[QUAD-L] Fwd: Hurricane Highlights Problems in Medicare Drug Benefit

[DAANOO]

More Medicare information. Dana (C 4-5, 31 years post, 52, KC)

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Asclepios               

 

Your Weekly Medicare Consumer Advocacy Update

ACT NOW: Hurricane Highlights Problems in Medicare Drug Benefit

September 15, 2005 • Volume 5, Issue 37

 

A Houston pharmacist opens up this morning to find Mary Bracken, a new patient, waiting. Displaced by Hurricane Katrina, she doesn't know the name of her HMO from Louisiana, she has no way to contact her doctor’s office, and she has never enrolled in Medicaid and has no idea if she is eligible.  She knows she is supposed to take four different pills every day, but she doesn’t even know their names.

 

The pharmacist shrugs, sympathetically but helplessly.

           

The health crisis brought about by Hurricane Katrina is visible to anyone who looks. It has exposed a fragmented health care system that erects financial and bureaucratic obstacles to care, leaving the most vulnerable unprotected. For health care consumers in America, the fragmentation is getting worse, not better.

 

Hidden catastrophes face ill Americans each day, catastrophes that are only noticed in the wake of a natural disaster. The poorer you are, the greater the risk for catastrophe.

 

But some Americans have been protected from the harsh reality of the health care market bazaar: they have been among the 43 million Americans who have Medicare health coverage.

 

Elderly and disabled Americans have for decades been protected by Medicare, a health insurance program governed by rules that allow near universal enrollment, provide access to a standard benefit, and protect people from financial ruin when they need costly health care.

 

It is a model that has worked for 40 years, yet it is a model consistently rejected by this generation’s political leaders. This fall, two of those rejections will be felt hard by Americans in need: those displaced by Hurricane Katrina and those striving to find benefit in the 2006 Medicare prescription drug plans.

           

No serious consideration is being given by the White House or Congress to a Disaster Relief Medicare, the most practical way to bring immediate health care to people displaced by Hurricane Katrina. Congress could offer Medicare eligibility to displaced persons, opening up virtually every health care provider to the men, women and children far from home scattered across the nation.

 

In all states nearly every doctor, hospitals and clinic accepts Medicare. The American health care infrastructure could be opened up tomorrow to care for middle class families far from their insurance networks and poor families quartered in shelters in states from New England to Texas.

 

The political will to make this happen is absent.

 

And come January not just hurricane victims will be offered sympathetic but helpless shrugs at pharmacies across the nation. That is because Congress and the White House, in enacting the 2006 Medicare prescription drug benefit, threw overboard the simplicity and fairness inherent in Medicare’s structure.

           

The 2006 Medicare drug benefit requires an individual to select among scores of private plans a single plan that may not allow purchases in certain pharmacies, that may not cover needed drugs, that may charge hundreds of dollars in co-payments for needed prescriptions and that may not work out-of-state.

 

Some people are eligible for special financial help, but only if they meet stiff income and asset tests and navigate the application maze. People in great need will be systematically excluded from the drug help they need because the structure of the benefit will be too much to master.

 

There are many flaws in this new drug benefit, 11 of which have been reviewed over the past three months by Asclepios, named for the Greek god of health. What these flaws have in common is that each is based on the rejection by our political leadership of the well established virtues of Original Medicare: reliability, clear national standards, automatic enrollment and clinical decision-making left in the hands of doctors and patients.

 

The White House and the Congressional leadership insist that there will be no fix to the drug benefit this year.  Next year will be too late to save some people who will be lost. But, here’s a recap, bullet by bullet, of 11 ways to fix the Medicare drug benefit:

 

• Create a nationwide, Medicare-administered prescription drug plan.
• Allow Medicare to negotiate prescription drug prices directly with drug makers.
• Extend Medicaid drug coverage during the transition to Medicare Part D.
• Automatically provide “extra help” to people who meet the low-income subsidy (LIS) eligibility criteria.
• Eliminate the asset limit for the low-income subsidy.
• Ban Medicare drug plans from changing their benefit packages during the course of the year.
• Ensure doctors are prescribing psychiatric drugs, not private plans.
• Remove benzodiazepines from the list of Medicare excludable drugs.
• Bar telemarketing so that people will not be subject to overzealous sales tactics.
• Suspend the Medicare Part D late enrollment penalty for one year.
• Eliminate lock-in that will prevent people from switching plans during the course of the year. Since people’s health needs change all year.

 

Click here to send an e-mail message or letter to your representatives in Congress demanding that your representative in Congress tell you how they stand on each of these points.

 

Sign up here to help build a national campaign to give people with Medicare the drug program they deserve.

 

Medical Record

 

People with Medicare have resoundingly indicated their desire for a drug benefit offered by Medicare, not private insurers (“National Survey of the Public’s Views on Medicare,” Kaiser Family Foundation/Harvard School of Public Health, 2003).

 

An estimated 2.4 million people with Medicare with incomes below 150 percent of the federal poverty level are expected to be ineligible for low-income subsidies because of the asset tests. Among these 2.37 million, approximately 70 percent have incomes below $1,077 per month/individual ($1,444 per month/couple), or 135 percent of the federal poverty level; and 30 percent have incomes between 135 percent and 150 percent of the federal poverty level ("Low-Income Subsidies for the Medicare Prescription Drug Benefit: The Impact of the Asset Test," Kaiser Family Foundation, April 2005).

 

Health and Human Services Secretary Michael Leavitt acknowledged it won't be easy to get those people to apply for the Medicare Part D extra help. “That's a very hard group to reach,” Secretary Leavitt said. “If 20 percent make it, that would represent a world-class effort on our part” (“Selling Seniors on Drug Benefit,” Albany Times Union, July 15, 2005).

 

Lower prescription drug prices could allow Medicare to eliminate the “donut hole” in Medicare prescription drug prices. In one estimate, a 50 percent reduction in prescription drug prices—a discount similar to what other industrialized countries have achieved through price negotiation—would enable Medicare to close the donut hole, increase access to prescription drugs and reduce total drug spending (Testimony of Gerard Anderson before the Subcommittee on International Trade and Subcommittee on Health, Senate Finance Committee, April 27, 2004).

 

Fast Relief: What You Can Do

Let everyone—your colleagues, friends, families—know how we can improve the Medicare prescription drug benefit for people with Medicare and American taxpayers. Help us build a national network of concerned citizens who want to create the Medicare prescription drug benefit Americans deserve.

Click here  to help build a national campaign for a real Medicare prescription drug benefit!

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Don’t Let Your Suffering Go Unnoticed

Are you struggling to pay for your prescriptions drugs or get the health care you need? Work with the Medicare Rights Center to bring your story to the ears of policymakers, the press and the public in an effort to expose the shortcomings of the American health care system. To learn more about how to make your voice heard in the national Medicare debate, visit www.medicarerights.org/maincontenthiddenlives.html

The Louder Our Voice, the Stronger Our Message

Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly action alert designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.

 

Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare. A national nonprofit founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.

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