Republican Medicare bill is a SHAM!

[Gimpy]

MEDICARE AGREEMENT WOULD MAKE SUBSTANTIAL NUMBERS OF SENIORS AND PEOPLE
WITH DISABILITIES WORSE OFF THAN UNDER CURRENT LAW

By Edwin Park and Robert Greenstein

A substantial number of the 6.4 million low-income Medicare beneficiaries who also are eligible for Medicaid and currently receive prescription drug coverage through Medicaid would be made worse off under the Medicare conference agreement. Those who would be adversely affected are among the sickest and most vulnerable Medicare beneficiaries.

Under current law, when a benefit or service is covered by both Medicare and Medicaid, Medicare serves as the primary payer, and Medicaid ?wraps around? that coverage. Medicaid fills in gaps in coverage that exists under the Medicare benefit. It also picks up most or all of the beneficiary co-payments that Medicare charges.

But the emerging conference agreement would make an unprecedented change in how Medicare and Medicaid work together. It would largely eliminate Medicaid?s supplemental ? or ?wrap around? ? role under the new Medicare drug benefit. As a result, substantial numbers of poor elderly and disabled people would be forced to pay significantly more for their prescriptions than they now do. Those who could not afford the higher co-payments could lose access to some of the prescription drugs they need. In addition, in cases where Medicaid covers a prescription drug but the private plan that administers the Medicare drug benefit in the local area does not provide that drug under Medicare, poor elderly and disabled beneficiaries who now receive the drug through Medicaid could lose access to it. Given their limited incomes, such people generally would not be able to afford such drugs on their own.

The elimination of Medicaid wrap-around coverage has been added in recent days in the conference in order to save money by reducing Medicaid costs. The resulting savings have apparently been used elsewhere in the drug bill to satisfy more powerful constituencies.


1. Most low-income seniors and people with disabilities who qualify for Medicaid would be charged higher co-payments for prescription drugs under the new Medicare drug benefit than they now pay under Medicaid. This could discourage some poor beneficiaries ? particularly those who have serious medical conditions and need a large number of prescriptions ? from obtaining all of the drugs they need.

Under current law, low-income beneficiaries who qualify for both Medicare and Medicaid (a group known as the ?dual eligibles?) either receive prescription drugs free of charge or are charged nominal amounts such as $1 or $2 per month per prescription. (State Medicaid programs may charge these individuals a maximum of $3 per month per prescription, but few states charge that much. Research has shown that, given the low-income status of these people, Medicaid co-payments at that level can discourage the purchase of medically necessary drugs.[1])
Under the Medicare conference agreement, dual eligibles with incomes below 100 percent of the poverty line would be charged $3 per prescription per month for brand-name drugs and $1 per prescription per month for generic drugs. Those with incomes above 100 percent of the poverty line would pay $5 per prescription per month for brand-name drugs and $2 per prescription per month for generics. There would be no ceiling to limit the total monthly charges imposed on a poor beneficiary who is sick and has a large number of prescriptions. Individuals in nursing homes, however, who constitute nearly one-quarter of the dual eligibles would be exempt from any co-payments as under current law. (Note: most dual eligible beneficiaries who have incomes above the poverty line are a group known as the ?medically needy;? they qualify for Medicaid because they incur high medical costs that reduce their disposable incomes to below the poverty line. Many of these people live in their own homes but require intensive and costly long-term care services. Although these individuals technically have incomes above the poverty line, much of their income is consumed by high medical costs.)

As a result, three-quarters of the 6.4 million dual eligibles would be charged more for drugs than under current law. Depending on how the conferees settle an issue that has yet to be resolved, the increased co-payment charges could become quite large over time.

