Bush Lends Hand to Seniors’ Drug Bills

With little fanfare, President Bush on Monday unveiled his proposal for a limited and temporary solution to the problem of providing prescription drug coverage to the elderly and the disabled.

But his decision to play down even the plan’s announcement seemed to acknowledge the potential political quagmire that the issue presents.

His proposal, which must be approved by Congress, tracks closely a campaign plan under which the federal government would give the states $48 billion over four years to meet the most dire prescription drug needs.

Congressional leaders of both parties, however, already have sent clear signals that they oppose his plan, and there is little support for it from either the National Governors’ Assn. or the prescription drug industry, both of which are key players in the debate.

The biggest concern for lawmakers is that Bush’s plan would reach only a tiny percentage of the elderly and disabled who lack prescription drug coverage. Roughly one-third of the 39 million elderly and disabled who have Medicare health insurance have no coverage for prescription drugs, while another third have plans that vary widely in coverage and cost. Bush’s plan would reach only part of the former group.

White House Press Secretary Ari Fleischer, anticipating criticism that the program would not go far enough in addressing problems posed by escalating drugs costs, let alone the overall challenges of paying for a Medicare drug benefit for all seniors and disabled, promised that Bush eventually would deliver “comprehensive Medicare reform.”

He said Bush is taking a piecemeal approach “because the president believes that we need to move as quickly as possible to get prescription drugs particularly to low-income seniors.” An overhaul with wider reach would take too long to enact, he said. The name of the program, Immediate Helping Hand, itself suggests a step-by-step approach.

Indeed, during a picture-taking session as he met with two top-ranking Republicans in the House and Senate, Bush said of congressional critics wary that the plan is too limited: “If, in fact what they’re saying is that they plan on expediting a Medicare reform that would include prescription drugs for all seniors, then all of a sudden I begin to say well, gosh, that may make sense.”

But, he added, “if they’re going to drag their feet . . . then I feel that it’s very important for us to have Immediate Helping Hand. There are a lot of seniors who need help when it comes to prescription drugs.”

The plan would target those seniors whose incomes are below 135% of the poverty line, or $11,300 for an individual and $15,200 for a couple. For them, there would be a complete subsidy of premiums for insurance to cover prescription drug costs as well as any coinsurance or co-payments. The subsidy then would tail down to zero for those with incomes above 175% of the poverty line.

Bush’s proposal also includes a so-called catastrophic plan guaranteeing that the government would pay all prescription drug costs above $6,000 a year for anyone regardless of income. Fewer than 10% of seniors have drug bills in that range, according to an analysis by the AARP, which represents Medicare beneficiaries.

It is hard to estimate exactly how many people would be helped by Bush’s plan. In documents released Monday by the White House, it appears that the plan would be authorized to run only through 2004. Based on the history of implementation of health care programs, that fact makes it unlikely the program would be fully operational in all states before it was terminated.

So far, the experience of the states in setting up plans helping low-income seniors get prescription drug coverage is varied. Although about 30 states have plans on the books, one study found that only 16 such programs were fully operational as of last summer.

The study also indicated that the plans cover only a small portion of those who are eligible. Based on that finding, one analysis of Bush’s proposal by Ken Thorp, a former Health and Human Services official in the Clinton administration, suggests that fewer than 1 million of the nearly 6 million people eligible for help under his plan would actually get it.

And still left out would be millions of middle-income elderly who lack prescription drug coverage, said John Rother, chief of legislative affairs for AARP.

“The real issue here is a voluntary affordable drug benefit in Medicare that is available to all seniors and disabled, and that’s the best and most efficient way to do this job,” Rother said.

Still, Bush appears to be attempting both to make good on a campaign promise and to ensure that there is a backup plan if Congress is unable to come to an agreement on a prescription drug benefit that reaches all the elderly. At this point, neither Bush’s proposal nor a broader plan appears likely to become law in the next few months.