By Jeffrey Young

Democrats are charging that the Bush administration is using the annual handbook for Medicare beneficiaries to mislead seniors about the new prescription-drug benefit.

A draft version of "Medicare & You," slated to be distributed to every Medicare recipient later this year, contains no mention of the so-called "doughnut hole" in prescription-drug coverage that critics cite as the chief flaw of the benefit, which takes effect Jan. 1, 2006.

Patrick g. Ryan

House Ways and Means Committee ranking member Charlie Rangel (D-N.Y.)

On Tuesday, five senior House Democrats issued a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Mark McClellan saying the handbook is "rife with omissions and inaccuracies and could exacerbate, not mitigate, beneficiary confusion."

House Ways and Means Committee ranking member Charlie Rangel (D-N.Y.), Ways and Means Health Subcommittee ranking member Pete Stark (D-Calif.), Energy and Commerce Committee ranking member John Dingell (D-Mich.), Energy and Commerce Health Subcommittee ranking member Sherrod Brown (D-Ohio) and Government Reform Committee ranking member Henry Waxman (D-Calif.) signed the letter.

A CMS spokesman insisted that the April 19 draft is not the most recent and that the handbook is undergoing continual change as the agency prepares for its traditional September mass mailing.

The administration has sought the input of many interested groups on the content of the handbook, the spokesman said, citing senior-citizen organizations as examples.

Among the groups that reviewed the draft were the Medicare Rights Center (MRC) and the Center for Medicare Advocacy (CMA). Representatives of each organization concurred with the objections raised in the Democratic letter.

The groups met with CMS officials April 19 as participants in the agency's National Medicare Education Partnership. MRC founder and special counsel Diane Archer said that CMS Deputy Administrator Leslie Norwalk has acknowledged their criticisms.

But the CMA's Vicki Gottlich suggested that CMS's interest in their comments was cursory. "Despite the massive changes in the handbook, we were given a very brief period of time to review the document," Gottlich wrote in an e-mail. She added that the time overlapped with Passover, which further restricted the availability of some reviewers.

A House Democratic aide questioned why any outside organization should get an earlier look than Congress. It is unclear if the Bush administration gave the draft handbook to congressional Republicans. Calls to key Republican lawmakers were not returned by press time.

In recent years, CMS has not shared drafts of "Medicare & You" with Congress, despite a tradition of having done so in the past, according to the aide. The handbook has generated controversy repeatedly, dating to the Clinton administration, the staffer added.

Now that a draft of the handbook has been leaked, the CMS spokesman said, the administration will consider congressional concerns. "We welcome constructive criticism," he said.

"The handbook does not even mention [the] likelihood" that many seniors will experience a lapse in coverage inside the drug coverage "doughnut hole," the Democratic letter states.

Under the privately administered drug plans, beneficiaries pay a monthly premium of about $30 and must meet a $250 deductible to receive 75 percent coverage for costs up to $2,250. Beneficiaries must then pay all drug costs up to $5,100, however, before they qualify for catastrophic coverage that covers 95 percent of all remaining costs.

The Medicare handbook reads, "After you meet the deductible, you pay part of the cost of covered prescription drugs and the plan pays part."

"As members of Congress who will undoubtedly hear from angry beneficiaries whose spending falls into the gap, we urge you to be clear about this possibility," the Democrats commented.

The controversy over the handbook — which House Democrats obtained Monday from an outside source — is only the most recent disagreement regarding the new drug benefit. Since passage of the Medicare bill in 2003, the administration has taken fire from Democrats over the promotional efforts for the drug benefit and other aspects of the law, such as the expanded participation of private health plans in Medicare.

The charges over the handbook are reminiscent of the reaction prompted by an early advertising campaign conducted by the administration using the tagline "Same Medicare, Better Benefits," which Democrats took issue with. Democrats also complained that the firm that produced the spots had ties to President Bush's reelection campaign.

More heated still was the backlash to "video news releases" (VNRs) made by the administration that resemble local television news segments that were broadcast unedited in some instances. The administration has defended the VNRs despite a rebuke from the Government Accountability Office.

The stakes for the Medicare handbook are higher, one House Democratic aide insisted. "Medicare & You" is the primary means through which CMS communicates to beneficiaries, who use the handbook as a guide to their benefits for an entire year, the aide remarked.

The 2006 edition of the handbook is even more important than usual, the Democratic letter indicates. Because the Medicare drug benefit is entirely new, the possibility of confusion is more pronounced.

The letter also notes that beneficiaries will be committed to whatever drug plan or comprehensive health plan they choose. Buyer's remorse could be chronic if beneficiaries are not clear on their choices. "Having accurate and balanced information is essential to ensure an informed decision," the Democrats state.

Moreover, the Democrats accuse the administration of favoring comprehensive private health plans under Medicare, called Medicare Advantage, to the traditional program.

Unlike in previous handbooks, the traditional "fee for service" Medicare program is described alongside the Medicare Advantage options rather than in separate sections.

Combining those sections of the handbook is "misleading at best, and potentially very confusing," the Democratic letter states.

The Democrats are concerned that references to private fee-for-service plans, which participate with health-maintenance organizations and preferred-provider organizations in Medicare Advantage, will be mistaken for traditional Medicare, an aide said.