VIEW FROM THE HILL:

Bush's Medicare proposal forces seniors to switch to private health insurance for a meaningful drug benefit

President Bush recently unveiled a Medicare prescription drug benefit that pressures seniors to switch from traditional Medicare to HMOs or private insurance plans to get coverage for medicines.

The President's outline, which leaves the details for Congress to figure out, suggests that a meaningful prescription drug benefit will be offered to only those seniors who are willing to leave Medicare as we know it.

The President's plan lacks specifics, but here's what we do know: to get prescription drug coverage, seniors must opt for one of two new plans -- "enhanced Medicare" or "Medicare Advantage." The Bush outline does not specify what benefits would be offered, or what costsharing would be required under these options. Nor does it offer seniors protections from the whims of private insurance companies, which may reduce benefits, increase premiums, copays, and deductibles, or leave the program entirely.

As an alternative, the House Democrats have proposed creating a new Medicare Part D to provide voluntary prescription drug coverage for all Medicare beneficiaries. Beginning in 2006, seniors would pay a $25-a- month premium, and a $ 100-a-year deductible. Medicare would pay 80% of drug costs up to $2,000 per year, and 100% of costs above that amount.

Before considering major benefit changes to Medicare, we must remember the program's history. Medicare was created in 1965 because 50% of seniors were unable to purchase health insurance in the private market. Insurance companies rejected applications from seniors because they were unable to profit from covering a population with such costly health care needs.

Little, if anything, has changed in that regard. In 1997, Congress tried the private-sector approach to Medicare. That year, Congress enacted Medicare+Choice, a plan intended to offer seniors a myriad of choices through managed care plans. Millions of seniors nationwide enrolled because these Medicare HMOs offered benefits not available in traditional Medicare, including prescription drug coverage.

But the extra benefits did not last. In 1997, eight Medicare HMOs covered more than 100,000 Maryland seniors. Today, not one of these plans remains in the state. They abandoned the senior market because they did not want to insure a sick and expensive population. The pull outs left thousands of Maryland seniors without any prescription drug coverage, the very benefit that attracted them in the first place.

After initially proposing legislation that would only provide a prescription drug benefit if seniors switched to private insurance companies, the President has revised his latest proposal to include very limited coverage for those remaining in traditional Medicare. His proposal offers only "catastrophic" benefits -- requiring seniors to first spend between $4,000 to $7,000 of their own money -- before they can get help with prescription drug costs.

The President's plan also offers a "discount card" that would be available to all beneficiaries. But these cards are already available to the general public, and it's estimated that these cards would save on average about 12%, barely enough to address prescription drug cost increases over the past year.

Even such leading Republicans as Sen. Olympia Snowe of Maine and Rep. Billy Tauzin of Louisiana insist that Congress must guarantee an adequate drug benefit for seniors who remain in traditional fee-for-service Medicare. They understand that seniors and the disabled deserve a meaningful drug benefit within Medicare.