Prescription drug promises for older Americans aging

WASHINGTON -- Some Republicans are finding fault with a prescription drug bill that their party put together for a crucial election-year vote in the House this week and is supported by pharmaceutical and insurance companies.

The GOP infighting, along with sharp criticism from Democrats and some advocates for older Americans, shows how difficult it will be for Congress to compromise and send legislation to the White House this year. Only two years ago, in the months before the last elections, candidates in both parties promised older Americans action.

GOP leaders have said they plan to debate the issue on the House floor Wednesday. Senate Democrats have pledged to bring up prescription drugs by August.

$35 monthly premiums

The Republican measure would spend $350 billion over 10 years and rely primarily on private insurers to administer the benefits. It would require seniors to pay premiums of about $35 a month along with a $250 yearly deductible.

The government would pay 80 percent of the first $1,000 of drug costs and 50 percent of the next $1,000. Patients would be responsible for drug costs beyond that, although with a cap on out-of-pocket spending.

The House Energy and Commerce Committee approved its version of the bill Friday with a $3,700 cap on out-of-pocket spending. The House Ways and Means Committee, which also has jurisdiction over the issue, has a cap that is $100 more.

Republicans on the Energy and Commerce Committee dropped a plan to charge home health patients a $40 co-payment, which many GOP lawmakers opposed. Rep. Bill Thomas, the Ways and Means chairman, had included that to help offset spending in the bill.

The differences in the two bills will have to be reconciled before Wednesday's debate.

Democrats have proposed spending far more money -- between $500 billion and $800 billion -- and requiring smaller premiums and co-payments. The government would be the primary administrator.

"We provide a comprehensive benefit within realistic budget parameters," Thomas, R-Calif., said.

In the days before the vote, however, some Republicans are questioning the plan.

The chairman of the House Small Business Committee wrote colleagues last week that the party's bill would hurt small pharmacies because private insurers would steer consumers to the big drugstore chains or mail-order programs.

"Congress must not enact legislation which harms these small businesses in the name of providing a prescription drug benefit," wrote Rep. Donald Manzullo, R-Ill.

Manzullo said other Republicans shared similar concerns about the bill during a closed-door meeting Thursday.

"The whole setup is flawed," Manzullo said. "It's the cost. It's the promise to seniors. There has to be a better way to come up with a plan."

Rep. Mac Collins of Georgia, the only Republican to vote against the plan in the Ways and Means Committee, said it cost too much.

"He would definitely be supportive of a measure that provided access to those seniors who had no access currently," said spokesman Dan Kidder. But Collins is "opposed to creating a universal entitlement," Kidder said.

GOP Rep. John Peterson said the bill, which contains about $40 billion in initiatives and additional money for health providers, does not do enough for rural hospitals and home health care.

"It's very important that rural gets as much help as they can get and that it needs and deserves in this round," said Peterson, R-Pa. "Once pharmacy benefits are in the Medicare mix, money will be scarce."

If those provisions are not added, "I don't vote for it," Peterson said.

The Republican dissent is in addition to nearly universal opposition from Democrats and some lobby groups.

The National Council on the Aging, a coalition of groups for the aging, and other advocates say offering the benefits through insurers will burden older Americans with too much out-of-pocket costs.

They also complain the plan does not specify in law the amount of premiums and deductibles, which gives too much leeway to private insurers to vary costs from state to state.

AARP, the largest lobbying group for seniors, praised parts of the measure but did not offer a complete endorsement.

"The House Republican plan is as full of holes as Swiss cheese," said Sen. Edward Kennedy, D-Mass.

In Saturday's weekly Democratic radio address Saturday, Rep. John Dingell of Michigan, the senior Democrat on the Energy and Commerce Committee, called it a "phantom benefit."