Is Medicare coverage gap a big issue?

WASHINGTON -- Democratic congressional challenger Ron Klein recently stopped by a Florida doughnut shop to tell seniors that Medicare's prescription drug benefit guarantees larger profits for pharmaceutical companies, but makes subscribers pay thousands of dollars in out-of-pocket expenses. Klein was referring to the ``doughnut hole," a gap in the Medicare plan's coverage that will affect millions of beneficiaries.

In a year in which Democrats could regain the majority in the US House of Representatives , the state senator's race against veteran Congressman E. Clay Shaw Jr. in Florida's 22 d Congressional District has been closely watched. It's attracting an added layer of attention by focusing on the Medicare coverage gap. One quarter of the district's voters are senior citizens.

The Medicare drug plan, called Part D, took effect in January. It provides drug coverage for more than 38 million seniors and people with disabilities, according to the government. Depending on the source, 3 million to 7 million of them will topple into the doughnut hole by the end of the year.

Beneficiaries initially pay low premiums and nominal out-of-pocket expenses. But after they use $2,250 of their drug benefit, they pay the full cost of any drugs until spending reaches $5,100, and they qualify for catastrophic coverage.

Brian Smoot , Klein's campaign manager, said the doughnut hole ranks among the top three issues for Klein in the sprint to next month's midterm elections. Part D's problems can be fixed to benefit seniors, according to Klein. For instance, he favors allowing the government to negotiate with drug companies to lower prices.

Shaw counters that most seniors signed up won't spend enough on medicines to enter the coverage gap.

Some polls, like one released this week by AARP , suggest such healthcare matters as insurance coverage and rising drug prices are pressing issues for older Americans. An independent nonprofit, however, said health policy is ``overrated" as a midterm voting issue.

``There is, in general, a big disconnect on health," said Drew Altman , president of the Henry J. Kaiser Family Foundation , which has conducted 15 tracking polls. ``People care about [healthcare] deeply. It's actually their number one personal and family economic worry. But, it's not their number one voting issue."

Democrats remain confident that doughnut hole angst can mobilize voters.

``I think it's a guaranteed win for Democrats," said Representative Pete Stark , Democrat of California , and the senior Democrat on the House Ways and Means health subcommittee . ``We Democrats had some defectors among the seniors in the last election."

Senator Frank Lautenberg , Democrat of New Jersey , blamed ``President Bush and the Republican-controlled Congress" for not passing legislation that would have spared seniors from having to deal with a gap in drug coverage.

``It's a Republican issue in the sense that they're the ones that drafted the prescription drug law," said Lautenberg's spokesman, Alex Formuzis . ``They're the ones that wrote the law that created this coverage gap, this huge gap that millions of people could fall into and will fall into -- and they're beginning to now."

Republicans say most seniors are happy with the benefit because they are spending less on prescription drugs.

``The scare tactics that are going on now are not going to be fruitful," said Senator Charles E. Grassley , Republican of Iowa and author of the Part D legislation on the Senate side.

Republicans place the number of seniors vulnerable to the coverage gap at 3 million , while Democrats say it's 7 million.

Senator Edward M. Kennedy, Democrat of Massachusetts, co sponsored a bill designed to objectively determine how many people will be affected.

If the bill becomes law, they'll be counting people like Duxbury resident Susan Trayser's 90-year-old mother .

Mary Elizabeth ``Betty" Bradley's drug spending recently exceeded the $2,250 coverage threshold. In anticipation, Trayser switched her mother to a plan with a premium that costs $5,000 less than her previous policy. Bradley is using $3,600 of the savings to cover her drug expenses.

The reality didn't settle in, however, until Bradley picked up an Advair prescription to treat her severe asthma. She had to pay full price.

``She didn't understand it," said Trayser, 65 . ``I explained it to her 10 times. I could have explained it to her a thousand times. I just said, `Mother, pay the bill, you're in the doughnut hole.' She was so distraught."

But Trayser's experience with the coverage gap is not likely to affect how she votes next month. A friend helped her find a plan for next year that has a higher premium, but also provides doughnut hole coverage. She's signing her mother up, too.

Diedtra Henderson can be reached at dhenderson@globe.com.