Washington Beat

By Michael Pretzer, Washington Editor

Medicare
Will an abundance of ideas kill prescription drug legislation?

Occasionally, a concept gathers so much momentum in Washington that it can't be stopped. Legislation becomes inevitable.

Prescription drug coverage for Medicare beneficiaries is developing into that kind of idea. A couple of years ago, the thought that Medicare would pay for drugs was nothing but a gleam in the eyes of a few ultraliberal Democrats. Now, the concept is claimed by nearly every legislator. Even the eyes of staid GOP leaders have that telltale glint.

In his eighth and final State of the Union address, President Clinton renewed his 1999 call for a Medicare drug benefit. His plan would (1) provide drug coverage to all Medicare beneficiaries, (2) pay half of a beneficiary's prescription costs up to $2,000 (that is, it would pay a maximum of $1,000), and (3) have no de-ductible. Phase-in would begin in 2003. In 2009, upon completion of the phase-in, the plan would pay half of a senior's drug costs up to $5,000 (or $2,500 max). The program would be run by pharmaceutical benefit managers in the private sector. Low-income Americans would have all or part of their premium for the drug benefit waived.

While the president waits for his proposal to be considered on Capitol Hill, House Republicans are scouting around for a better version of the same idea. In late January, House Speaker J. Dennis Hastert, R-IL, appointed a task force to develop a GOP proposal. Nobody knows yet what the group will come up with, but one option it's expected to consider would have seniors buy drug coverage from private insurers, similar to the way they now buy Medigap insurance.

Nearly every lawmaker wants in on the action, but some prefer their own legislation to Clinton's. Sen. John Breaux, D-LA, and Rep. Bill Thomas, R-CA, think drug coverage ought to be tied to broad Medicare reform, for example. Breaux just happens to be sponsoring—and Thomas is drafting—legislation that would dramatically restructure Medicare.

Rep. Pete Stark, D-CA, sees a link between drug coverage and a reduction in medical errors, another grave concern in Washington these days. "If we could enact a prescription drug benefit in Medicare, we would need a system that keeps track of medications for billing purposes," explains Stark. "That same system would warn us when people are taking too many pills, when multiple prescriptions could cause adverse reactions, and when patients are failing to take needed medicines." And as it happens, Stark is sponsoring drug coverage legislation that creates a system to review prescriptions.

Reps. Tom Allen, D-ME, and Sherrod Brown, D-OH, see the establishment of a drug benefit as an opportunity to press for lower prescription prices. And just by coincidence, their Prescription Drug Fairness for Seniors Act of 1999 would consolidate the purchase of prescription drugs so seniors could get them more cheaply.

Many observers are betting that prescription drug coverage is the one horse that crosses the legislative finish line this year. Several factors are in its favor. Drug prices are going up while drug benefits from Medicare HMOs are dropping, and Congress is being pressed to do something. Opposition to drug benefit legislation from the powerful Pharmaceutical Research and Manufacturers of America has begun to soften. And passage of a drug benefit bill right before an election would surely make senior citizens favorably disposed to those who supported the measure.

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