HARRISBURG How will federal proposals affect state prescription programs?

Sen. Santorum opposed the Senate plan, and Sen. Specter voted for it.
HARRISBURG (AP) -- A complex federal Medicare prescription drug bill under construction in Congress could either expand Pennsylvania's drug plan for low-income seniors or prompt a radical overhaul.
Pennsylvania's two Republican U.S. senators have cast conflicting votes on the subject, while uncertainty over the bill's future is holding up a separate bill in the state Legislature to expand the state's drug plan to cover more low-income seniors.
One question that could affect the 224,000 Pennsylvanians in the state plan -- it comprises the Pharmaceutical Assistance Contract for the Elderly and a companion program called PACENET -- is whether federal money will complement the state program, or whether state money will complement a new federal program.
The $400 million spent on PACE and PACENET could be used instead to "wrap around" and fill holes in a new federal drug program that replaces it. Or, if the state program remains intact, Pennsylvania could use a federal subsidy to expand the income limits to allow more people into the program.
A joint congressional committee is trying to work out differences between House and Senate bills that passed last month. Both would create broad Medicare prescription drug plans on top of privately managed health-care plans, but it's anyone's guess how a unified bill will look if and when it emerges.
U.S. Sen. Rick Santorum voted against the Senate bill because he said the federal subsidy that Pennsylvania and certain other states would have received to expand their state programs would "compete" with Medicare's new managed health plans, which would also offer drug coverage. State officials estimated that the federal subsidy provided in the Senate bill would be $250 million.
The proposed low-income Medicare drug program, without any special subsidy, "is better financially for Pennsylvania, and with the option of seniors' being able to participate in the Medicare Advantage [managed health care] program, it's better for seniors," Santorum said.
U.S. Sen. Arlen Specter voted for the Senate bill -- in part at the urging of Gov. Ed Rendell -- saying that the many seniors in the program could be confused by the complex federal system to which they would have to switch.