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Medicare Drug Benefit Proposed

WASHINGTON (AP) — Eager to show unity on a key election-year issue, President Clinton and Democratic congressional leaders today unveiled a proposed prescription drug benefit under Medicare that the White House first touted last winter.

To underscore his point that drugs are too costly for many older Americans, Clinton appeared in the White House Rose Garden today with Betty Dizik, 73, a widow who said she skips prescribed medications for diabetes and a heart condition when she cannot afford them.

``I'm not asking for a handout or charity. I'm willing to work and do my part,'' Dizik said. ``I'm just asking for a little help.''

Clinton said providing prescription coverage for people like Dizik is ``the smart and the right thing to do. We would never even think of creating Medicare today without it, and it's high time we fixed it.''

The White House also released a study by the Older Women's League that concluded women on Medicare spend 13 percent more than men for prescription drugs. On average, the women's incomes are 40 percent below those of men.

The proposal outlined today will stand as an alternative to the House Republican approach calling for private insurance, and thus set the stage for a debate in the final months of the congressional session.

``We need some Republican support,'' Clinton said. ``This is a good bill.''

Senate Minority Leader Tom Daschle, D-S.D., said the Republicans' plan, which would limit the prescription benefit to those earning up to $15,000 a year doesn't address the needs of people like Dizik.

``It wouldn't do a thing for her,'' he said.

Daschle, House Democratic leader Dick Gephardt and numerous rank-and-file Democrats joined Clinton at today's announcement. There are likely to be minor differences between bills advanced in the House and Senate, they said, but stressed that the party was unified on its approach.

According to a description of the proposal that circulated in Congress on Tuesday, coverage would be optional, and any beneficiary wishing to enroll would pay a premium that one official estimated at roughly $24 a month.

The basic Medicare benefit would pay for 50 percent of the cost of the first $2,000 in prescriptions annually, rising to $5,000 by 2009. Low-income beneficiaries up to 135 percent of the government's poverty level would receive subsidies, and beneficiaries with slightly higher incomes would receive a slightly reduced subsidy.

In addition to the basic benefit, Democrats said the plan envisions catastrophic coverage after out-of-pocket expenses exceed a certain level, likely $3,000 to $4,000 a year.

Democratic efforts to achieve a measure of unity have been complicated by internal debate over a separate bill to require reduced prices for certain drugs.

The bill, advanced by Rep. Tom Allen of Maine and backed by more than 150 House Democrats, was opposed strongly by others in the party, including several senators, party officials said. It would permit pharmacies to buy prescription drugs for Medicare at the same preferred price given providers under Medicaid or Veterans Affairs Department health programs.

The provision is not included in the White House bill, although Clinton and Democratic lawmakers are expected to include a provision that establishes a goal of eliminating the higher price that seniors pay for drugs.

The Democrats' measure is expected to specify using so-called pharmacy benefit managers to seek discounts from both drug companies and pharmacies, as Clinton proposed last winter.

In an interview, Allen said Democrats have been ``able to reach agreement on the structure of the benefit proposal. That doesn't mean we are dropping the discount approach. We will continue to advocate that.''

At the same time, he said, ``This is an important step for (Democrats) to be able to get cohesion'' on the prescription drug bill.

A consumer group attacked the decision to jettison the price mandate in advance. ``They have completely ignored the best cost-containment bill in their program,'' contended Frank Clemente, a spokesman for Public Citizen Congress Watch. He said Democrats ``buckled'' to the pharmaceutical industry.

Clinton recommended a Medicare drug benefit in his State of the Union address last winter, and House Republicans responded last month with an alternative of their own.

That proposal, sketched thus far only in outline, would establish a program of voluntary private health insurance, freeing companies for the first time to sell policies that provide benefits only for prescription drug costs. Like the Democrats, Republicans envisions government subsidies for lower-income older people as well as those with unusually high prescription drug costs.


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