This week the American people got a glimpse of where their senators stand on the Part D drug benefit. The picture is a little muddled, but there are glimmers of hope in the vote tallies.

An amendment by Senator Bill Nelson, Democrat of Florida, to the 2006 budget resolution that would extend the enrollment period for Part D beyond May 15, fell two votes shy of a majority. Senator Nelson’s amendment would waive late enrollment penalties for 2006 and allow people with Medicare an extra chance to switch plans.

The Senate did approve by a 76 to 22 vote an amendment offered by Senator Chuck Grassley, Republican of Iowa and chair of the Finance Committee, which would allow, but not require, the Bush Administration to extend the enrollment period, waive penalties and allow an additional plan change. That same day, President Bush called the May 15 cutoff date a good deadline and said he would not roll it back.

Senator Grassley explained that people with Medicare may need pressure to enroll by May 15. People with Medicare already get plenty of pressure from Part D plan salespeople. The hard sell will only get harder as the deadline nears.

People with Medicare do not need more pressure. They need an honest accounting of how Part D is working, and how it is failing. Part D’s backers blame critics for discouraging enrollment, but ignore what is driving people with Medicare away from the benefit: restricted drug coverage, high co-payments and drug prices, gaps in the benefit, misleading marketing, false information from Medicare and Part D plans, and bad customer service.

Those problems are the fault of the Congress and administration that brought us Part D; older Americans and those with disabilities should not have to pay for them through a late enrollment penalty.

On a more positive note, 54 senators voted to give Medicare the right to negotiate drug prices under Part D. Like all the Medicare votes this week, this vote was largely symbolic, but it sets the stage for a later vote on a bill co-sponsored by Senator Olympia Snowe, Republican of Maine, and Senator Ron Wyden, Democrat of Oregon, allowing passage by a simple majority of senators.

Although the Snowe-Wyden bill would lift a prohibition on direct price negotiations by Medicare, a scandalous provision included at the request of drug manufacturers, it is unclear how the negotiations would work in practice since competing insurance companies, and not Medicare itself, would still deliver the drug benefit.

Even more unclear is how an administration that often appears to be captive to the drug industry would exercise statutory authority to drive pharmaceutical prices lower.

Unfortunately, only 39 senators, 12 short of a majority, voted for an amendment that would provide drug coverage directly through Medicare.

If senators really want the buying power of 43 million people with Medicare to be used to negotiate lower drug prices, a drug benefit provided directly through Medicare is the way to do it.

If senators are worried about their constituents getting hit with a late enrollment penalty, and want to eliminate the confusion and frustration with Part D that is suppressing enrollment, a Medicare drug benefit is the way to do it.

It has taken older Americans and people with disabilities a few months to figure out that Part D does not provide the health security they have come to expect from Medicare. Senators need a little more time.

Medical Record

The Senate approves the Snowe-Wyden Amendment to authorize the Secretary of Health and Human Services to negotiate the best possible prices for prescription drugs provided through Part D, by a vote of 54 to 44 

The Senate rejects the Nelson Amendment to extend the enrollment period of Part D plans 

The Senate approves the Grassley Amendment to give the Secretary of Health and Human Services the power to extend the enrollment period of Part D plans