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Teresa Heinz Kerry: An Unhappy New Year for Seniors on Medicare

by Pamela Leavey

The Chicago Defender has an OP/ED today on the Medicare crisis, written by Teresa Heinz Kerry and Jeffrey R. Lewis (president of the Heinz Family Philanthropies). This will be an unhappy new year for seniors, they predict…

KERRY & LEWIS: An unhappy new year for seniors on Medicare
by Teresa Heinz Kerry and Jeffrey Lewis
January 19, 2006

The New Year should bring hope and joy to everyone, but unfortunately, 2006 is proving to be unhappy for many African American seniors who hoped to receive the prescription-drug benefits of the new Medicare Part D law on Jan. 1.

Part D, supported by President George W. Bush and forced through Congress by the former House Majority Leader Tom Delay (R-Texas) in 2003, required that all interested seniors sign up in advance and choose from a multitude of prescription drug plans. For those without other prescription drug coverage, this might have seemed like a great option. For those with a low-income, the new benefit simply replaces the prescription drug coverage that they had previously under Medicaid, so there is no net change in care.

At least, that is how it was supposed to work. However, Medicare Part D, which was sold to the public as a way for the elderly and the disabled to save money, in fact increases costs in many cases. It is more expensive than necessary, cuts health care, and gives most of the savings to private businesses. The sad-but-true result of this so-called reform is that – instead of Part D benefiting the people in real need – it is insurance companies and other businesses that are getting the real benefit.

The Bush administration claims that its new benefit is a good deal for moderate-income beneficiaries with high drug costs – i.e. people who are not eligible for Medicaid. Yet these seniors, now enrolled in the new plan, pay not only a monthly premium, but also a $250 deductible and 25 percent of the next $2,000 in covered costs.

In addition, the new Medicare Part D requires each senior to cover 100 percent of the costs over $2,000, until catastrophic coverage kicks in at the $5,100 mark. This creates a huge $3,100 “doughnut hole” in the coverage that seniors now have to pay out of their own pockets. For many elder Americans living on fixed incomes, it might as well be called the “bankruptcy hole.”

The hole presents two major problems. First, low- and middle-income seniors who are already struggling to eat and keep a roof over their heads don’t have an extra $3,100 for medication. Second, married couples are doubly penalized under this plan: each spouse must pay these out-of-pocket costs separately – leaving not a $3,100, but a $6,200 doughnut hole in their household.

Some of us anticipated and crowed about the problems with Medicare Part D prior to the law taking effect, but we were often dismissed as naysayers. Now, many financially crunched states are forced to step in to fill the hole because of the federal government’s inadequate preparation. Despite having months to get prepared, the federal government’s computer database system is failing local pharmacies all over the country, potentially putting the health of low-income seniors in jeopardy.

In some areas of the country, the federal government has failed to deliver important information to pharmacy computers – making no distinction being made between middle- and high-income seniors who have enrolled in the new Medicare plan and low-income seniors who need the Part D to replace their Medicaid coverage. As a result, the neediest seniors, who had received their medicine at little or no cost under Medicaid, are suddenly being told they can’t receive their necessary medication until they first pay the $250 deductible and higher co-payment that more well-off seniors pay.

To make matters even worse, pharmacists seeking to resolve the problems by telephoning federal Medicare pharmacy hotline face long and frustrating waits on hold-because other pharmacists from around the country are also calling in with problems and there are too few people answering the toll-free number.

Nine states have taken emergency action to respond to this serious problem, while more are considering doing so. South Dakota initiated a program to allow people who previously qualified for Medicaid prescription drug coverage to get a 30-day supply of their drugs. New Jersey reportedly has spent more than $4 million to cover low-income seniors since January 1.

It’s becoming clearer by the day that of all the ways they might have chosen to help seniors purchase prescription drugs, the Bush Administration and the Republican-controlled Congress chose the worst.

Outsourcing bureaucracy to the private sector doesn’t magically make prescription drug benefits cheaper or the system more efficient. In fact, funneling benefits through dozens of private companies makes Medicare Part D needlessly confusing. And, since private companies are profit-driven, not service-driven, they have no real incentive to provide seniors with the coverage they deserve.

The President Bush should mark this New Year by calling on the bureaucratic grinches at HHS to fix the problems swiftly so Medicare Part D recipients can receive the prescription drug medications they need.

Teresa Heinz Kerry is chairman of the Heinz Family Philanthropies and the wife of U.S. Sen. John F. Kerry (D-Mass.). Jeffrey R. Lewis is president of the Heinz Family Philanthropies.

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