Martha Beery takes 25 pills every day. The 87-year-old woman, who broke her back in 1999, has osteoporosis and emphysema. She spends her days at her daughter’s house breathing with the aid of an oxygen tank.

Beery is one of millions of Medicare recipients who get no reimbursement for prescription drugs.

“I don’t have any help from anybody,” she said. “I don’t know how people do it.”

Her predicament — and the thought of older people doing without medicine — is the crux of a national debate over whether Medicare should be overhauled or given a quick fix proposed by President Bush.

On Jan. 1, Beery and 70,000 other elderly or disabled Ohioans were affected by health-maintenance organizations either dropping out of the Medicare program or reducing their service areas. The insurance companies that run HMOs blame the pullback on inadequate federal reimbursement, competition, a lack of enrollees and the inability to maintain a network of doctors.

Beery paid an average of $226 a month for prescriptions, with an Aetna U.S. Healthcare HMO providing some drug coverage. Now that the HMO has withdrawn from the Medicare program in Ohio, Beery’s out-of-pocket prescription bill is about $700 a month.

Her daughter, Barbara Dudrow, has spent a lot of time trying to find a better plan.

“It has been a problem,” said Dudrow, a retired schoolteacher who has been battling cancer. “But who I really feel sorry for are the people who don’t have the help, don’t know where to go to get coverage.”

Bush released a budget proposal Feb. 28 that includes money to start immediately helping some seniors pay for prescription drugs without a prescription.

The coverage is limited to people 65 and older who have incomes below $11,600. For elderly who live off less than $15,000, the government would pay a portion of the drug coverage fees. Some seniors who spend more than $6,000 a year on medicines would also get their premiums covered — regardless of their incomes.

Bush’s plan would not help Beery because Social Security, earnings from a rental property, plus interest and dividends put her annual income at about $22,000.