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Congress slow to fill prescription void


WASHINGTON - As Vice President Al Gore and Texas Gov. George W. Bush each claim credit for proposing the best plan to help seniors buy prescription drugs, Congress is engaged in an unlikely effort to enact its own solution before the fall elections.

Access to high-cost pharmaceuticals has become a red-hot national issue in this election year, confronting congressional candidates as well as the presidential nominees. But with only about five weeks left in this term of Congress, the lawmakers appear to lack both the time and the will to reach a consensus.

"The substantive differences are just too great," observed Thomas A. Scully, president of the Federation of American Hospitals, who put the odds against a prescription drug benefit receiving final approval this year at 20-to-1.

Lawmakers in both parties appear to see greater political advantage in staking out positions on the issue this year than in forging the compromises necessary to enact legislation.

Democrats are reluctant to pass landmark legislation that would become an achievement of the Republican-led Congress. Instead, the Democrats and such allies as organized labor are running campaign ads that highlight the failure of the Republican Congress to act on the prescription drug issue as a reason to restore Democrats to the leadership.

Republicans want to blunt the do-nothing charge - but not enough to enact the sweeping expansion of Medicare that the Democrats and Gore favor. Many of them would rather wait until next year in hope of adopting something more like Bush's prescription drug plan, which would rely heavily on private health insurance companies.

"This is something neither side wants to deal with this year," said Jennifer Duffy, an analyst with the Cook Political Report. "It doesn't serve anyone to get a bill passed. Acting on issues gets in the way of good politics."

Earlier this year, there had been speculation that perhaps some deal could be struck between House Republicans, who are fighting desperately to retain their slender six-seat majority, and President Clinton, who would like to see a Medicare drug benefit approved before he leaves office in January. But a key obstacle for the Republicans is that they have failed to reach agreement on the prescription drug issue among themselves.

The House in June passed a Republican-sponsored measure that would subsidize private insurance companies that offer a Medicare prescription drug benefit.

Sen. William V. Roth Jr., a Delaware Republican, countered in July with a more sweeping plan to incorporate the drug benefit within a restructured Medicare program. But Senate Majority Leader Trent Lott complained that it was too expensive.

And the prescription drug program that Bush unveiled this week differs from both the House and the Roth versions, thus blocking the momentum of either one.

Rep. James C. Greenwood, a Pennsylvania Republican who is a leading advocate of the House bill, said yesterday that he had "sadly" concluded that Clinton would be no help. Greenwood asserted that the president would rather have "a political legacy" of helping the Democrats regain control of Congress they lost under his watch in 1994 than share achievements with the Republicans.

The White House says that Clinton remains more than willing to strike a bargain with the Republicans on a drug benefit but that they would essentially have to accept his proposal in return for his support on other issues. The president and most Democrats contend that the House Republican plan, like the Bush plan, relies too heavily on private insurers that won't likely find it profitable to offer drug coverage to high-use elderly patients

"Right now, it looks like a long, long shot, but that could change if the Republicans decide they can't go home without doing something," said Chris Jennings, a Clinton health care adviser.

Roth, who is in a close re-election contest this year, has produced a temporary alternative proposal to provide immediate drug coverage to the elderly poor through targeted grants to states until a broader program of universal coverage can be passed.

Lott formally embraced Roth's "targeted" drug benefit proposal Tuesday and listed its passage among his top priorities.

Early this summer, the president proposed a deal in which he would back a Republican tax bill to ease the "marriage penalty" that affects many two-earner couples if Congress would pass his prescription drug plan for Medicare. The deal was not accepted.

Rep. Bill Thomas, a California Republican who is the chief architect of the House drug legislation, said yesterday that he was eager for the Senate to pass any bill on the issue so lawmakers could get to work on a House-Senate compromise.

But Senate Democrats have no intention of cooperating in that effort and can be expected to use the delaying tactics at their command to impede it. They are opposed to providing a drug benefit to the elderly poor without making it available to all Medicare beneficiaries.

"It's not just who you cover, but how you cover them," said Senate Democratic Leader Tom Daschle. "Keep in mind that all they're doing is giving them a voucher, and that voucher has nothing to do with Medicare. This is older seniors who have economic challenges that they have endured and cannot afford prescription drugs. I don't think it's in our interest to pass legislation that would provide so little hope to so few people."

Even without Democratic obstruction, "there isn't enough time to really do something, even on the short-term proposal," said Martin Corry of the AARP, which lobbies for the interests of retirees.

That doesn't mean there's been no progress, though, Corry said.

"From our vantage point, the issue has really matured over the past 15 months," he said. "Both presidential candidates have offered proposals for providing drug benefits to everyone in Medicare. The debate now is over how much to spend and how to structure it."

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