The prescription drug benefits approved in separate House and Senate bills are confusing and inadequate, but they might be a step toward adequate coverage.
Published June 30, 2003
A prescription drug benefit for Medicare recipients is closer to becoming reality after bills passed both houses of Congress early Friday morning. Yet many retirees have greeted the news with ambivalence or confusion. And who could blame them?
The legislation is so complex it requires a chart and calculator to understand. While major details of the Senate and House bills are similar, important differences exist that could threaten success. Even the more responsible Senate bill, which Sen. Bob Graham opposed and Sen. Bill Nelson supported, offers only modest help for many Medicare recipients.
None of that should doom the effort, however. If the Senate's better provisions can prevail in conference, then Medicare would be strengthened overall. Low-income retirees and those with catastrophic drug costs - essentially, the neediest - would get substantial relief. Improvements could be made in coming years.
John Rother, AARP's policy director, explained the opportunity this way: "If we don't go with something now, even if it is inadequate, it could be quite a while before we have another chance."
Similar logic helped gain 35 Democratic votes in the Senate. Democrats once could claim ownership of the issue, which was a reliable vote-getter with retirees. After Republicans dropped their insistance that the drug benefit be tied to privatization of Medicare, however, they gained political momentum. In recent polls, Americans say they are as likely to trust Republicans as Democrats to deliver the long-promised benefit.
So Democrats could appear uncaring if they fail to support a reasonable bill. There is risk for Republicans, as well. Once retirees understand the legislation, they may believe more was promised than delivered.
The House bill, in particular, would open more of Medicare to private insurers. The final version was so highly partisan that it passed by a mere one-vote margin. The House couldn't resist adding a massive tax cut - $170-billion in tax-free savings accounts for health expenses that would be a boon only to higher income retirees. And the House would force the government to compete with private plans on drug premiums in 2010, which would probably penalize those who stay in traditional Medicare.
If American retirees have made one thing clear, it is that they prefer Medicare to handle both medical and prescription benefits.
Otherwise, the Senate bill provides more of its subsidy to retirees who spend more on prescriptions, while the House benefit is greater for those who spend less. It makes more sense to tilt coverage to those most in need, as the Senate does.
Many Medicare recipients, who already have adequate prescription coverage through their former employers, wouldn't be tempted into either plan. And there is a legitimate concern that employers will use the legislation as an excuse to drop retiree drug coverage. Yet people who purchase supplemental Medigap policies on their own probably would be better off switching to a Medicare drug plan.
Congress is close to historic reform of Medicare. Members shouldn't let partisanship or ideology get in the way of an agreement that helps relieve the financial burden and health concerns of millions of older Americans.
