Changes in drug benefit weighed

As Bush promotes Medicare program, some in Congress are uneasy

March 15, 2006|By JULIE HIRSCHFELD DAVIS | JULIE HIRSCHFELD DAVIS,SUN REPORTER

WASHINGTON -- Spurred by election-year jitters and anxious seniors, Congress might consider changes in the new Medicare prescription drug plan even as President Bush works to convince the public that he is getting the troubled program on track.

Bush, who counts the enactment of the program as one of his signature domestic achievements, is stepping up his efforts this week to defend it and prod people to join, scheduling appearances such as the one today at Riderwood Village in Silver Spring in an effort to calm seniors' worries about the plan.

"It's a good deal," Bush said yesterday at a Canandaigua, N.Y., senior center. The president said he was "aiming to convince people to - the very minimum - to take a look. I think you're going to like what you see."

The president is also working closely behind the scenes with health insurers who offer the drug benefits in order to counter a campaign-style effort that liberal groups began this week to bash the program and help Democrats exact a political price from those who backed it.

The bigger challenge might come from uneasy Republicans who are increasingly signing on to proposals to modify the program or shield seniors from its difficulties.

"There are two kinds of seniors right now, the ones who have bought it and are mad, and the ones who haven't bought it and are mad," said Robert Laszewski, a health policy analyst. "Republicans are worried that they're going to go into the November elections, and if they don't appear to be doing something, it could have a very negative impact on them,"

Most Republicans have counseled restraint, arguing that Congress should stand back and let the Bush administration solve the administrative problems that have hindered the drug benefit's implementation.

But some acknowledge that the May 15 enrollment deadline might not be realistic and that Congress might step in this spring to extend it or eliminate the penalty for failing to join in time.

Others are pressing to limit the number of options under the program, arguing that the dizzying array of choices is overloading beneficiaries and discouraging them from signing up.

"There are people who are feeling the pressure of the deadline, and I don't want to see people penalized to the point that they don't want to get back in the program," said Sen. Jon Kyl, an Arizona Republican who is running for re-election this year.

Congress should soften the blow for seniors who might face a steep cost for failing to sign up in time, he said, adding that he might also consider extending the May 15 deadline.

Sen. Olympia J. Snowe, a Maine Republican, is working this week to win approval of a measure aimed at keeping drug prices low by allowing Medicare to bargain with pharmaceutical manufacturers.

"We cannot sit idly by as the cost of the drug benefit continues to rise when we have the power to fix this problem now," said Snowe, who is also pushing to extend the enrollment deadline.

Bush is working to block such moves, but the temptation for members of Congress to tinker with the drug program to help seniors, a key group of voters, might prove irresistible, analysts said.

Lawmakers have been stunned at the level of discontent with the program that they have heard from constituents when they return home during breaks, Laszewski said.

The complaints contrast starkly with Bush's message about the plan and assertions by insurers - including in a survey released this week - that signing up is fast and easy, drugs are inexpensive and enrollees are happy with their new coverage.

Technical problems and bureaucratic foul-ups have delayed enrollments and resulted in low-income seniors' paying for drugs they used to receive free under Medicaid. Seniors have griped that the program is too elaborate and confusing to navigate.

"If things continue to be as shaky as they are, you will see some action" by Congress, Laszewski said.

Bush is doing everything he can to avoid reopening the Medicare prescription drug debate this year.

"We had some early challenges" implementing the measure, he said yesterday. But he added later that "we're making sure this opportunity for our seniors is done in a cost-effective, efficient way."

The changes lawmakers are considering could upset the complex blend of incentives and market forces that fuel the drug benefit and make it affordable, officials say.

"The way that it's been set up, we need to have the opportunity to make it work," said Leslie Norwalk, the No. 2 official at the Centers for Medicare and Medicaid Services, the agency in charge of the program. "We should be given the opportunity to implement it as it is."

John B. Breaux, a former Louisiana senator who had a hand in crafting the measure and is helping insurers promote it, said "it would be unfortunate" if Congress changed the law "before the ink is dry."

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