Posted: Dec. 4, 2003


By Celia Cohen

Grapevine Political Writer

No one pounded on U.S. Rep. Michael N. Castle's car, much to the nervous Republican congressman's relief.

Castle was taking a two-day tour through Delaware, holding town meetings Wednesday and Thursday at senior centers in Georgetown, Dover, Hockessin and Newark to talk about the new prescription drug benefit being added to Medicare -- the most sweeping change in the 38-year history of the federal health program for Americans who are 65 and older.

Like other members of Congress, Castle knew all too well one of the most famous horror stories told on Capitol Hill, even though it happened before he got there in 1993 after two terms as governor.

It was the last time that the federal government decided to amend Medicare. The plan was to add catastrophic health coverage and a surtax to pay for it, 1988 legislation that came to be judged as so costly and unnecessary that recipients attacked the car of U.S. Rep. Dan Rostenkowski, an Illinois Democrat who was a key architect of the bill. After that, the Congress could not repeal the measure fast enough.

As the vote on this new Medicare change approached last month, some Democrats actually resurrected the ugly scene involving Rostenkowski by showing "a 14-year-old videotape of enraged senior citizens in flowered shirts pounding on the car of one of the nation's most powerful lawmakers," according to Reuters news.

Castle, who will be eligible for Medicare himself next year, voted for the new prescription drug benefit. So did U.S. Sen. Thomas R. Carper, who is 56 years old. U.S. Sen. Joseph R. Biden Jr., who had his 61st birthday last month, voted against it.

Biden called the measure "the first steps toward the breakup of the traditional Medicare program" and criticized the Bush administration for "misplaced priorities [that] put enormous tax cuts first and left us little room to provide the comprehensive and fair drug benefit that seniors deserve."

Among the state's three-member congressional delegation, it is Castle who is most likely to experience the immediate political fallout, good or bad, of this history-making benefit that has been decades in coming. Not only is Castle the only one up for re-election next year, but he is the sole Republican, and the new program was passed by a Republican-led Congress and is scheduled to be signed into law Monday by a Republican president.

At Castle's first stop at the CHEER Community Center in Georgetown, he arrived a half-hour early for his session at 9 a.m., and the parking lot already was full. Visions of Rostenkowski danced in his head.

"I almost said, I'm not going in," Castle said.

False alarm. The members of the senior center were there mostly for a different program. Castle drew a crowd of about 30 people. His audience in Dover at the Modern Maturity Center was about half that size, and at the Newark Senior Center it was about 50 people. The largest turnout was as many as 100 residents of Cokesbury Village in Hockessin, according to estimates by Castle's staff and news reporters.

On this first swing, Castle reached only a tiny fraction of the 119,000 or so Delawareans on Medicare.

The groups did not seem hostile, but rather interested, curious, perplexed, somewhat frustrated and maybe a little worried about what these complex and largely uncomprehended changes will mean for their peace of mind and their pocketbooks.

"Senior citizens do not want choice. They want certainty," said Irving Levitt at the Dover meeting.

"The thing that scares me is the cost of this plan. I think we're putting it on our grandchildren, and they can't vote," said Adele Salvucci in Newark.

Castle seemed to feel the same way his listeners did. "Is it a perfect bill? No. Is it the best you can do? Arguably," he said. "Could it have been simpler? I don't know. If we work at it, we can make it understandable."

The program, which is expected to cost $400 billion for the first 10 years and more after that, was passed in response to rising drug costs, especially for approximately 38 percent of Medicare beneficiaries who lack any prescription drug coverage.

Castle distributed 17 charts to try to explain the benefit, 13 charts in one handout and four in another as he described the way it would work.

He made the point repeatedly that the new program is voluntary. It means that people can stay in existing drug-benefit plans, such as those provided by the state and federal governments, unions and corporations, while keeping their current Medicare benefits. They also will be able to move in and out of the program, as their circumstances change, although with certain restrictions yet to be determined. 

Castle acknowledged the enormous cost -- so "highly concerning," as he called it, that it emerged in the town meetings as the single greatest doubt he had to overcome before deciding to vote for the bill.

Of course, no one knows for sure what the effects of the new benefit will be. The program is to be phased in. It will begin in Spring 2004 with a discount card expected to provide savings of 10 percent to 25 percent on prescriptions, more for people with low incomes.

The program will go into full effect in January 2006. Recipients will pay a $35 monthly premium and a $250 annual deductible. Then Medicare will pay 75 percent of drug costs up to $2,250. Then there will be a gap -- commonly called a "doughnut hole" -- in which recipients are responsible for all of the costs until they have paid approximately $5,000 out of pocket, at which point Medicare will pick up 95 percent of their bills. Low-income people are treated more generously.

It is the "doughnut hole" that seems to cause the most anxiety, even though it is estimated that 80 percent of Medicare recipients have drug costs under $2,250, when the gap in coverage begins.

"Who is going to determine when the doughnut hole appears?" asked Gertrude Johnson at Newark. "I don't understand it, and I don't know how anybody of normal intelligence can understand it."

What is particularly unsettling is that retirees are notoriously suspicious of differential coverage, as in the case of the "notch babies." These are Social Security recipients who were born between 1917 and 1921 and get smaller checks than their older brothers and sisters. The "notch" opened up because of a glitch that inadvertently gave the older recipients extra benefits and was corrected by phasing in a new benefit formula for the "notch babies."

It remains to be seen whether there will be "doughnut holers" as dissatisfied as "notch babies."

Castle acknowledged the concerns about the "doughnut hole," but he explained that filling it would cost another $400 billion, the entire price of the legislation.

In a personal conclusion, Castle predicted that over time individuals would benefit from the new program, not be hurt by it, especially as health care increases both in quality and cost.

"When you and I are celebrating our 100th birthdays, we'll be grateful for all this," Castle said.