SUSAN DENTZER: While running for office last year, President Bush had to tackle the topic of Medicare and the fact that the federal health program for the aged and disabled doesn't pay for most prescription drugs used outside the hospital.
GEORGE W. BUSH: Medicare does more than meet the needs of our elderly; it reflects the values of our society. We will set it on firm financial ground and make prescription drugs available and affordable for every senior who needs them.
SUSAN DENTZER: Earlier this week, the President began to follow through on that pledge by submitting the outlines of his drug coverage proposal to Congress.
PRESIDENT GEORGE W. BUSH: I was informing the chairman today, we're sending up to the Hill our immediate helping hand proposal, which is help for prescription drugs for seniors.
SUSAN DENTZER: But the President has found little interest from either party in passing his plan. It's a temporary measure to channel money to the states so they can help low-income seniors buy prescription drugs. Senators discussed it at a recent confirmation hearing for incoming Health and Human Services Secretary Tommy Thompson.
SEN. KENT CONRAD, (D) North Dakota: (January 18) You know, there's just not much support-- my governor doesn't like it. Other governors don't like it.
SEN. OLYMPIA SNOWE, (R) Maine: I think the concern is that if we have a temporary program, we may never get any more on prescription drug, because of the difficulty and complexity of those issues.
SUSAN DENTZER: Although many seniors have at least some drug coverage thorough private insurance plans, about 15 million of Medicare's 40 million beneficiaries have none at all. President Bush says he ultimately wants to address that as part of a comprehensive Medicare reform. That would not only add a drug benefit, but would also dramatically restructure the program. But that would take time and would be politically difficult. So Bush wants to start with a drug plan for the worst off seniors that he calls an "Immediate Helping Hand."
GEORGE W. BUSH: (September 5, 2000) But we will not wait to help seniors afford prescription drugs. We'll give them direct aid now by expanding and funding state assistance programs for four years, during the transition to better Medicare coverage. We'll provide $12 billion a year in direct aid to low-income seniors in all 50 states.
SUSAN DENTZER: Under the President's plan, states could use that $12 billion a year for so-called pharmaceutical assistance programs for the low- income aged and disabled. The state programs would pick up the entire cost of prescription drugs for the lowest-income seniors and a portion of the costs for others.
GEORGE W. BUSH: (September 5, 2000) Every senior with an income of less than $11,300-- $15,200 for a couple-- will have the entire cost of their prescription drugs covered. For seniors with incomes less than $14,600 or $19,700 for a couple, there will be a partial subsidy.
SUSAN DENTZER: Other provisions of the President's plan would help up to several hundred thousand seniors who spend more than $6,000 a year out of pocket on drugs. Bush's proposal builds on programs now in place in 14 states and scheduled to begin soon in five more. Together, the programs currently offer help with drug costs to an estimated 800,000 of the aged and disabled. But 31 states don't have such programs and many are leery of setting them up now. Robert Reischauer is President of the Urban Institute, a Washington think tank.
ROBERT REISCHAUER: It's a very complex undertaking and if this program really is going to last only four years, the states would have to expend a lot of energy designing, implementing, and administering a program that would quickly disappear. But of more concern to the states is that the program may not disappear after four years. The Congress and the President may not agree on long-term Medicare reforms and they would, therefore, be having a permanent responsibility for drug assistance to the elderly and disabled. They would get increasingly pressured by middle class and upper-middle-class people without drug assistance, saying, "why are only the poor getting this?"
SUSAN DENTZER: Although most Democrats in Congress oppose the "Immediate Helping Hand" plan, they're also split over the broader issue of reforming Medicare. Some are wary of efforts to revamp the program and mainly want to focus on adding a drug benefit for all enrollees.
SEN. PAUL WELLSTONE: The President's proposal is a great leap sideways, I think - a great leap sideways. Many people, just because you make $16,000 a year or $20,000 a year or a little bit over that as a couple, doesn't mean with the prescription drug costs as they are, that you can afford it. The whole point of this is to make it part of Medicare, to make it universal and to meet the need.
SUSAN DENTZER: Other Democrats, like Senator John Breaux of Louisiana, support adding a universal benefit through overall Medicare reform. They fear that the helping hand proposal would be a time- consuming distraction.
SEN. JOHN BREAUX: I want to do this as quickly as we possibly can and I'm convinced now that the best way to do it is as a part of Medicare reform.
SUSAN DENTZER: At a meeting this week with top GOP health lawmakers, the President took note of the resistance to his plan.
PRESIDENT GEORGE W. BUSH: If in fact what they are saying is that they plan on expediting a Medicare reform that will include prescription drugs for all seniors, then all of a sudden I begin to say, well, gosh, that may make sense that you look at our proposal the way you do. If they are going to drag their feet, if the members of the Congress on both sides of the aisle don't feel the same urgency that I feel and these two chairman feel on Medicare reform, then I feel it's very important for us to have an immediate helping hand. There are a lot of seniors who need help when it comes to prescription drugs.
SUSAN DENTZER: And with at least a few Republicans voicing some tepid support for the program, the debate over prescription drug coverage could begin in earnest soon, as Congress starts work on the next fiscal year's budget.