WASHINGTON -- Donald Soule, a 70-year-old retired electrical engineer from Lutherville, takes six medications for acid reflux and clogged arteries. His 75-year-old wife, Catherine Soule, takes three prescription drugs. Their bill: $11,000 a year.
"It's taking most of my discretionary income," says Donald Soule.
Not one cent of those costs is covered by Medicare, the government program that guarantees health care for 39 million elderly and disabled Americans. And the Soules don't get anything from his longtime employer, who dropped medical coverage for retirees on the day Soule retired four years ago.
Shelling out ever higher amounts of money for drugs, millions of older Americans, many worse off than the Soules, are seeing red, while many Democrats are seeing campaign gold in the retirees' dilemma and are pressing the issue with a new-found vigor.
Republicans, wary of the substantial cost of a prescription program, are nevertheless beginning to move tentatively on the issue, confronted by their own polling that shows Medicare drug coverage to be a potent political issue.
As health care has tilted toward drug regimens and away from extended hospital stays, lawmakers on both sides of the aisle have been deluged with complaints from the elderly about the cost of their medication.
"Every meeting I have with seniors, it is the No. 1 issue I hear about," says Rep. Benjamin L. Cardin, a Baltimore-area Democrat.
Earlier this month, Cardin introduced legislation to compel Medicare to pay most of the costs for prescription drugs that treat five conditions and diseases common to the elderly: diabetes, depression, heart disease, hypertension and rheumatoid arthritis.
Sen. Edward M. Kennedy, a Massachusetts Democrat, and Rep. Pete Stark, a California Democrat, have gone further, calling for significant drug coverage for all Medicare recipients. Under their plan, the government would pay most of the first $1,700 spent on drugs, and the individual would pay the next $1,300. After that, the government would pay all additional drug costs.
President Clinton called for Medicare coverage of prescription drugs in his State of the Union address five months ago, but he has not yet announced a specific proposal. A senior adviser says Clinton is leaning toward a less expansive bill than Kennedy's measure.
Cost estimates vary
Budget analysts on Capitol Hill and at the White House have not calculated the cost of the Cardin and Kennedy-Stark bills. Estimates of the cost of prescription coverage for the different proposals vary widely, ranging from $8 billion to $44 billion a year.
Republicans, who control both houses of Congress, say drug coverage for Medicare recipients would cost far too much. While senior GOP officials have not publicly announced their stance, their deep skepticism is believed to make sweeping legislation unlikely anytime soon.
Nevertheless, the issue is a tough one to ignore.
Although U.S. senior citizens make up 12 percent of the population, they consume 35 percent of all prescription medications. A survey by the National Academy of Social Insurance found that more than 9 million Medicare recipients have out-of-pocket expenses for medication that exceed $500 annually; more than 1.3 million pay more than $2,000 a year for their prescriptions.
In response, there are some stirrings on the Republican side.
"My seniors are often forced to choose between food and drugs," says Rep. Jo Ann Emerson, a Missouri Republican. "It's absolutely critical to find a means for them to afford prescription drugs. To me, it's a no-brainer."
Emerson offered an alternative based on free-market principles: She would overturn a law that bars domestic distributors from buying American-made drugs overseas, where they are sold for less than the prices the distributors pay in the United States.
Perhaps more important, California Rep. Bill Thomas, a force within the GOP on health care policy, has joined Louisiana Sen. John B. Breaux, a Democrat, to propose modest drug coverage.
The two lawmakers call for guaranteeing prescription drug benefits for lower-income retirees -- individuals whose income is less than roughly $10,600 and couples whose joint income is less than about $13,300. The poorest senior citizens, like all lowest-income Americans, already receive prescription drug coverage under Medicaid.
Many Democrats dismiss that proposal as too weak.
The Breaux-Thomas plan wouldn't help the Soules, whose modest retirement income is still well above the plan's limits. And, while the Soules haven't had to choose between food and drugs, their big prescription costs do make a difference.
They are forgoing their annual drive to New Hampshire and are finding other ways to cut corners. "I'm sandbagging a little on my medication, too," Donald Soule confides. "I'm not taking it as reliably as I should, to save money."