WASHINGTON -- A Senate majority endorsed yesterday the creation this year of a prescription drug benefit for Medicare beneficiaries, signaling growing election-year pressure to help the elderly afford the soaring cost of medications.
Republican leaders used a procedural device, however, to block the proposal from becoming part of this year's $1.83 trillion Republican budget blueprint. That blueprint sets aside $40 billion over five years for a Medicare drug benefit but would not require it and includes no details of how such a program would be designed.
Democrats sought to embarrass the Republicans by accusing them of putting a higher priority on broad tax cuts than on helping the elderly -- and they did so with a proposal to require a vote on the drug benefit before tax-cut legislation can be passed.
Some Democrats say that the 51-to-49 tally yesterday shows that the momentum is on their side. The vote was supported by all 45 Democrats and by six Republicans, four of whom are up for re-election.
"It is telling because it shows the political potency of the issue," said Rep. Benjamin L. Cardin, a Baltimore Democrat who is working on the Medicare issue in the House. "It'll be magnified five times over here because all House members think they are vulnerable."
Democrats have such faith in the political appeal of providing drug coverage for older voters that they have made it a top issue in their re-election campaigns. The sponsor of the proposal was Sen. Charles S. Robb of Virginia, who has not been active on health issues but is considered the Democratic incumbent most in danger of defeat this year.
"We have an obligation to our seniors, and future generations of seniors, to strengthen and modernize Medicare by adding a prescription drug benefit," Robb said. "Unfortunately, the Republican budget does not require that Congress spend a dime on this vital benefit."
Sen. Pete V. Domenici, a New Mexico Republican who is chairman of the Senate Budget Committee, argued that the Robb proposal was unnecessary because Republicans intended to provide the Medicare drug benefit before they cut taxes.
Even so, six Republicans voted for Robb's proposal: Sens. Peter Fitzgerald of Illinois, Arlen Specter of Pennsylvania and the four who face re-election this fall: Spencer Abraham of Michigan, Conrad Burns of Montana, Lincoln D. Chafee of Rhode Island and Mike DeWine of Ohio.
Any final action this year on a prescription drug benefit for Medicare beneficiaries remains much in doubt, however. Competing proposals are being developed in the House and Senate, in addition to a plan offered by President Clinton. Resolving differences in the complex legislation might prove too difficult for the relatively brief election-year session.
"I think we'll see something roll off the House floor, and maybe something get through the Senate," said Patricia Smith, a lobbyist for the American Association of Retired Persons. "But it seems doubtful that a conference will have enough time to put together something that reaches the president's desk. These issues are so complex."
Among the issues to be resolved is whether to extend drug coverage to all Medicare beneficiaries, as Clinton and many Democrats propose, or to limit the benefit to the lower-income elderly, as most Republicans suggest.
Lawmakers must also agree on whether to simply add the drug benefit to the Medicare program or instead take the opportunity to also restructure and modernize the 45-year-old program and improve its financial stability.
Most legislators in both parties agree that the Medicare program needs major adjustment to be able to meet the increasingly expensive costs of health care as the baby-boom generation enters retirement age. But Democrats are more willing than Republicans to add the drug benefit before the harder work of redesigning the Medicare program is completed.
Making the task of creating a drug benefit for the elderly even more daunting, lawmakers must strike some balance among the competing interests of insurance companies, drug companies, beneficiaries and the taxpayers.
Rep. Bill Thomas, a California Republican who, as chairman of a House Ways and Means subcommittee, has been working on developing a Medicare "modernization" proposal for months, says he's not sure when he will be finished.
"We're moving forward," Thomas said yesterday.
The debate on a prescription drug benefit for Medicare came as the Senate worked to complete this week its outline of budget priorities for the fiscal year ahead. Republican leaders hope to quickly resolve differences with a House-approved budget blueprint and put a final proposal to a vote before the Easter recess begins April 15.
Democrats also planned to try to embarrass Republicans by forcing them to vote on a rollback of the 18.4-cents-a-gallon federal gasoline tax, an issue that has divided the Republicans because the loss of the gasoline-tax revenue would threaten federal highway projects.