WASHINGTON (AP) -- As the White House and Congress debate who should be eligible for a new Medicare prescription drug benefit, researchers are bolstering the Republican argument that aid should go to the neediest senior citizens.
''There is a core group of elderly -- those who are poor and those who have chronic illness -- who have the greatest need for a drug benefit,'' said John K. Inglehart, founding editor of the policy journal Health Affairs, which published three new studies of retirees' prescription costs and usage in an issue released Monday.
''Together, the studies indicate that, given the Medicare program's limited financial resources, government assistance should be targeted to those beneficiaries most in need,'' he said.
The findings come as Congress and the Clinton administration wrestle over how best to help elderly and disabled Americans, who get health insurance under Medicare, pay for drugs. Medicare provides no reimbursement for most prescriptions.
At the heart of the debate are questions about who should get expensive new government drug benefits -- all Medicare beneficiaries or just those in greatest need.
President Clinton has proposed offering an optional, limited drug benefit to all 39 million Medicare beneficiaries. Republican congressional leaders say it should be targeted more narrowly.
Responding to the new findings, the Clinton administration released a statement from Medicare administrator Nancy-Ann DeParle noting that many middle-class retirees struggle to pay for prescriptions. ''We must not limit a benefit to those with low incomes,'' she said.
One of the studies confirmed past estimates that at least two-thirds of Medicare beneficiaries already have some type of drug coverage -- generally from private sources such as corporate retirement benefits, HMOs and Medigap insurance, or from state health programs for the poor.
The study also found that a smaller share of retirees with incomes below or near poverty level have drug coverage -- 65 percent compared with 69 percent overall.
Researchers John A. Poisal and George S. Chulis, who work at the federal agency that runs Medicare, based their findings on a 1996 government survey of beneficiaries.
The percentage of Medicare recipients who said they were in fair or poor health was roughly the same -- about a quarter -- regardless of their drug coverage, suggesting similar medical needs.
But the 11.6 million recipients without drug coverage used five fewer prescriptions on average in 1996 and still spent 83 percent more of their own money on drugs -- an average $463 compared with $253 for those insured, the researchers found.
These disparities were greatest among two subgroups: those near poverty, and disabled Americans under age 65 covered by Medicare.
''Policy-makers should keep this in mind as they plan how to structure and pay for any Medicare drug benefit,'' Poisal said.
A second study suggested that senior citizens with chronic illnesses would continue to face high out-of-pocket costs under a widely available but limited Medicare benefit like the one President Clinton has proposed.
The study, financed by the Henry J. Kaiser Family Foundation and conducted by private researchers, looked at 1998 claims by 375,000 Americans age 65 and older who have drug coverage as part of a corporate retirement plan.
It found that 18 percent purchased no drugs at all in 1998. But among those who bought drugs used to treat chronic diseases -- including diabetes, high blood pressure, depression and osteoporosis -- more than one in four spent at least $2,500, with the top 1 percent spending as much as $10,000.
Clinton's plan would initially cap Medicare drug reimbursements at $1,000 annually.
The third study looked at possible consequences for people with chronic illness. It found that elderly patients with high blood pressure are less likely to buy medication for the condition if they lack insurance coverage. Those who did buy it paid 36 cents more per pill and purchased an average of 37 fewer tablets a year than their insured counterparts.
Those findings by Jan Blustein, an assistant health policy professor at New York University, were based on data from a 1995 Medicare beneficiary survey.
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