Specifically, while the $1 and $3 amounts for those below the poverty line ($8,980 for an individual) would be increased at the rate that the Consumer Price Index increases, the $2 and $5 amounts for those above it would be raised annually by the percentage that Medicare drug costs increase per beneficiary. The Congressional Budget Office projected earlier this year that such drug costs would rise at least 10 percent per year. Yet these low-income elderly and disabled Medicaid beneficiaries above poverty ? who generally already have catastrophic medical costs ? subsist on small Social Security payments that are increased annually in accordance with the Consumer Price Index. The CPI rises much more slowly than prescription drug costs; the CPI ? and hence Social Security benefits as well ?are increasing about two to three percent per year. The Congressional Budget Office projects that in the years ahead, Medicare drug costs will rise about four times faster than the CPI.

Thus, if the co-payment charges that dual-eligible beneficiaries must pay are raised each year at the rate that drug prices increase, low-income elderly and disabled people who now receive prescription drugs free of charge or at very low cost through Medicaid will face co-payment charges that rise much faster than their incomes.

2. Some low-income Medicare beneficiaries could lose access to particular drugs they currently are prescribed through Medicaid if those drugs are not covered under their Medicare drug plan?s formulary

Under the new Medicare drug benefit, each Medicare drug plan could have its own list of covered prescription drugs. The only requirement is that the private drug plans that will administer the Medicare drug benefit must cover at least one drug per ?therapeutic class.? (There is no generally accepted definition of what constitutes a class of drugs.) Some private drug plans may exclude certain high cost drugs for financial reasons; the drug itself is very expensive or the beneficiaries who often need it have higher-than-average drug costs. If a prescription drug that a beneficiary needs is not covered by the private plan, the beneficiary may use a Medicare appeals process, but how effective this appeals process will be in providing access to medically necessary drugs is unclear.

The conference agreement would prohibit Medicaid from wrapping around Medicare by covering a prescription drug that a low-income elderly and disabled beneficiary may need but that is not included in the Medicare drug plan?s formulary. Yet certain specific drugs may be the only drugs that are effective for an individual patient; such drugs can be necessary to ensure that the patient receives appropriate care even though other drugs in the same therapeutic class are intended to treat the same condition. In some such cases, if a poor elderly or disabled individual enrolled in Medicaid is unable to get a drug because it is not one of the drugs covered under the Medicare drug plan in which the individual has enrolled, the patient?s health may suffer.

Conclusion

The conference agreement?s unprecedented step in prohibiting Medicaid from fulfilling its traditional wrap-around role, coupled with the co-payment charges the bill would impose on dual eligibles, would result in several million of the nation?s poorest and frailest seniors and disabled people paying more for drugs than under current law. The effects would be largest on those who need a large number of prescriptions.

To avert such an outcome, states would have to elect to wrap around the new Medicare drug benefit at 100 percent state cost. According to a report by the Kaiser Commission on Medicaid and the Uninsured, based on discussions with state Medicaid directors, ?to maintain the same coverage, states that historically have provided a comprehensive prescription drug benefit to dual eligibles under Medicaid would be forced to use their general revenue funds to finance...the wrap-around on their own. To the extent they cannot find ways to supplement the Medicare coverage, many dual eligibles could end up with worse drug coverage than they currently receive through Medicaid.?[2]
In many states, already strained state budgets are unlikely to be able to absorb the financial cost of providing wrap-around coverage solely with state funds. If so, substantial numbers of low-income elderly and disabled people who are enrolled in both Medicaid and Medicare would be adversely affected by the new legislation.

End Notes:
[1] Leighton Ku, ?Charging the Poor More for Health Care: Cost-Sharing in Medicaid,? Center on Budget and Policy Priorities, May 7, 2003.
[2] Vernon Smith, Sandy Kramer and Jocelyn Guyer, ?Coordinating Medicaid and Medicare Prescription Drug Coverage,? Kaiser Commission on Medicaid and the Uninsured, November 2003.
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November 25, 2003
The Republican Medicare Bill Means Suffering and Death for Our Seniors

A READER COMMENTARY

I am a retired surgeon, doubly board-certified. For many years I have had experience as a consultant to HMOs when they received a surgical problem which they were incapable of handling or which had been badly mishandled with consequent complications.

