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Seniors Weigh Benefits of Medicare Drug Provision

Small armies of supporters and opponents are leading competing public relations blitzes on senior centers and town halls, trying to educate older voters who — at least one poll shows — have no idea how the new Medicare prescription drug benefit (search) is going to work. 

“The lack of understanding of the prescription drug law makes it ripe for political demagoguery on both sides as we enter the election season,” said Drew E. Altman, president and CEO of the Kaiser Family Foundation (search), which released a poll last month showing that only 31 percent of seniors knew the prescription drug benefit became law last year.

Even so, since the mammoth Medicare overhaul was passed and signed by President Bush in December, those seniors have been caught in the crossfire of competing political rhetoric about the benefits of a new prescription drug provision.

AARP (search), the nation's largest seniors group with an estimated 37.5 million members, backed the package, said officials, because it offers seniors badly-needed relief.

“It has become critical in the last several years. We’ve seen drug costs increase at double digits, we’ve seen people lose their employer coverage,” said AARP spokeswoman Kirsten Sloan. “We don’t think it’s a bad bill, we think it is a foundation we can build upon.”

But at least 50,000 members have dropped their AARP membership in protest, charging that the bill caters to greedy pharmaceutical interests and gives companies with retiree health plans an incentive to drop their coverage altogether, now that Medicare is picking up both health care and prescription costs.

“We don’t begrudge the fact that people are getting coverage who don’t have it, and that’s a good thing. But if you look at it closely, it’s inadequate and there’s a huge doughnut hole,” said Dick Ciocca, president of the National Association of Prudential Retirees (search), which serves former employees of the insurance company giant, and a board member on the National Retiree Legislative Network (search).

The "doughnut hole" refers to the lapse in coverage that is provided under the Medicare bill.

According to the law, beginning in 2006, seniors eligible for Medicare will have voluntary access to a Medicare-provided drug benefit for an estimated premium of $35 a month.

The lowest income seniors — an estimated 14 million in the United States — will enjoy the benefit without paying premiums or deductibles and will experience no gap in coverage, paying $1 to $3 per prescription.

Those with more assets, but still considered lower-income, will pay on a means-tested sliding scale.

All other seniors will pay out-of-pocket until reaching a $250 deductible, and then the government will pay 75 percent of drug costs until they reach $2,250 in one year. After that, the doughnut hole kicks in — enrollees will pay all expenses until they reach $3,600, beyond which Medicare will pay 95 percent of all additional costs.

Most Democrats resisted that middle gap in coverage. Republicans mindful of a $400 billion limit for the total Medicare package said the gap would have to be addressed down the road.

In 2010, the federal government will launch a controlled pilot in which seniors in selected regions will be given the choice to participate in a private drug plan regulated in part by the government. The pilot will run for five years only and will be terminated until further congressional action.

This was a compromise of Republicans’ earlier ambition to give seniors the choice for private benefits right away.

The plan also resists price controls called for by many Democrats, though it does provide some relief through generic drug purchasing.

Democrats and Republicans are split over whether the drug plan is a positive step for seniors or a real disaster, and GOP lawmakers who helped push through the bill are working doubly hard to beat back the negative messages being sent out back home, said Amy Spanbauer, spokesman for Rep. Jim Gibbons (search), R-Nev.

“The seniors in Nevada and elsewhere are constantly inundated with media reports attacking the drug bill with scare tactics and rhetoric used to make this a political football instead of what the legislation really is,” Spanbauer said. “[Rep. Gibbons] is just trying to cut through the hysteria and political rhetoric and to give seniors the facts.”

“They’re getting a lot of mixed messages in our area,” said Stephanie Fischer, spokeswoman for Rep. Jim Greenwood (search), R-Pa., who supports the bill and has held at least one major town hall meeting to answer questions from seniors. Fischer said seniors appear amenable to the plan once they hear the facts.

Opponents say they have gotten the opposite results from Greenwood's once they explain the law.

“We’ve found that the more seniors learn about this, the more upset they are,” said Ron Pollack, executive director of Families USA (search), which recently embarked on a 22-city “road show” to explain the new law to seniors. While claiming to be informational-only, Pollack acknowledges that his organization opposed the Medicare bill from the start.

“There isn’t anything meaningful being done to contain costs,” said Pollack. “The drug benefit is bizarre and skimpy.”

Rep. Frank Pallone (search), D-N.J., has said his goal is to tell seniors how shortsighted the entire plan is, according to spokesman Andrew Souvall.

“I think it’s been something that not only he, but members of the Democratic caucus, feel is something we need to educate seniors about in the next several months," Souvall said.

Ciocca said his group has been fighting for legislation that would make it tougher for private companies to dump retiree health coverage. He said the Medicare bill undermines that effort though they continue to argue their points.

“The lobby is so great and we’re just so afraid that the companies are just going to walk away from retirees,” Ciocca said.

But Sloan said Congress has crafted a law that works within fiscal parameters and addresses the greatest need: poor seniors and very sick people with huge drug costs. “But it’s our goal to get that [doughnut hole] filled.”

She said the AARP will both publicly defend the current bill and promote improvements.