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Democrats Face Hurdles in Bid to Close Medicare Gap

Back in 2003, proponents, mainly Republicans, saw the unusual setup as a way to provide some help to all beneficiaries, and substantial help to those with catastrophic drug costs, and yet not break the bank with the new benefit. Lately, GOP lawmakers have contended that the doughnut hole is not a problem because it does not apply to low-income beneficiaries, and because other seniors can choose more expensive drug plans that offer coverage without the gap.

Filling the hole soon is unlikely, many analysts say. The White House's opposition means that drug-price negotiations are not likely to be enacted even if the idea manages to win approval in the Senate, where the going is likely to be tougher than in the House, they say.

Even if it were to pass and escape a presidential veto, the House bill would not authorize the health and human services secretary to limit Medicare coverage to a list of approved drugs -- called a formulary -- a tool that some experts say would be necessary to win major price concessions. The legislation would also not explicitly require that any savings be applied to filling the doughnut hole.

"There is virtually no chance that we are going to see any change to the doughnut hole in the foreseeable future," said Robert Laszewski, a nonpartisan health policy consultant in Washington. "The doughnut hole is sort of institutionalized now. . . . It's there for a reason. It's there because that's the kind of plan design the Congress could afford. And just because you change the Congress doesn't mean the affordability changes."

John Rother, policy director for AARP, the powerful seniors' lobby, agreed that substantial changes to the doughnut hole are unlikely this year. But he does not think that Democrats would pay a political price for that.

"It's not an overriding, intense concern for most seniors," Rother said. "What we get a lot from our members is concern about overall drug costs, not just the doughnut hole."

House Energy and Commerce Committee Chairman John D. Dingell (D-Mich.) said requiring government negotiations is just the "first step."

"I plan to hold hearings early in the new Congress to identify additional changes needed to improve the Medicare drug program, and reviewing the donut hole will be part of that process," he said in a statement.

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