Asclepios
Making the Baucus Bill Better
September 17, 2009 • Volume 9, Issue 37
America’s Healthy Future Act, the health reform bill introduced by Senate Finance Committee Chairman Max Baucus, Democrat of Montana, is the starting point for Senate legislation to fix our health system. Both in the Senate Finance Committee and on the Senate floor there will be amendments designed to improve the coverage for Americans as well as amendments designed to derail any and all health reform efforts. We all must work with those Senators, including Senator Baucus, to pass health reform that will meet the needs of all Americans, including those with Medicare.
Coverage under the Finance Committee bill falls short of the health benefits for those under 65 and not eligible for Medicare outlined in HR 3200, the bill pending in the House of Representatives, as well as the legislation passed out of the Senate Committee on Health, Education, Labor and Pensions (HELP). Under the Finance Committee plan, insurers could charge older adults approaching Medicare eligibility five times what they charge younger consumers for the same health plan: both the House and Senate HELP bill cap premium differentials based on age at 2 to 1. The Finance Committee plan also provides less help paying premiums for low and moderate income people than either HR 3200 or the HELP committee bill. Improving the Finance Committee plan in these two areas will help all Americans afford health insurance, including 1.8 million people with disabilities who are stuck in the two-year wait for Medicare.
The Finance Committee bill stops short of closing the doughnut hole, the coverage gap in the Medicare drug benefit that leaves consumers on the hook for the full price of their drugs. Instead, the Finance Committee bill requires a 50 percent discount on brand name drugs in the doughnut hole. Both President Obama and the authors of the House bill would phase out the doughnut hole, providing full coverage to the millions of people with Medicare who struggle to afford their medicines. Including a doughnut hole phase-out in the Senate bill would represent a substantial improvement in drug coverage for older adults and people with disabilities.
The Finance Committee bill also does nothing to expand access to the Extra Help program, which helps low income people with Medicare afford drug coverage, or Medicare Savings Programs (MSPs), which help with premiums and cost sharing for medical services. At a minimum, the Senate bill should include the provisions from HR 3200 that expand access to Extra Help and MSPs by allowing low income older adults and people with disabilities to keep a modest nest egg for their retirement and still qualify for assistance. The Senate bill should also include common sense reforms that align eligibility criteria for the two programs.
The next few weeks will be crucial for shaping legislation in the Senate. Please write your senator and urge them to
Remember Medicare and improve health coverage for older adults and people with disabilities in America’s Healthy Future Act.
Medical Record
“I have a Medicare Advantage Prescription Drug Plan and have already fallen into the doughnut hole. We haven't even finished up with the first quarter of the year 2009. My drug now costs me over $800.00 for a 30-day supply. It is an antibiotic that has no generic or competitors. So now I have to use my credit card and pay over 15% interest on the drug plus my monthly Medicare Advantage plan premiums, which provide no coverage during this time. I will have to take this drug for the rest of my life or until my credit card is maxed out; whichever happens first.” (Story submitted to the Medicare Rights Center, March 2009, Aurora, Colorado)
“In January of this year, when going to refill some of my prescriptions it was a startling shock when I was expecting to pay about $18.00 to $20.00 for my meds. I almost fell over when informed it would cost $317. Whereas before there was no annual deductible, now it was $295. All the brand-name drugs went up to $22 and the rest were also more, plus now I must pay $24.90 monthly to the plan. I have stopped taking one brand of medicine that would cost $63 for a refill. Since I must take two different doses of this medication it would cost $126 a month just for this one. Because of the 5 percent raise we got in January I no longer qualify for Extra Help.” (Story submitted to the Medicare Rights Center, March 2009, New Baden, Illinois)
“Until this point, Pamela had been able to pay the $675 per month necessary to extend her health insurance for an extra six months. But she now realized that she would not get Medicare until January 2007 and she could not further extend her health insurance with COBRA because her former office did not employ enough people to qualify for this benefit. Pamela’s husband had recently turned 65 and qualified for Medicare, but she now faced the prospect of being uninsured.
Pamela panicked. Without insurance, she could not afford to see her doctor—one appointment with the post-polio specialist in New Jersey cost $600—or buy braces, which cost thousands of dollars. Pamela knew that without proper treatment her condition would worsen and she might die. She also knew from her experience in a medical practice environment that ‘many patients have to declare bankruptcy because of medical bills.’
Desperate for insurance, Pamela began to call private health insurance companies—but none would cover a person with her condition, even for an extremely high premium. Luckily, in Ohio, if COBRA cannot be used to extend employer health insurance, an individual can buy a policy through a former employer’s health insurance company. Armed with this knowledge, Pamela purchased an individual policy through her former employer’s insurance company at a cost of $2,500 per month.” (Too Sick to Work, Too Soon for Medicare: The Human Cost of the Two-Year Medicare Waiting Period for Americans with Disabilities, Medicare Rights Center, April 2007)
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Medicare Part D Appeals Help for Advocates Is Here!
Medicare Rights Center’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
Register for a FREE copy of this great resource.
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Medicare Part D Monitoring Project
The Medicare Rights Center would like to hear about your experience, or that of someone you know, enrolled in a private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed.
Submit your story at http://www.medicarerights.org/issues-actions/tell-your-story.php.
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The Louder Our Voice, the Stronger Our Message
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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 e-newsletter 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.
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The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.
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