Prescription drug compromise has Senate in quandary

WASHINGTON -- Senators continued making last-minute changes to a compromise Medicare prescription drug plan, hoping to pick up enough votes to pass a measure they can tout before the November election.

Democrats were lined up behind a scaled-back plan, already endorsed by AARP, to help primarily low-income seniors and those facing catastrophic pharmacy bills. Lawmakers decided in late-night meetings Monday to lower the threshold for government support and make more seniors eligible.

It was unclear whether they could pick up enough Republicans to have the 60 votes needed to pass the measure. To complicate matters, GOP leaders were trying to revive a plan -- to be run by private insurers -- that was rejected last week.

"I think we're in a big mess," Sen. Orrin Hatch, R-Utah, declared Monday.

The new, scaled-back compromise, estimated to cost around $400 billion over 10 years, is likely to emerge on the Senate floor Tuesday. Democratic leaders have made moves to end debate and have a final vote on the issue sometime Wednesday.

Democrats such as Sen. Edward Kennedy of Massachusetts, who had lobbied for a universal plan to offer benefits to all older Americans, have thrown their support behind the scaled-back measure.

"It's a significant down payment, which will help millions of senior citizens who need help the most and protect all senior citizens against catastrophic drug costs," Kennedy said Monday. Kennedy is chairman of the Senate's health committee.

So far, however, Sen. Gordon Smith, R-Ore., the author of the plan with Sen. Bob Graham, D-Fla., is the only Republican on board. Smith spent Monday lobbying fellow Republicans for support. It was unclear if he would be successful.

The Graham-Smith plan would call for older people with incomes below 175 percent of the federal poverty level to get full drug coverage with nominal co-payments of around $1 to $3.

All others would receive government help of at least 5 percent of the cost of each prescription drug, with more government help available once a patient reached $3,300 in drug costs. At that point, the person would pay a $10 copayment on each prescription drug and the government would pay the remainder. There would be a $25 annual enrollment fee for the plan.

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"I don't think they have the votes and they shouldn't have the votes," said Sen. Charles Grassley, R-Iowa.

Grassley, Hatch and others want lawmakers to return to a 10-year, $370 billion proposal that was rejected by the Senate a week ago. They argue that, although it is less expensive than a $594 billion measure originally offered by Democrats, their plan would offer at least some prescription drug benefits to all seniors.

The group, which has called itself tripartisan because of the support of a Democrat and the Senate's lone independent, even offered to buy more support by raising the cost of the plan to $400 billion.

Democrats have opposed that plan largely because it uses private insurers to administer the benefit. They want to see a benefit administered by Medicare.

The debate exhibited the frenzy of both parties to craft a prescription drug bill before Friday's adjournment for summer recess. Both sides want to appeal to elderly voters, who participate disproportionately in midterm elections.