Chronicle Publishing Company  
The Houston Chronicle
May 26, 2002, Sunday 4 STAR EDITION
SECTION: A; Pg. 1

LENGTH: 1422 words

HEADLINE: The Rx fix;
Tackling the politically popular but thorny issue of prescription drug benefits with Medicare is vexing Congress

SOURCE: Staff

BYLINE: JULIE MASON, Houston Chronicle Washington Bureau

DATELINE: WASHINGTON

BODY:
WASHINGTON - When lawmakers on Capitol Hill started talking about adding a prescription drug benefit to Medicare, Joyce Royster grew alarmed.

The former oil company manager and retiree in The Woodlands feared new government spending on costly prescription drugs could mean a corresponding reduction in other Medicare programs.

"I don't need prescription drugs, and I was concerned that whatever they do, it would diminish the plan that I have," Royster said. "That has happened before under Medicare."

It could happen again. In the coming weeks, Congress begins debate on how to shoehorn a costly new drug benefit into a federal budget that is heavy on defense spending but lean on social programs.

Already, a partisan brawl is breaking out over how to add the politically popular drug benefit to Medicare, with both parties striving to claim ownership of the issue through dueling plans for how much the government should pay.

Fueling lawmakers' fervor are recent polls showing health care ranks high among voter concerns in this election year.

"It's regularly the second or third question asked at almost every town meeting I have," Rep. Kevin Brady, R-The Woodlands, says of the prescription drug benefit issue.

Concern about domestic policy issues like Medicare is forcing the Bush administration to change its strategy for campaigning in support of candidates in the November elections.

With President Bush still posting phenomenal public approval ratings for his handling of Sept. 11, Republicans and the White House initially planned to highlight national security issues and tax cuts in the GOP fall campaign.

But a recent memo from the Republican polling firm Public Opinion Strategies warned lawmakers that the GOP needs more than tax cuts and terrorism to prevail in November.

According to the memo, voters "perceive the parties as headed toward a matchup of Republicans on taxes and terrorism, versus Democrats on economy, education and the elderly."

With voters saying they care more about domestic issues right now, perceptions about the parties' contrasting agendas suggest Democrats have a built-in political advantage.

"Republicans passing a prescription drug benefit would go a long way to leaving Democrats with very little on the table to try to use against us," the memo said.

The strategists warned Republicans that domestic issues trump foreign affairs in congressional elections.

Not coincidentally, Bush in recent weeks began highlighting domestic issues such as education, local law enforcement and Medicare reform while visiting key battleground states touting Republican candidates.

At stake in November is control of the House, where Republicans have a six-seat advantage, and the Senate, where Democrats hold a one-vote lead.

Democrats, who hope to build on electoral gains in 2002 to win back the White House in 2004, plan to highlight their own domestic agenda this year, including a more generous prescription drug benefit than the ones being pushed by Republicans.

"You just can't find anybody in a focus group or anything that thinks this administration has even checked in on this issue," said Democratic strategist James Carville.

Added Democratic pollster Stan Greenberg, "The place where the country thinks the president is most vulnerable is health care."

A recent Gallup poll for USA Today and CNN found 56 percent of Americans believe Democrats will do a better job addressing health care issues such as prescription drug benefits for seniors, compared with 32 percent who said Republicans would.

The AARP, with millions of members the nation's leading organization representing retirees, claims 80 percent of Americans over 45 support drug coverage under Medicare.

A senior on Medicare pays an average of about $ 2,150 a year on prescription drugs, according to several estimates. Many pay more, such as a woman cited in Bush's budget proposal who pays more than $ 2,400 a year just on special eye drops.

Political interest in the issue is motivated in part by the huge numbers of Americans affected by Medicare issues, combined with the high turnout rates of the same voting bloc in midterm election years.

Bush, who campaigned on a promise to create a prescription drug benefit for all seniors covered by Medicare, is proposing a $ 190 billion, 10-year program that would provide a drug benefit for only low-income seniors, or a fraction of all Medicare beneficiaries.

House Republicans, meanwhile, drafted a plan based on Bush's initial blueprint, that increased funding to $ 350 billion over the same period and expanded eligibility.

A competing plan developed by Senate Democrats would cost $ 500 billion over 10 years and require Medicare to pay 50 percent of the cost of prescription drugs for all seniors in the program, up to a certain level.

Even the more generous plans under discussion would fall short of past political promises from both parties, which called for providing all seniors under Medicare with comprehensive coverage.

According to the Congressional Budget Office, a 10-year prescription drug benefit for 10 million of the nearly 40 million seniors in the Medicare program would cost about $ 1.8 trillion.

The plan outlined by Bush would benefit about 3 million seniors, while the Republicans' would help slightly more. The Democratic plan would help all beneficiaries but only up to a certain level.

Boxing lawmakers in, however, is a budget process already committed to significant increases in defense and homeland security spending, with scant resources left over for domestic programs like Medicare.

Bush said his plan is part of a larger effort to give seniors more Medicare choices.

"We need a system that guarantees that patient protections and all of Medicare's required benefits are included in every choice, a system that encourages additional benefits and options for better care at lower cost, including improved medical savings accounts," Bush said. "That is where we ought to head here in America."

With such strong interest among voters in securing a drug benefit in this election year, it's likely some form of a program will come out of Congress, which is expected to begin debating the issue in the coming weeks.

Brady, who sits on the House Ways and Means Committee, said he warns constituents not to be seduced into supporting Medicare programs that could prove too costly in the future.

"I caution them that this is an election year, that parties are going to want to bid for votes, but it's real important we be financially responsible, meaning we don't have a plan that explodes in costs for baby boomers and the next generation," Brady said.

In the coming weeks, Senate Democrats are expected to debate a bill aimed at reducing the price of prescription drugs by limiting the annual deduction pharmaceutical companies can take for advertising.

House Republicans have warned that price controls on drug makers could force companies to scale back spending on vital research.

It's those kinds of potential trade-offs - price caps for research, or drug benefits at the cost of medical tests - that leave Royster feeling unsettled about the upcoming debate in Congress.

"I don't think it can keep going on like this, especially with more and more people getting into the older age group," Royster said. "I think it's going to be a real big problem, and something is going to have to change."



  



Prescription drug plans



Congress in the coming weeks is expected to begin debating changes to the Medicare program, which is administered by the Health and Human Services Department. Three different plans in circulation would add a prescription drug benefit for seniors, who pay on average about $ 2,150 a year for prescription drugs.



President Bush's plan would:



Cost $ 190 billion over 10 years;

Subsidize prescription drugs for low-income seniors;

Encourage more private plans to provide services under Medicare.



House Republicans' plan would:



Cost $ 350 billion over 10 years;



Cover 100 percent of prescription drug costs for a larger pool of low-income seniors than the White House plan;



Pay 100 percent of drug costs in the case of catastrophic illness, up to a certain level.



Senate Democrats plan would:



Cost $ 500 billion over 10 years;



Cover 50 percent of all prescription drug costs for Medicare recepients up to a stopgap level;



Pay all costs of catastrophic medical care over $ 4,000 out of pocket expenses by Medicare beneficiaries.





GRAPHIC: Photo: 1. Plans to change Medicare prescription drug benefits have Woodlands retiree Joyce Royster concerned about the future of her health care coverage (p. 14); Graph: 2. Prescription drug plans (p. 14, TEXT); 1. Carlos Antonio Rios / Chronicle, 2. Houston Chronicle

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