The new Republican system of private HMOs taking over the responsibilities of Medicare is a disaster of monumental proportions which will bring suffering and possible death to a considerable proportion of our Senior population.

This system has been tried, and it doesn't work. I know, because I've seen the problems firsthand. The concept of captivation, upon which the profit motivation of a private medical care service is based, has encouraged medical practitioners to intervene in the care of patients, without experience or training, in order to "save a few bucks."

Consequently, trouble results. I know, because I've seen these patients as a consultant.

I remember some real horror tales and we're going to see a volume of repetition of these problems which stagger the imagination. WE'VE TRIED THIS SYSTEM, AND IT DOESN'T WORK! Let's bring out the old saw about those who do not learn the lessons of history are doomed to repeat its mistakes etc., etc. We're about to do this again.

I won't get into the obvious problems of the "new" drug distribution system, which should be apparent to the most naive individual, to be a total rip-off, and is "lie down and play dead" obeisance to the drug lobby. Enough said about this, since we ought to start standing up on our hind legs and start barking to the responsible individuals and quit our grousing.

The president of AARP has sold his membership down the drain. I am not a rabid liberal trouble maker, but I have walked the walk and personally seen the disaster which is about to recur should we bow down to this paean to greed. Today, I am returning my card to AARP. Will write my congresspeople and awaken friends to the danger that is before us.

*********************************************

I returned MY AARP membership card to them today as welll!

[Andy]

This aid bill is one that has totally baffled me. All the Dem?s who represent my state were against the bill. However, the Democrats have a history of being hand and glove with AARP. There were numerous commercials on TV paid for by AARP that said, ask your reps to vote for this this bill. We also received mail saying the same thing. The way all the blue hairs swoon when they hear the name Ted Kennedy around here I know AARP has not gone over to the Republican side. The President of AARP can't, all by himself, change the direction of that organization, hell they have more lobbiest that the car industry.

Thus, I have a question. If the bill is so bad for seniors why did AARP spend so much money pushing for it?s passage? Is there something that's actually good in this bill/law?

Stay healthy,
Andy

[Keith_Hixson]

I have not taken the time to go over the bill piece by piece but I also noticed strange reaction to this bill.

Some noted liberals have backed the bill here in the Northwest and some noted conservatives have spoken out against the bill. In this state, Washinton, Most republicans and democrats voted for the bill, but there were exceptions on both side of the issue as it worked its way through congress.

I know Ted K. says its the end of MediCare, but he is so Ultra Liberal I always take it with a grain of salt. From what I have seen of the Bill is:

It allows Insurance Companies to have quite a bit of latitude in utilizing the law. I for one have a distrust of ambiguous directives. Spell it out so there are no loop holes however you want a bill to work. I think that causes concerns on both ends of the political spectrum.

I'm going to study it more. I also noticed that it seems to target only those over 65 which I believe could be a mistake. But as most politicians on both sides have indicated, it seems to be at least a start.

Keith

[Gimpy]

for you guys. The AARP is no longer just an "advocacy group"........but instead have become "big business'!

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November 21, 2003
OP-ED COLUMNIST
AARP Gone Astray
By PAUL KRUGMAN


