PORT ST. LUCIE, Fla. -- When the last health maintenance organization in this working-class town pulled out two months ago, it cut a vital lifeline to prescription drugs for hundreds of retirees like Mary Elizabeth Johnson.
Johnson, 83, has Medicare, but the federal program does not cover drug costs for people outside the hospital. So Johnson, whose HMO partly offset the cost of her drugs, must pay nearly $84 a month from her $850-a-month Social Security check for medications to lower her blood pressure and treat a thyroid condition.
"I'm definitely not poor, but I'm not rich," Johnson told her congressman, Rep. Mark Foley, who met with two dozen retirees at a senior center here. "When the HMO was here, I paid a $10 co-payment for each prescription. That was OK. Now, one day, I won't be able to eat."
As Congress wrestles with the white-hot political issue of Medicare drug benefits, Republicans like Foley, a popular three-term centrist with a strong health care record, are in the hot seat at home.
President Clinton has proposed expanding Medicare to give prescription drug benefits to all of the program's 39 million beneficiaries. One-third of Medicare recipients have no drug coverage, and the remainder often face inadequate coverage or must make expensive co-payments. The issue has riveted the attention of voters here in South Florida, as well as across the country.
People 65 or older make up almost one-quarter of Foley's district, which has the seventh-largest number of retirees of any congressional district in the country. And while they make up 12 percent of the nation's population, they use one-third of all drugs prescribed each year.
Republicans on Capitol Hill agree that Medicare recipients need legislative relief this year, but they have stumbled in their response to Clinton's initiative, which would cost more than $160 billion over 10 years.
Speaker Dennis Hastert appointed a task force last month to draft a House Republican alternative, but the effort has yet to get off the ground. House Democrats are using a parliamentary tactic to try to force a vote on drug coverage for all Medicare beneficiaries. Democratic candidates in border states are taking busloads of retirees to Canada and Mexico, where having a prescription filled costs one-third to one-half of what it costs in the United States.
"We should have engaged earlier," conceded Foley, a member of the House Ways and Means Committee, which has jurisdiction over Medicare. "But the Democrats, rather than being constructive, are trying to box us in."
Under the president's proposal, Medicare would pay half of a beneficiary's drug expenses, up to certain limits. The maximum federal payment would start at $1,000 a year and would rise gradually to $2,500 in 2008.
Beyond that basic benefit, Clinton is also asking Congress to set aside $35 billion to help protect Medicare beneficiaries with extremely high drug costs from 2006 to 2010.