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Medicare Drug Program
Controversy Follows Medicare Drug Plan Despite
Enrollment Claims
April 21, 2006 Despite the satisfaction expressed
by the Bush Administration with Medicare drug plan enrollment and polls
saying many senior citizens are happy with their plan, the controversy
will not die. The Administration announced yesterday that 30 million now
have coverage but critics say millions are not covered and the Wall
Street Journal challenges the Administration numbers. And, according to
the daily report from KaiserNet.org, the Los Angeles Times reports that
not only are the rates for the drug program set to increase by 7 percent
next year, the size of the "doughnut hole" may also be enlarged.
 Medicare Officials Say They Have Exceeded
Enrollment Goal for Drug Benefit
More than 30 million Medicare beneficiaries now
have prescription drug coverage, exceeding the Bush administration's
goal of ensuring coverage for 28 million to 30 million beneficiaries in
the first year of the Medicare prescription drug benefit,
HHS
Secretary Mike Leavitt said on Thursday, the
AP/Philadelphia
Inquirer reports (AP/Philadelphia Inquirer, 4/21).
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Medicare Says 30 Million Senior Citizens Now Have
Drug Coverage
Over 93 million prescriptions
filled in March; stand-alones jump 1.7 million
April 20, 2006 With the deadline for enrollment
only days away (May 15), Medicare announced today that more than 30
million Medicare beneficiaries are receiving prescription drug coverage,
including more than 8 million beneficiaries who have gotten new,
individual prescription drug coverage since the program began. More than
93 million prescriptions were filled for beneficiaries during
March - averaging 3 million prescriptions filled per day.
Read more...
Senators Push for Vote to Extend Medicare Drug
Program Deadline
House sponsor fears a vote because House may repeal
the program
April 20, 2006 While Senators are pushing hard
for a vote on a bill to extend the Medicare drug program enrollment
deadline past May 15, Rep. Pete Stark (D-Calif.) is not pushing hard on
his bill in the House. He says the Bush administration should extend the
deadline without legislative action because, he says, the House may
repeal the whole program. In other news, insurance companies are mailing
letters to senior citizens threatening to cut off prescription drug
service for non-payment, while many of the seniors say they have paid,
according to a report by KaiserNet.org.
Read
more...
Medicare Drug Plan Deadline Extension Not Legal,
Says CMS
April 18, 2006 With the May 15 deadline for
enrolling in the Medicare Drug Program less than a month away, the
voices begging for an extensions are growing louder, but the deputy
administrator at the Centers for Medicare and Medicaid services says
there is no legal way to extend the deadline. The media, too, seems to
have increased its interest in the program, including the announcement
that rates are going up about seven percent in 2007, according to a
round-up of Medicare news by KaiserNet.org.
Read
more...
Choose Carefully as Medicare Drug Benefit Deadline
Nears on May 15
Kaiser Family Foundation
finds wide variations
across plans
April 14, 2006 - Medicares new private stand-alone drug plans vary
significantly in terms of covered drugs, out-of-pocket costs for
specific medications, and restrictions placed on the use of certain
drugs - according to a new analysis released today by the Kaiser Family
Foundation.
Read more...
Final Medicare Enrollment Effort Begins Monday
Across the U.S.
Hundreds of events
planned for 'Medicare Rx Get Enrolled Week'
April 12, 2006 With the deadline for enrollment
for the Medicare drug program looming May 15 and new polls showing
satisfaction with the program, a week-long grassroots effort is being
held April 17-23 in all 50 states and Washington D.C. to help senior
citizens get enrolled. Medicare Today, a national partnership of more
than 400 organizations, today announced "Medicare Rx Get Enrolled Week."
Medicare experts and volunteers will provide seniors with the
information they need to make decisions about enrollment in Medicare's
prescription drug benefit.
Read more...
Read more
on
Medicare Drug Program |
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In the
last month,
1.7 million beneficiaries enrolled in stand-alone prescription drug
plans, bringing the total number of beneficiaries with coverage through
stand-alone PDPs to 8.1 million, HHS said (Abrams,
AP/Chicago
Sun-Times, 4/21). The 8.1 million total includes 1 million
low-income beneficiaries "who had their enrollment facilitated by
CMS,"
HHS said. According to HHS, beneficiaries receiving drug coverage also
include:
● Nearly 5.8 million beneficiaries in Medicare
Advantage plans, including about 950,000 beneficiaries who voluntarily
enrolled in MA plans since Jan. 1;
● About 5.8 million dual eligibles who were
automatically enrolled in the drug benefit and an additional 500,000
dual eligibles who were enrolled in MA plans with drug coverage;
● More than 8.2 million retirees who receive
employer-sponsored drug coverage to supplement Medicare drug benefits or
who receive drug benefits through unions or former employers that
receive a subsidy from Medicare; and
● 3.5 million retirees who are enrolled in
TRICARE
-- the military health program -- or the
Federal Employee
Health Benefits Program.