This is a good bill that will help every Medicare beneficiary," wrote Tom Scully, the Medicare administrator, in a letter to The New York Times defending the prescription drug bill. That's flatly untrue. (Are you surprised?) As the Center on Budget and Policy Priorities points out, the bill will force millions of beneficiaries to pay more for drugs, thanks to a provision that cuts off supplemental aid from Medicaid. Poorer recipients may find previously affordable drugs moving out of reach.
That's only one of a number of anti-retiree measures tucked away in the bill. It contains several Trojan horse provisions that are clearly intended to undermine Medicare over time ? it will allow private insurers to cherry-pick healthy clients in selected cities, and it will heavily subsidize private plans competing with traditional Medicare. Meanwhile, the bill prohibits Medicare from using its bargaining power to cut drug prices; drug company stocks have soared since the bill's details became public.
Yet the bill has a good chance of passing, thanks to an endorsement from AARP, the retiree advocacy organization, which has already begun an expensive advertising campaign on the bill's behalf. What's going on?
Let's step back a minute. This is a bill with huge implications for the future of Medicare. It's also, at best, highly controversial. One might therefore have expected an advocacy group for retired Americans to take its time in responding ? to make sure that major groups of retirees won't actually be hurt, and to poll its members to be sure that they are well informed about what the bill contains and don't object to it.
Instead, AARP has thrown its weight behind an effort to ram the bill through before Thanksgiving. And no, it's not urgent to get the bill passed so retirees can get immediate relief. The plan won't kick in until 2006 in any case, so no harm will be done if the nation takes some time to consider.
Many of AARP's members feel betrayed. The message boards at the organization's Web site have filled up with outraged posts. A number of those posts say something like this: "Now you're just an insurance company." Indeed, that may get to the heart of the matter.
Over the years AARP has become much more than an advocacy and service organization for older Americans. It receives more than $150 million each year in commissions on insurance, mutual funds and prescription drugs sold to its members.
And this Medicare bill is very friendly to insurance and drug companies. Senator John Breaux, one of only two Democrats who participated in negotiations over the bill, takes the controversy as a good sign: "No one got everything they wanted." But as Jonathan Cohn points out in The New Republic, drug and insurance companies got exactly what they wanted: no efforts to limit prices, generous subsidies and lots of additional business. For example, insurance companies that offer an alternative to Medicare will not only be able to pick and choose their customers, but will also get 30 percent more per client than the government spends on the average Medicare recipient.
So do AARP executives support this bill because they hope to share in the bounty? Maybe, but it probably runs deeper than that. Once an advocacy group becomes as much a business as a service organization, its executives are likely to start identifying more with industry interests than with the groups they are supposed to serve.
Thus it may seem odd on the surface that William Novelli, AARP's chief executive, wrote a glowing preface to Newt Gingrich's book on health care reform. After all, Mr. Gingrich has long advocated turning the administration of Medicare over to private companies ? an unpopular idea, and also an expensive one (forget the clich?s about inefficient government: private companies have much higher overhead than Medicare). But what looks like wasted money to taxpayers and retirees looks like opportunity to private providers. Enough said.
Am I being too cynical? How could I be? In case you haven't noticed, we live in a golden age of pork: the other big piece of legislation marching through Congress, the energy bill, makes the Smoot-Hawley tariff look like a classic of good government.
So it should come as no surprise that Medicare "reform" appears likely to be another triumph for the coalition of the bought-off ? a coalition that, sadly, includes AARP.
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[blues clues]

One of the problems I see with this thing is what the BIG DRUG COMPANYS tell them a price and medcare has to by law that it, I don't know about you but that sounds like high way robby and in my neck of the woods we start looking for a tall tree and some rope.

razz

[Bernadette]

Not only does this affect the drugs but also the durable medical equipment. Wheelchairs etc. bad news!

[HARDCORE]

GUYS & GALS -

Some years back, I wrote my second book, entitled "CIVILUTION!"

Sent it out to a major publisher on the East Coast at the suggestion of a highly decorated friend (at the time).

The original (rough draft) was over 700 pages and it was a "What If Book", similar (in some ways) to George Orwell's (Eric Blair's) 1984!

It outlined, at that time (1995) the direction that I felt the world was traveling in, including a second involvement in Iraq, trouble with the United Nations, vast power struggles, selective medical care and medicinal drugs, and eventually, a CILVILUTION (Civil War/Revolution)!

Of course, and as I have said before, it was pure fiction, but I'll be damned if a lot of what I said almost nine (9) years ago, has not already come to pass! No Nostradamus I, just logic and direction. A society where party political power, casts off all pretense and shows (and acts upon) their true colors!?

