Drug plan gap may affect fall elections

By Ed Tibbetts | Monday, July 31, 2006

When Jules Cohen signed up for his Medicare-backed prescription drug plan, he’d heard about the “doughnut hole.”

The hole is a built-in gap, aimed at holding down the program’s cost, that will force senior citizens to cover all their drug costs that exceed $2,250 a year.

The plan doesn’t pick up coverage again until a senior’s out-of-pocket expenses reach $3,600, then insurance pays 95 percent of drug costs.

Vaguely aware of the gap when he signed up, Cohen, a 69-year-old retiree from Bettendorf, said he thought the threshold referred to his out-of-pocket expenses, not the total cost of his drugs.

So when he paid roughly $25 for his Zocor prescription, he didn’t realize it was accumulating about $125 toward the threshold.

“When I realized how they achieved that,” he says, “I went berserk.”

This fall, Democrats are hoping millions of elderly Americans will have the same reaction.

The Medicare prescription drug plan has been a target of critics since it was signed into law in 2003.

Now, Democrats and others say the doughnut hole will swallow 7 million senior citizens, the bulk of them Sept. 22, just weeks before Election Day. And they believe angry seniors will take it out on Republicans — seniors like Jules Cohen, who supplied documents showing his drug costs had already exceeded $3,300, putting him in the hole.

“If I was Howard Dean,” Cohen says, referring to the Democratic Party chairman, “I would make this a priority. I’d nail every Republican for voting for this thing.”

The prescription drug plan isn’t a disaster with most seniors, though, according to a poll conducted last month by the Kaiser Family Foundation.

The survey showed that nearly equal numbers saw the overall program favorably as unfavorably.

Most satisfied with plan

Meanwhile, 80 percent of the seniors enrolled in a drug plan say they’re satisfied with their coverage, according to the survey, which was released Thursday by the nonpartisan health policy group.

About 38 million seniors get drug coverage through the program, private companies or by other means, 375,000 of them in Iowa and 1.3 million in Illinois.

“I think the doughnut hole will affect attitudes toward the program,” says Roger Hickey, the co-director of the Institute for America’s Future, which says the gap ought to be eliminated.

Seniors are shocked when they hit the gap, he says.

The institute has put out a report with its partners — the Iowa Citizens Action Network released the study in Davenport on Friday — that drew attention to the issue.

In Iowa’s competitive 1st District congressional campaign, Democrat Bruce Braley frequently brings up the doughnut hole and says he would vote to eliminate it.

“I think it fits into the overriding concern people have for economic security,” says Jeff Link, a Braley strategist.

While Democratic gubernatorial candidate Chet Culver has mostly criticized rival Jim Nussle’s record on the federal budget, a spokesperson also faults him for the prescription drug plan, which he voted for as a congressman.

“We are certainly going to make sure he’s held accountable for that in the fall,” said Taylor West.

Maria Comella, a spokesperson for Nussle, says his leadership has given seniors a program that provides greater access to drugs than they had before, including when Democrats held control of the Con-gress.

“The proof is in the numbers and the fact that 75 percent of (eligible) Iowans have enrolled in this program and are seeing benefits firsthand in lower prices for prescription drugs,” she said.

She adds Democrats may criticize, but they don’t have a substitute plan that “doesn’t bankrupt the Iowa taxpayer.”

Republican 1st District candidate Mike Whalen calls the drug benefit the most significant expansion in Medicare history — and it was achieved by a Republican White House and Congress.

Democrats are not happy about the program’s success and instead want to “carp, criticize and complain,” he said.

Backers say the problem isn’t as severe as critics claim, either. An analysis of the doughnut hole, done by PricewaterhouseCoopers, said only about 3.4 million would experience a gap in coverage.

The study was done for the Health Leadership Council, a group that represents pharmaceutical companies.

Regardless of the political impact, it does appear some seniors are in for a surprise when they hit the gap.

The Kaiser survey reported that more than a third of the 1,585 seniors polled said their drug plan didn’t have a gap in coverage, even though Kaiser says nearly all the plans do.

Critics believe an unexpected crush of drug bills, coupled with a public nearly split anyway on the program as a whole — as opposed to their individual plans — may lead to a backlash among seniors just as they’re getting ready to go to the voting booth.

Says Cohen: “I blame the Republicans. It was a Republican administration that passed the plan.”

Ed Tibbetts can be contacted at (563) 383-2327 or etibbetts@qctimes.com.