Closing ‘doughnut hole’ is complex

Washington Post

WASHINGTON — Six years after Congress added a prescription-drug benefit to Medicare, Democrats in the House and Senate are poised to make a central change that they and most older Americans have wanted all along: getting rid of a quirk that forces millions of elderly patients with especially high expenses for medicine to pay for much of it on their own.

The closing of an unusual gap in Medicare drug coverage — a gap that Republicans had, when they controlled Capitol Hill and the White House, insisted was needed for the government to be able to afford the program — would “forever end this indefensible injustice for America’s seniors,” Senate Majority Leader Harry M. Reid, D-Nev., said in announcing that the Senate would join the House in supporting the change.

But details of the change underscore that, for patients and the federal budget alike, the implications of the sprawling health-care bills pushed through by congressional Democrats are more nuanced than lawmakers’ talking points.

The Democrats and President Barack Obama have been clear that the “doughnut hole,” as the gap is known, would disappear gradually over the next 10 years. They have not mentioned that Medicare patients would, according to House figures, face a slightly larger hole in coverage during two of the next three years than they do today.

Proponents say the government can afford to eliminate the gap because the pharmaceutical industry would pay for the phaseout. But less than half of the $80 billion that drug makers agreed to provide, under a health-care reform agreement over the summer with Senate Democrats and the White House, would be used to help fill the gap, according to Senate Democratic aides.

The prospect of filling the hole in drug coverage responds to a strong desire among older Americans — a significant constituency that tends to be wary of changes to the health-care system. The 2003 law that added the drug benefit to Medicare was the largest expansion since the creation of the federal health-insurance system for the elderly four decades ago. The new coverage became available in 2006. As of last year, about 32 million people, nearly three-fourths of everyone on Medicare, had it.

Nancy LeaMond, executive vice president for social impact at AARP, said that although the benefits have proved popular, “you really can’t have a meeting with a chapter, you can’t have a town hall” without complaints surfacing about the doughnut hole.