Never got the damned thing published (YET), as I was told that it was far too provocative and controversial. I guess that the problem was that fiction is a all too often stranger (and more truthful) than fact. Also, people tend to consider all such work - misinformation, and if government allows such literary labors to get aired or published, it can not possibly be true - "COULD IT!"

Could this be what was meant by that telephone call, some years back, and I quote:

"Mr. T, The First Amendment is a wonderful thing, but you sir have pushed the envelope to the limit?!"

Well maybe the book will be required reading in the great beyond, "OR NOT!?"

VERITAS

[MM38084]

Congress has a way of fixing a problem by putting a bucket under the leak. It keeps the floor dry, but the roof continues to deteriorate. Someday, comes the collapse.This describes the current effort in Congress to help older Americans by adding some prescription drugs to the benefits provided by Medicare.


This will ease their financial and personal pains but ignores the true problem - the too-frequent prescribing of too-expensive drugs when much less costly, but effective, relief is available. The medical profession has, by and large, turned its required continuing-education programs over to drug companies. They, in turn, use them to tout the curative powers of their new drugs, which often are only slight modifications of existing drugs that have entered the so-called generic marketplace at far lower prices.


This is not a tale concocted by angry radicals. It has been told by, among others, two former editors of the prestigious New England Journal of Medicine. They were active Harvard Medical School professors when they described it in learned detail.


One of them, Arnold Relman, brought the subject up again this week on The New York Times editorial pages.In his article he says: "So it is not merely that the pharmaceutical industry is using doctors to sell its products. Medical schools and other educational institutions are not teaching doctors how to use drugs wisely and conservatively."


The drug makers' overall profit margins are 18.5 percent of sales, more than five times as much as those of the typical large company. The cost of the free food, gifts and so forth that come with the "continuing education" they sponsor obviously is money well-spent.Medicare often is criticized as an obsolete program in need of reform because it does not recognize that drugs now rival hospitalization among health care costs.And that's true, as far as it goes. But picking up the cost of most medications would only subsidize what Relman and others describe as wasteful medical spending.


The "cure" for the drug-cost burden on the elderly lies at least as much in the direction of fewer and less costly prescriptions overall as in Medicare coverage itself.The latter by itself means only that the nation's taxpayers will directly subsidize an industry that is doing very well already.


When the Medicare drug bill become law, it included various provisions aimed at creating more competition in the drug marketplace in an attempt to drive prices down a bit.


But you can be assured it will do little to steer the medical profession away from its addiction to the newest and most costly "designer drugs" of the day. At best, their use is an attempt to provide a marginal increase in effectiveness at a vastly disproportionate cost.Health is not priceless. Nothing is. One way or another, our spending on whatever we need or want is limited.


Drug coverage under Medicare would help many seniors become healthy or stay healthy. But it could and should be provided for at much less cost to the taxpayer.

[HARDCORE]

MM38084

"Great & Truthful Piece!!"

VERITAS

[Keith_Hixson]

There is some truth to analogy of the bucket keeping the floor dry but the roof continuing to rot.

The problem with American Medicine is: Overpaid doctors, overpriced drugs, overpriced medical equipment, overpriced insurance, too many over paid lawsuits, and the unwillingness to acknowledge they are overpaid and overpriced. I have been a local hospital board commissioner and I presently sit on the local finance committee of the local hospital and these are my personal observations. Its all called one thing: Greed.

The poor do pretty well in American Medicine, the rich do well because they have money, the upper middle class do okay, but the lower middle class and upper level poor are just getting ripped off by the medical establishments.

One day the roof is going to cave in and government will be forced to take over medicine by establishing strict guidelines from top to bottom. Doctors will be screaming, producers of drugs and medical equipment will be screaming, lawyers will be screaming, insurance companies will be screaming, and the quality of medicine will slip slightly.

This bill is samo, samo, both parties are equally as quilty of using the "catch the drip" method. The emphasis is a little different in each party but its all "catch the drip" rather than really getting in and attacking the problem.

We will eventually have something similiar to the English or Canadian Medical programs, because the roof caved in.

Keith