Now, where's the 'compassion'?

The Bush administration has quietly told Congress that it should not provide Medicare drug benefits to six million poor elderly and disabled people because they are already eligible for similar help through state Medicaid programs.

Administration officials said they were siding with the Senate, against the House and all 50 governors on one of the most divisive issues in the Medicare legislation. A major issue of principle and large amounts of money are at stake. The principle, rooted in the history of Medicare, is that all benefits are generally available to all beneficiaries, regardless of their income.

Under the House version of the legislation, the new drug benefit would be available to all 40 million Medicare beneficiaries, including 6.2 million who are also eligible for Medicaid, the insurance program for low-income people. By contrast, the Senate bill denies Medicare drug benefits to people eligible for both programs. They would have to rely on Medicaid for assistance with their drug costs.

Although states are not required to provide drug benefits under Medicaid, all have chosen to do so. Medicaid has historically provided extensive drug benefits, but they vary widely from state to state, and in recent years states have reduced the coverage in an effort to hold down soaring costs.