Separately, more than 5.8 million beneficiaries
receive drug coverage through the
Veterans
Administration or other sources with coverage at least as
good as Medicare, bringing the total number of beneficiaries with drug
coverage to about 35.8 million, according to HHS (HHS
release,
4/20).
Comments From Bush Administration
Leavitt said that 90% of the estimated 43 million Medicare
beneficiaries will have prescription drug coverage by the May 15
enrollment deadline if sign-up rates continue at the same pace
(AP/Philadelphia Inquirer, 4/21).
Leavitt and CMS Administrator Mark McClellan said
about three million beneficiaries who have not enrolled qualify for a
low-income subsidy. "That's a very hard population to reach," McClellan
said (Mussenden, Richmond Times-Dispatch, 4/21).
Leavitt and McClellan also reiterated that the
administration does not support an extension of the enrollment deadline,
a move urged by some
lawmakers
who have pushed for legislative action on the matter.
Leavitt said, "The deadline is a very important
part of this. It helps seniors focus on this, and it's working" (Carey,
CQ HealthBeat,
4/20). McClellan said Medicare actuaries estimate that two million fewer
beneficiaries would sign up for the benefit by May 15 if the deadline
were extended than if it remained in place (Brand,
Denver Rocky
Mountain News, 4/21).
More Comments
Rep. Pete Stark (D-Calif.) said in a statement that the
administration projected in December 2003 that 40.7 million
beneficiaries would receive coverage under the drug benefit, adding,
"Despite President Bush's cross-country dog and pony show, millions of
seniors have yet to sign up for a prescription drug plan."
Robert Hayes, president of the
Medicare Rights
Center, said the numbers show that more than 80% of the
lowest-income beneficiaries have not been enrolled in the Medicare drug
benefit and that "less than 20%" of beneficiaries overall have "new drug
coverage" (CQ HealthBeat, 4/20).
Hayes added administration officials do not want to
extend the enrollment deadline because "[t]hey want to maximize the
pressure," noting, "[C]ome May 15th, if the enrollment remains low, that
may well be when the president says, 'let's extend it'" (Richmond
Times-Dispatch, 4/21).
Dan Mendelson, president of
Avalere Health,
a health care consulting firm, said relatively healthy beneficiaries
have not enrolled in the benefit in large numbers because they think
they do not need it, adding, "Those are really the people you have to
worry about" (CQ HealthBeat, 4/20).
Enrollment Estimates
In related news, the Wall Street Journal on Friday examined how the
number of beneficiaries who are "actually enrolled" in the drug benefit
is lower than 30 million, "[d]espite the headline on an [HHS] press
release -- '30 million Medicare beneficiaries now receiving prescription
drug coverage.'"
The 30 million estimate includes 3.5 million
individuals who receive coverage through TRICARE or the FEHB Program,
"but aren't signed up for the Medicare benefit," meaning about 26.5
million beneficiaries currently are "benefiting from the Medicare drug
program," the Journal reports.
Of that total, 5.8 million previously had drug
coverage through Medicaid and were enrolled automatically and an
additional 6.8 million receive drug coverage through their former
employer, who receives subsidies from Medicare.
HHS spokesperson Christina Pearson said all
beneficiaries "were able to make the choice that works best for them"
because of the new drug benefit, regardless of their source of coverage.
Some critics of the drug benefit have said the administration has
revised its enrollment goals since the program was created or otherwise
altered the enrollment count to meet projections, the Journal reports.
However, according to Pearson, "We've consistently said our goal was 28
to 30 million, [a]nd by any measure we've surpassed that goal" (Lueck,
Wall Street Journal, 4/21).
Additional Coverage
Two newspapers on Friday examined issues related to the drug benefit.
Summaries of the articles appear below.
