Short on detail, Bush plan for drug coverage debated

Restructuring Medicare sparks doubt in Congress

January 30, 2003|By Julie Hirschfeld Davis | Julie Hirschfeld Davis,SUN NATIONAL STAFF

WASHINGTON - President Bush's plan to reform Medicare, billed as a cornerstone of his domestic agenda, is facing long odds and sparking sharp debate in a Congress that has long been divided over the fate of the health-care program for the elderly.

Bush has provided few details of his vision for a restructured Medicare, which he announced in his State of the Union speech Tuesday night.

Under his plan, seniors could opt for prescription drug coverage as part of a privately run health plan, such as an HMO. Like Bush, most congressional Republicans want private companies to offer such coverage; Democrats say the government should guarantee the benefit.

Congress has failed in recent years to achieve the politically popular goal of adding a prescription drug benefit for Medicare's 40 million recipients.

Now, Bush appears to be asking Congress to bridge the divide in a way that could redefine how the government provides health care to seniors, pushing the entire program toward a private model. That has alarmed many on Capitol Hill, including some Republicans.

"This is a commitment that America must make to our seniors," Bush said yesterday in Grand Rapids, Mich., where he reiterated that he would request an additional $400 billion over 10 years to reform Medicare.

"A reformed and strengthened Medicare system, plus a healthy dosage of Medicare spending in the budget, will make us say firmly: `We fulfilled our promise to the seniors of America.'"

Even without the details in place, Democrats attacked the Bush plan as a cynical effort to privatize Medicare. Such a plan, they argued, would force seniors to choose between selecting their own doctors - a right they enjoy under the government-run program - and obtaining drug coverage under an unreliable, potentially high-priced private plan that would limit their choice of doctors.

"It wouldn't add to Medicare; it would actually gut Medicare," said Senate Minority Leader Tom Daschle, a South Dakota Democrat. "At every turn, Republicans have worked to turn over health care for seniors to the private sector ... until Medicare no longer exists."

The stakes are high for lawmakers in both parties, who have nothing to show for past efforts to provide prescription drugs for seniors in Medicare. One-third of Medicare beneficiaries have no prescription drug coverage; the rest are covered through retiree health plans, HMOs or supplemental plans they buy themselves.

Many of those without drug coverage have suffered as increasingly sophisticated medicines have come to market in recent years and soared in price.

With Bush crafting his own plan and Republicans controlling both houses of Congress, the party risks shouldering blame for yet another failure to enact Medicare changes before the next elections in 2004.

"Having one-party control brings with it accountability," said John C. Rother, director of policy and strategy for AARP, the advocacy group for 35 million older Americans. "There have been many promises - clear ones - to voters that they would do this, and now they have to produce."

Bush delivered yesterday's wide-ranging speech before one of his trademark backdrops, emblazoned all over with the words "Strengthening Medicare." But his remarks were short on specifics, and senior lawmakers in both parties have expressed concerns about what Bush is actually proposing.

Sen. Charles E. Grassley, the Iowa Republican who chairs the Senate Finance Committee, has said he would oppose a plan that required seniors to leave the traditional fee-for-service Medicare system in order to obtain prescription drug coverage.

"I agree that we need to strengthen Medicare," Grassley said yesterday, "first by adding prescription drug coverage that's available for all seniors - not just those that switch into managed care."

By linking a prescription drug benefit to a broader reform of Medicare, said Sen. Olympia J. Snowe, a Maine Republican and leading moderate, Bush might be reducing the chances that the long-awaited benefit will be enacted into law.

"I am concerned ... that the president's focus on ways to reform Medicare could hamper our efforts to pass comprehensive prescription coverage," Snowe said.

White House officials have left the plan's specifics sketchy.

"The details are still being worked on," a senior official said. "We are still engaged in consultations with the Congress."

Republican leaders are waiting until Bush sends them a full-fledged plan, expected in coming weeks, before they unveil their own proposal.

Democratic leaders say they will propose a plan to guarantee prescription drug coverage under Medicare, along with measures to control the rising costs of prescription medicine.

Many lawmakers say they believe that Bush and his allies in Congress will propose a drug benefit under Medicare available only to seniors who join a private plan.

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