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Doughnut holes may be delicious, but the one the government cooked up is tough for seniors to swallow.

And that's why some of them are worried about Republican promises to repeal the Obama health care reform law.

The Medicare prescription drug "doughnut hole," which hits many seniors with hundreds of dollars in extra costs per year for their medications, is in the process of being repealed, thanks to "Obamacare."

But if Congress kills the Obama health law, many seniors would see their prescription expenses increase immediately.

That fact deeply worries some Western New York seniors - and it has left both candidates in the heated race in New York's 27th Congressional District insisting that no matter what, the doughnut hole must die.

"I hope to God you never fall into that doughnut hole, because it's a very scary place to be," said Rep. Kathleen C. Hochul, D-Hamburg.

Hochul's Republican opponent, former Erie County Executive Chris Collins, said in an interview that while he strongly favors the repeal of Obamacare and its individual mandate and its new taxes, he favors subsequent legislation that would again close the doughnut hole.

Lamenting that the doughnut hole "shows the dysfunction of Washington," Collins added: "Absolutely, this has to be addressed once we repeal Obamacare."

At issue is a provision in the 2003 law that created the Medicare prescription drug benefit.

To save money, the Republican Congress at the time constructed the drug benefit in a way that cost seniors more if they had lots of prescriptions to fill.

Seniors whose annual drug costs surpassed $2,830 found themselves paying the rest of their bills in total until they hit an out-of-pocket limit of $4,550. At that point "catastrophic coverage" kicks in, and the government pays 95 percent of the costs.

Designed in part to put the brakes on escalating prescription drug costs, the doughnut hole has long been the most hated feature of the otherwise-successful Medicare drug program.

That being the case, closing the doughnut hole became a priority for the Democrats who drew up the Obama health law. They devised a system that eliminates the doughnut hole over 10 years.

Already, seniors who fell into the doughnut hole have received a $250 tax-free rebate. Meanwhile, federal subsidies are slowly closing the doughnut hole, meaning a patient's share of drug costs will fall from 100 percent in 2010 to 25 percent a decade later.

The Obama health bill also gives seniors in the doughnut hole a 50 percent discount on some brand-name drugs.

All of that would go away, though, if the Obama health law is repealed and Congress does nothing to replace it.

And that would be bad news for June Grier, 75, of Williamsville.

At an event Hochul sponsored Tuesday at People Inc.'s Oak Senior Housing in Clarence, Grier shared her story.

She suffers from a form of fibrosis in her abdomen and has to have surgery every three months to stay alive, she said. She takes prescriptions for that, as well as for asthma and urinary tract problems.

Because of the doughnut hole, her coverage changed from a co-pay of $4 for one medication to a co-pay of $127. Her payments have increased for multiple medications.

Her doctor gave her three months of sample prescriptions to save money, but when those samples run out, she will have to pay.

She said she does not like either presidential candidate, but she will vote for Obama because her main concern is the cost of her health care.

"I have to look out for myself and my medical issues first," Grier said. "I need this coverage to be covered. I need the doughnut hole to be closed, and there's a lot of people who need that to be closed."

That's especially true in the Buffalo metropolitan area, where 15.7 percent of the population is 65 or older, compared with 13.5 percent statewide.

Democrats are proposing to close the doughnut hole the easy way: by simply letting the Obama health law take effect.

"It's not happening overnight, but it's certainly a step in the right direction," Hochul said.

Meanwhile, it's hard to say exactly what Republicans would do with the doughnut hole if they are able to repeal Obamacare.

GOP presidential nominee Mitt Romney has said he would like to restore some parts of the health law, such as the provision barring insurers from blacklisting people with pre-existing medical conditions.

But his campaign website makes no mention of the doughnut hole, either in the section on Medicare or in the section on health care reform.

Collins, for one, said Romney should offer a more specific health care reform plan to replace Obamacare - including a section that would end the doughnut hole.

"I believe that we'll be hearing a lot more from Mitt Romney on specifics; I do expect that," said Collins, adding that Congress was "wrong-headed" to create the doughnut hole in the first place.

For her part, Hochul is suspicious of any Republican promises to resurrect parts of the health law they have been trying so hard to repeal.



"The House took 33 votes, at least, to repeal the health care bill," she said. "Not one of them ever replaced any benefit. It was all repeal, all repeal."

While calling for a permanent end of the doughnut hole, Collins also downplayed the issue, saying he was more concerned about the cuts to the Medicare Advantage program that are included in the Obama health law.

That law includes about $716 billion in cuts in future subsidies to Medicare providers, with Medicare Advantage providers taking a big hit. Collins said that's especially important in Western New York, where more than half the seniors belong to Medicare Advantage plans.

Those plans typically include generous prescription drug benefits, so cuts to those plans would be sure to affect seniors, said Collins, who repeated his contention that the Obama health plan "ends Medicare Advantage as we know it."

However, Buffalo-area Medicare Advantage providers have said they will continue offering those plans, despite Collins' contentions, prompting Hochul to say: "Just saying it doesn't make it so."

She noted that the Obama health law includes a provision for preventative care, such as cancer screenings and flu shots, that also would go away if the bill is repealed.

While including such popular provisions, any replacement for Obamacare also must include medical malpractice reform, Collins said.

He said that would be one way to pay for the significant cost of filling the doughnut hole, which now exceeds $4 billion annually. He also suggested going after "the age-old waste, fraud and abuse" to pay for the cost of replacement health legislation.

Some at Hochul's event Tuesday turned a harsh eye on Washington.

Susan Anastasia, 75, lamented Congress' inability to compromise on such issues. "These members are smart. They're supposed to come up with solutions," she said.

And Joy Kincses, 69, questioned Hochul about the health insurance members of Congress receive.

It's not fair, Kincses said, that benefits are ripped from the poorest Americans, yet taxpayers foot the bill for health care for members of Congress.

Too many members of Congress don't understand the tough choices that many people must make regarding health care, she said.





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