●
Los Angeles Times:
The Times examined how the cost of drug coverage for beneficiaries will
increase slightly next year because of stipulations in the 2003 Medicare
law. Medicare officials announced recently that the cost increase likely
will be about 7% for next year, the Times reports. In addition, the
so-called "doughnut hole" -- the gap in drug coverage -- could change to
between $2,400 and $5,451 (Alonso-Zaldivar, Los Angeles Times, 4/21).
The current coverage gap requires beneficiaries to pay for 100% of drug
costs between $2,250 and $5,100 (Kaiser
Daily Health Policy Report, 4/10). McClellan said drug plans
"could keep the beginning of the doughnut hole in about the same place,"
adding, "It could look very similar to what the coverage is this year"
(Los Angeles Times, 4/21).
● Wall Street Journal: The Journal examined how
the drug benefit already "has produced clear winners and losers among
businesses and seniors." The "early winners" include large health
insurers, who "have snagged roughly 15 million new customers and healthy
government subsidies" under the program. UnitedHealth, which offers an
AARP-endorsed
plan, is "[b]y far the biggest winner" and has enrolled more than 3.9
million new customers through the drug benefit.
Pharmaceutical companies also have been "buoyed" by
the drug benefit, with some drug makers reporting increased demand for
certain treatments used by seniors. Smaller insurers "are seeing only
minimal enrollment gains." Large retail drug stores have seen "some cuts
in profit," but some big chains, such as
Walgreen
and
CVS,
predict profits will improve in the long-term as customer volume
increases. Independent pharmacists have "complain[ed] that they are
being driven out of business" because of slow payments and lower
reimbursement rates than under Medicaid (Lueck/Fuhrmans, Wall Street
Journal, 4/21).
Editorials, Letter to the Editor
Several newspapers recently published two editorials and a letter to the
editor that addressed physician reimbursements and the prescription drug
benefit. Summaries appear below.
●
Boston Globe:
American Medical
Association President J. Edward Hill "made a strong case this
week" for increased Medicare reimbursements to physicians, but his
"arguments would be more persuasive if he and his organization endorsed
the repeal of some of President Bush's tax cuts, so the government could
afford to pay the higher rates," a Globe editorial states. According to
the editorial, Hill proposed to address the issue of the uninsured
through "a combination of tax credits and individualized policies,"
funded by a tax on employee health insurance. The proposal is
"intriguing," but "coverage would be more affordable if it could rely on
other federal revenue," such as a "good dose of new tax money," the
editorial states (Boston Globe, 4/21).
●
Salt Lake Tribune:
The Medicare prescription drug benefit is "mind numbing" and "makes the
tax code look simple," and Congress should "give America's seniors an
extra month to get the help they need to figure it out without paying a
penalty," a Tribune editorial states. According to the editorial, 48
senators have signed a letter that calls for an extension of the
deadline, and other lawmakers "should give that ball a push" (Salt Lake
Tribune, 4/20).
● Robert Goldberg,
USA Today:
The failure by Brad Woodhouse, communications director for
Americans United,
to state in a recent USA Today
opinion piece
that the group is "largely funded by labor unions and Democrats" is
"just the beginning of the half-truths," Robert Goldberg, vice president
of the
Center for
Medicine in the Public Interest, writes in a USA Today letter
to the editor.
According to Goldberg, Woodhouse would "essentially
eliminate private-sector competition" from the Medicare prescription
drug benefit and would "have the government force drug companies to sell
products at prices" similar to those received by the
Department of
Veterans Affairs, although the program currently allows
beneficiaries to "choose a plan that offers more of the medications and
spend less of their own money than the VA requires." He concludes, "Why
are Woodhouse and his group united against the future of innovation,
freedom of choice and health of seniors?" (Goldberg, USA Today, 4/21).
Broadcast Coverage
NPR's "All
Things Considered" on Thursday reported on enrollment in the
Medicare prescription drug benefit. The segment includes comments from
Robert Hayes, president of the
Medicare Rights
Center; Jacqueline Kosecoff, CEO of drug programs at
United Healthcare;
Leavitt; and McClellan (Rovner, "All Things Considered," NPR, 4/20). A
transcript of the segment is available
online.
 The
complete segment is available
online
in RealPlayer.
"Reprinted with
permission from kaisernetwork.org You can view the entire
Kaiser Daily Health Policy Report, search the archives, and sign up
for email delivery at
www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser
Daily Health Policy Report is published for
kaisernetwork.org, a free service of The Henry J. Kaiser Family
Foundation. © 2006 Advisory Board Company and Kaiser Family Foundation.
All rights reserved.
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