AUSTIN - The U.S. Supreme Court has refused to block a feature of the Medicare prescription drug law that Texas denounces as an unconstitutional "direct tax" on states.

Justices declined without comment Monday to temporarily stop part of the 2003 law that added a prescription drug benefit to Medicare, the federal health insurance program for the elderly and disabled.

Texas and several other states disputed a requirement that they pay the federal government for drugs that until this year their Medicaid programs bought for the poorest of elderly and disabled people. Those patients were automatically enrolled in Medicare's private health plans on Jan. 1.

On Monday, spokesmen for the governor and Attorney General Greg Abbott said the state is weighing its options, which include filing a second lawsuit in federal district court. The initial lawsuit was filed directly in the Supreme Court.

"We are very concerned about the long-term impact," Perry spokeswoman Rachael Novier said, noting that the state has already paid $66 million this year under an order from Health and Human Services Commissioner Albert Hawkins.

States have argued that providing health coverage for the elderly should be a federal duty. While Medicare is covering drugs for the first time, states say they no longer should have to pay any of the drug costs of 6 million people who qualified for both Medicare and Medicaid. In the past, Texas paid 40 percent of those Medicaid bills.

Anne Dunkelberg, a former Texas Medicaid official who is associate director of the Center for Public Policy Priorities, an advocacy group for low-income Texans, said states also object to details of a formula for payments that Congress approved.

She said the formula doesn't recognize savings that states have achieved by using preferred drug lists and driving hard bargains with pharmaceutical companies.

"States really could end up spending more ... than they would have if they'd just continued to cover those folks directly," Ms. Dunkelberg said.

Texas Solicitor General Ted Cruz told justices that states are finding it difficult to plan for spending on schools or natural disasters because they haven't been told how much or when they must pay Medicare.

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