MEDICARE REFORM: Pitfalls of Taking Action This Year

      National Journal's Marilyn Werber Serafini sounds a pessimistic note over the prospects for adding a prescription drug benefit to Medicare this year. She reports that many issues, "both substantive and political," have yet to be addressed, and that "the lawmakers best suited to lead the battle are just beginning to turn their proposals into legislation." Entering the ring against President Clinton's proposal, will be a handful of Republican initiatives. Rep. Bill Thomas (R-CA), who co-chaired the National Bipartisan Commission on the Future of Medicare, while expressing caution about adding a drug benefit until he receives assurances of the program's solvency, has advocated a universal benefit, in which subsidies only go to those in lower income brackets. He also appears to support "having seniors pay more up front, but allowing more-generous caps to help those seniors who have greater expenses." Rep. Michael Bilirakis (R-FL), chair of the House Commerce health and environment subcommittee, similarly is said to support a benefit for all seniors, with higher caps than those proposed by the president, but with subsidies only for low-income beneficiaries. One lobbyist said Bilirakis has asked the House leadership to make his bill the centerpiece of the debate, but Congressional aides said they expect that role to be played by a Thomas bill. Meanwhile, Sens. William Roth (R-DE) and John Breaux (R-LA) are developing a broad reform package that would include a drug benefit. While chances are good that this bill will pass the Finance Committee, and perhaps even the full Senate, such a proposal could expect significant resistance in the House. Werber Serafini reports that many predict that reform efforts will collapse and that "key lawmakers, possibly in tandem with White House negotiators, will have to decide whether to add a prescription drug benefit to other legislation at the 11th hour. ... Another alternative is to wait until next year. The politics that would await a prescription drug bill in an election year is already exciting some legislators -- and worrying plenty of others" (9/10 issue).

A Senator Speaks Out
      Writing in the St. Petersburg Times, Sen. Bob Graham (D-FL) argues that while "President Clinton deserves tremendous credit for trying" to add a prescription drug benefit, "it would be a tragedy if the goal of prescription drug coverage was lost because we failed to provide the kind of benefit that seniors want and are willing to pay for." He relates the story of a visit to a St. Petersburg senior center, in which only one-third revealed they would participate in the president's plan, despite genuine need. He writes, "Since the president's plan is largely aimed at these moderate- to low-income seniors, the stark contradiction between their concern over rising prescription costs and their unwillingness to use the proposed benefit was surprising -- until we looked at the numbers." If the benefit began tomorrow, a beneficiary would have to spend $288 in annual premiums and $576 on drugs to reap the benefits of the Clinton plan. By 2008, the figures would rise to $528 in premiums and $1,056 in drug expenses. Thus, seniors conclude, the "benefit isn't worth the cost." Graham concludes: "Next July 30, Medicare will celebrate 35 years of outstanding service to our nation's 65-and-older population. Some have suggested that the best birthday present that we can provide is fiscal solvency that preserves Medicare for future generations. I wholeheartedly agree. But it is also critical that we leave our children and grandchildren an updated, modern program flexible enough to cover the medical treatments that will be relevant when they are seniors" (9/13).