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The Medicare Doughnut Hole

Patricia MacIntyre: My husband takes diabetic medication - and then he takes his Zocor for cholesterol, Formex for prostate, Chorzar for high blood pressure, Torsamide is a water pill and potassium chloride. And I take five.

Patricia MacIntyre of Elyria is a retired cook. Her husband is a retired railroad worker. Both signed up for the Medicare prescription drug benefit earlier this year to help cut the cost of their many medications. MacIntyre hasn't calculated the cost reductions, but she admits the plan has saved them money. But now those savings are about to evaporate.

Patricia MacIntyre: And now I'm ready to move into the second part - the doughnut hole.

MacIntyre and her husband have each spent more than the $2,250 Medicare coverage limit. So now most of the cost of their prescriptions will come out of their own pockets until they've each spent another $3,600, when Medicare kicks in again. This $3,600 gap in coverage is what's known as the Medicare doughnut hole.

Patricia MacIntyre: That $7,200 is going to be a killer. We're on a pension, we make a good pension with the railroad. But we have bills and we have to pay those bills, plus the high cost of utilities and now this. And this is a killer. We need help.

MacIntyre is luckier than some - her insurance plan will still cover 20% of the price of her drugs. But many who signed up for Medicare coverage will hit the doughnut hole with no help at all from their insurance providers. That's why MacIntyre and others have come here to this apartment building for seniors in downtown Cleveland. They want to hear what kind of solutions one Ohio politician is proposing.

Sherrod Brown: Thank you for joining us this morning on this very, very hot day.

Democratic Congressman Sherrod Brown of Avon is challenging Republican Senator Mike DeWine for his seat this November. Brown has been a strong advocate for extending senior Medicare benefits, but he voted against the drug benefit in the House. He believes it was designed to benefit drug companies more than seniors. Now he wants to fix what he considers the program's flaws.

Sherrod Brown: First, allow seniors to go directly to Medicare for their benefit. Second thing we should do is to negotiate drug prices, have the government sit down with the industry, the drug companies, and negotiate prices on behalf of 40 million Medicare beneficiaries.

Brown says the Veteran's Administration already negotiates prices. But during the drug benefit debate Republicans refused that approach, calling it government price-setting. Brown's opponent Mike DeWine voted for the Medicare plan because, flawed or not, he says it does provide seniors with help paying for their prescriptions.

Not everyone will reach the coverage limit. But the Kaiser Foundation estimates that as many as seven million Americans could fall into the gap this year. Joe White, director of the Center for Policy Studies at Case Western Reserve University, says for that reason alone, the issue could become a political football in this fall's election.

Joe White: We know that there will be a substantial number of people who will fall into the doughnut hole and when they get into the doughnut hole they're going to be very upset. And so I would expect it to be a significant issue.

But White doesn't believe that solutions being proposed by Democrats like Brown will be taken up by Congress anytime soon.

Joe White: They have zero possibility of succeeding before 2009, since clearly President Bush would veto anything of the sort and the Republicans are going to have enough votes to uphold the veto.

In the meantime, seniors facing the donut hole will have a chance to find better coverage when the Medicare drug plan re-enrollment period opens this November. Karen Schaefer, 90.3.