The Elephant in the Florida 22nd: Medicare Prescription Benefit

By Anushka Asthana
Washington Post Staff Writer
Sunday, October 1, 2006

HOLLYWOOD, Fla. -- Betty Priscak has voted for veteran Rep. E. Clay Shaw Jr. (R-Fla.) in every election he has been in, but now she thinks it is time for a change. Priscak, a 74-year-old in increasingly poor health, plans to vote for Ron Klein, Shaw's Democratic challenger, in November.

Why? She is upset with the Medicare prescription drug program passed by the Republicans in 2003. She calls it "devastating."

The initial uproar over the program's complexity died down once many seniors had signed up, but now Priscak and millions of other older Americans are confronting an interruption in their drug coverage that will require them to pay the full cost of their prescriptions -- or go without. Priscak came up against the coverage gap, known as the "doughnut hole," in May, and it was months before the drug coverage kicked back in.

If it had not been for financial assistance from her partner, she said, she would not have been able to meet the thousands of dollars of uncovered drug costs. "If you think I dare vote for a Republican, you have another thought coming," she said.

Priscak is not alone. According to the consulting firm Price Waterhouse Coopers LLC, 3.4 million seniors will fall into the doughnut hole this year.

The doughnut hole ends federal payments for a person's drug purchases once an annual spending limit is reached, resuming them only after the beneficiary has spent thousands of dollars out-of-pocket. It was one of the most contentious elements of the 2003 legislation that created the drug benefit, which was championed by the Bush administration and congressional Republicans.

Shaw's district, which stretches from West Palm Beach to Fort Lauderdale, has one of the highest concentrations of Medicare recipients in the country. Tens of thousands of residents have signed up for the prescription drug program, known as Part D. Democrats have long hoped to tap into voter dissatisfaction with the program, thinking it could affect some congressional races.

"When folks show up at the pharmacy and get hit with paying 100 percent of their drug costs, while continuing to pay 100 percent of their premiums, they become concerned," said Klein, a state senator. He said his main objection to the program is that it does not allow the federal government to negotiate drug prices to bring down costs -- a suggestion that pharmaceutical and insurance companies successfully fought.

But as the election draws closer, polls suggest that the GOP-backed program may not win as many votes for Democrats as they had thought. A Washington Post poll in April found that, among seniors, 50 percent said they approved of the drug program and 41 percent disapproved. Most respondents at that time said it would make no difference to them whether a candidate for Congress had voted for or against the drug program.

"Seniors are saving on average $1,100 a year in Florida; monthly premiums are $24," said Ed Patru, a spokesman for the National Republican Congressional Committee. "At the beginning of the year, the Democrats were politically invested in the failure of the program. Now there is overwhelming approval."

In one of Shaw's campaign offices, a converted diner in Fort Lauderdale, the congressman said seniors are better off under the program . "It's like the big lie. If you tell it enough, people begin to believe it," Shaw said of the criticism. "They are trying to convince people it was a windfall for the drug companies. It's not."

Shaw credits the plan with creating the competition that led Wal-Mart and Target to decide to discount their generic prescription drugs.

Don Monroe, 79, who has volunteered for Shaw's campaign, is one of many seniors not affected by the doughnut hole because of limited need for prescription drugs. Monroe said he is eager to see Shaw win reelection and become chairman of the powerful House Ways and Means Committee.

Shaw, who has served in Congress since 1980, has sought to shift the focus of the campaign to other issues, including national security, terrorism, Social Security and the environment. Last week, he hosted Interior Secretary Dirk Kempthorne in Florida for a tour of the Everglades. Shaw "is one of the leaders on environmental issues," Kempthorne said in an interview.

Klein also is not focusing on Medicare; he has raised the subject in only one television ad. His main focus is trying to tap into anger at Bush and the Iraq war in a district that sided with Sen. John F. Kerry (Mass.), the Democratic presidential nominee, in 2004. Shaw, Klein keeps telling voters, votes with Bush 90 percent of the time.

"The overall focus by Ron Klein is to make Clay Shaw look like a pawn of the Republican leadership," said Amy Walter, senior editor of Cook Political Report. "If it is Clay Shaw versus Ron Klein, then I think Clay Shaw can win. If it is a referendum on Washington or President Bush, then the advantage goes to Klein."

Klein trails Shaw in campaign fundraising, $2.8 million to $3.4 million, according to an August campaign-finance disclosure.

Bush and Vice President Cheney have visited to help Shaw raise money, and former president Bill Clinton is due at a fundraiser for Klein this month. Walter has classified the race as a tossup -- some polls have shown Shaw in the lead, others Klein -- but said she had seen no indication that the drug program is driving voters.

Some local commentators disagreed. The Medicare drug benefit "is still going to be a very, very, very viable election issue," said Edith Gooden-Thompson, a coordinator of Serving Health Insurance Needs of Elders.

Sitting in the Aging and Disability Resource Center of Broward County, Gooden-Thompson was surrounded by others who worked with seniors and agreed with her assessment. Nancy Ackerman said she had seen people cutting back on food so they could buy prescriptions.

Even so, though, it could be a tossup: "Clay Shaw has been very supportive to senior issues in all the years we have known him," said Edith Lederberg, the center's director, but she added that Klein had, too. "He has been a state senator for many years and is very popular. That is why it is going to be such a tough choice for people to make."

Perhaps playing in Klein's benefit: More seniors are finding themselves in the doughnut hole as the election approaches. The Institute for America's Future, a group calling for the closure of the gap, calculated that, on average, seniors who enrolled in the benefit at the beginning of the year would have fallen into the doughnut hole on Sept. 22.

On that morning, Klein was talking about the doughnut hole with seniors at a doughnut shop, Dandee Donut Factory in Pompano Beach. Jane Shaffer said she has been in the doughnut hole since March, and she and her husband Robert -- a registered Republican -- say they will back Klein.

For the first time, the Voters Coalition, which encourages voter participation, will not endorse Shaw, said Harold Ostrow, 78, former chairman of the group. "It's easy to get into the doughnut hole, but very hard to get out," Ostrow said.

The question is whether there are enough people like Ostrow, Priscak and the Shaffers to swing the vote -- and whether other issues will erode Shaw's longtime base.

Klein is hoping that by closely linking Shaw to Bush, he can overcome the incumbent late in the campaign. Shaw said that Klein's tack is misguided. "He is running against the president and not Clay Shaw," Shaw said. "I represent the 22nd Congressional District of Florida and not the Republican Party."

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