It looks as if Medicare is about to get a long-needed overhaul.

In a sign of the continuing clout of America's elderly when there's an election on the horizon, the Senate Monday is poised to take up the largest expansion of social services in three generations: prescription-drug coverage for Medicare. The House will follow suit with a similar measure. And the president has indicated he'll support a compromise.

If it passes, as expected, America's seniors will get partial relief from the steep cost of prescription drugs. Those with catastrophically high bills will get the most help.

The legislation breaks a five-year logjam over how to help elderly citizens pay for pharmaceutical drugs. They're already the only group in the United States to enjoy universal healthcare coverage.

The issue has gained political salience over the past decade as the use of pharmaceutical drugs, and their cost, have skyrocketed. Drug prices, in fact, have increased even faster than the double-digit rises in overall healthcare.

For the past five years, incumbents from both parties have promised to help elderly citizens pay for the pharmaceuticals they've become increasingly reliant upon. But deep partisan differences over how to provide the coverage, and its extent, had always tripped up legislation.

Conservatives, including President Bush, had insisted on a limited benefit that increased in generosity only if seniors agreed to leave traditional Medicare for a private plan. Liberals wanted a more generous benefit for everyone, whether or not they chose to stay in the traditional fee-for-service system that allows them to go to the doctor of their choice.

In the end, moderates forged a compromise that satisfies neither the conservatives nor the liberals, but does provide a legislative accomplishment for incumbents to take back to their constituents.

"If you're an incumbent, you don't want to say you stood in front of seniors getting any benefit at all for the promise that maybe somewhere down the line the Democrats would have a better bill," says Robert Blendon of Harvard's Kennedy School of Government in Cambridge, Mass.

The compromise would give seniors partial drug coverage in exchange for a monthly premium of $35. The House and Senate versions differ on the amount of the yearly deductible and when different levels of coverage would kick in. The House also proposes that people with higher incomes pay more out of pocket before they get full catastrophic coverage.

Some analysts are skeptical that the legislative houses can work out their differences. But others are more optimistic. "This is one of those benefits that will be universally used, so it has very broad appeal, even though the coverage is mediocre," says Mark Schlesinger of the Yale School of Public Health in New Haven, Conn.

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