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Lawmakers lukewarm on drug benefit

By SUZANNE SATALINE
© St. Petersburg Times
published June 25, 2003

WASHINGTON - Congress will race this week to pass the first-ever prescription drug benefit for America's seniors. But in their rush to pay for Paxil and Prevacid, members from the Tampa Bay delegation readily admit that the plan likely to become law will be neither comprehensive nor palatable to all.

Members interviewed all said they would vote to approve a benefit, although each named numerous flaws that rankle them. Even Republicans, who tend to be happier with the versions now up for debate than the Democrats, sound more resigned than triumphant.

"My mama taught me that something is better than nothing," said Rep. Ginny Brown-Waite, R-Brooksville.

Lawmakers in both houses, with a push from the White House, have pitched largely similar versions of a drug plan that would cost nearly $400-billion over 10 years and would aid 39-million older and disabled Americans. Slated to start in 2006, the voluntary program would require participants to pay an average monthly premium of $35 and meet a deductible of several hundred dollars. Both houses are eager to pass a law before the Independence Day break.

Like many other Republicans, Brown-Waite says she will support the House version, but has reservations about the constantly changing details.

"I'm concerned we're treating millionaires and those truly in need with the same benefits," she said. "I want to make sure we're not setting up a system that's going to bankrupt our children and grandchildren."

If there is a nexus for the frustration and confusion legislators have for the bills, it lies with the mysterious provision referred to around town as "the doughnut."

Under the current Senate proposal, the government health insurance program would pay half the cost of a subscriber's prescriptions until the patient had spent $4,500 from his own pocket. Then reimbursement would stop, although the patient would be required to continue paying his monthly premium, estimated to be $35 monthly. The government would not restart reimbursements until the patient spent $1,300 more, or a total of $5,800 out of his own pocket in one year.

"I think it's more like a black hole," Sen. Bob Graham, D-Fla., announced in the chamber Friday. "Let's call this gap what it is: a gimmick that is designed to lower the cost of this legislation at the expense of seniors who are most in need of the drugs."

Graham proposed an amendment that would cancel premium payments for seniors once they had maxed-out of their coverage. The amendment is scheduled for a vote Wednesday.

Republican leaders insist the provision will not exclude most seniors. "You're getting huge assistance at the end of the year," Majority Leader Bill Frist, R-Tenn., argued from the floor Friday. "They're still getting about 40 percent of their expenses paid."

Graham's was just one of several amendments offered to smooth over bumps in the legislation. Democrat Bill Nelson, Florida's junior senator, urged the Senate to include a provision requiring the government to "use its purchasing power" to negotiate discounts from pharmaceutical companies.

Nelson applauded provisions that would help states pay to care for legal immigrants' children and pregnant women and increase federal reimbursements to centers that provide emergency care to undocumented workers.

Nelson proposed his own amendment Friday asking for a General Accounting Office investigation into one of his pet peeves: so-called "concierge care" practices, in which physicians help only those patients who pay annual fees. Nelson said even if the practice is legal - something he doubts - it is exclusionary. Congress, he said, should close loopholes that allow those doctors to collect Medicare reimbursements.

"It completely violates the intent of Medicare," he said.

Rep. Jim Davis, D-Tampa, said he was worried that the government was weakening its long-term commitment to seniors. "There's a determination in the House to push a radical overhaul of Medicare," Davis said.

The proposals, he said, would force the elderly to pay for benefits that would not provide total coverage. According to his calculations, the current House version would require seniors spending $2,000 annually on medicine to pay $400 out of pocket for drugs, a deductible of about $250 and at least $420 in monthly premiums, totaling $1,070. The government would pay for the remainder of the drug costs, or just $930 - $140 less than the senior's outlay.

Then seniors would be forced to scramble for supplemental coverage from for-profit companies, but policies would not be written for people who are the sickest or who live in rural regions where care is not delivered en masse.

Despite all the frustration and negative comments, at least one member of Congress seemed upbeat about the drug plans. Rep. Adam Putnam, R-Bartow, said the new bills are much more generous than previous House versions.

"I think it's largely a good policy," he said. "There are a couple of big kinks to be worked out."

Also ...

The Senate voted 93-3 Tuesday to lower their own prescription drug coverage to whatever emerges from Congress for seniors. The amendment, dubbed "Taste of Their Own Medicine," would apply to both senators and House members, but is unlikely to survive House-Senate negotiations when the lawmakers reconcile their bills.

- Information from the Associated Press was used in this report.

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