Press Release             

FOR IMMEDIATE RELEASE
Contact:
Akiko Takano
Deputy Director of Communications
212-204-6214

January 18, 2011

Repeal of Affordable Care Act Would Eliminate Coverage Improvements for People with Medicare

-- Consumer Group Responds to Affordable Care Act Repeal Efforts --

New York, NY—A review of consumer cases handled by the Medicare Rights Center demonstrates that people with Medicare will be harmed by the repeal of health care reform as proposed in H.R. 2, which was introduced in the House of Representatives earlier this month. The bill would repeal the Affordable Care Act (ACA) in its entirety, thereby eliminating a variety of coverage improvements for older adults and people with disabilities, such as:

• Increased prescription drug coverage by closing the Medicare Part D coverage gap, known as the “doughnut hole”
• Expanded access to affordable preventive care services
• Better coverage for people with pre-existing conditions and disabilities

H.R. 2 would also threaten the fiscal future of Medicare and add to the federal deficit.

“Our clients and people with Medicare simply cannot afford a repeal of the Affordable Care Act,” said Joe Baker, president of the Medicare Rights Center. “Their health and financial security are being jeopardized.”

First, the ACA closes the coverage gap, or doughnut hole, in the Medicare prescription drug benefit. “For the past five years, the doughnut hole has plagued many people with Medicare, especially those in poor health and with multiple conditions,” said Baker. “Repeal would return us to the days when people with Medicare were forced to put their financial stability at risk to access medically necessary drugs, split or share pills, or forgo medications altogether.”

Since the advent of the Part D drug benefit in 2006, the Medicare Rights Center has handled hundreds of calls from clients who have entered the doughnut hole. Although this is a small fraction of the millions of individuals who reach the doughnut hole each year, their stories spotlight the issue. In 2010, individuals in the doughnut hole were eligible to receive a $250 rebate on drug costs. This year, they will receive a 50 percent discount on brand-name drugs, so long as the ACA remains intact.

Ms. G, a client from Arizona, called Medicare Rights Center because she is in the doughnut hole and cannot afford her medications. She has diabetes, a heart condition and high blood pressure, and is currently on 16 medications. She also has very high hospital bills. Ms. C’s income is $2400 per month, so she does not qualify for a program that would help her pay for the cost of her medical bills or drugs. The closure of the coverage gap will help Ms. C afford her medically necessary prescriptions that help prevent her serious health conditions from getting worse.

Ms. C, a client from New York, takes several medications, including a very expensive anti-cancer medication to keep her cancer at bay. She called the Medicare Rights Center when she learned from her pharmacist that she was approaching the doughnut hole. She said that she would be able to avoid the doughnut hole if she did not take her anti-cancer medication, but wanted to know if there was any assistance she could receive that would allow her to afford and take this medication. Due to her income, Ms. C had limited options. Medicare Rights advised her that a far too common option was to ask doctors for free samples of medications in order to sustain treatment if no other assistance was available. Without closure of the doughnut hole, Ms. C will face unaffordable drug costs. If she is unable to access her medication, the chances of her cancer recurring are increased.

The ACA also allows for the provision of new or expanded preventive services under Medicare. In addition to providing annual wellness exams and prevention plans to people with Medicare, the ACA eliminates consumer cost-sharing for many Medicare-covered services recommended by the United States Preventive Services Task Force, like mammographies, colonoscopies and osteoporosis screenings. This increased access to affordable preventive services will improve Americans’ health and could reduce long-term costs to the health care system.

Ms. C, a client from Oklahoma, called Medicare Rights Center because she wanted to quit smoking. Her doctor prescribed a medication to assist her in her efforts, but her drug plan would only cover the drug if she agreed to attend smoking cessation counseling sessions, which Medicare covered, but with cost-sharing that Ms. C could not afford. Now, as a result of health reform, Ms. C., and those in similar situations, will be able to go to smoking cessation counseling sessions free of charge.

In addition to these improvements, health reform improves coverage for people with pre-existing conditions and those with disabilities who do not yet qualify for Medicare. Americans under 65 with Social Security Disability Insurance have to wait two years before they are eligible for Medicare coverage. In many cases, these individuals and any other individual who is uninsured and has a pre-existing condition, can now join states’ high-risk pools created by the ACA and receive immediate insurance coverage while they wait for Medicare. Most importantly, in 2014, they will have access to even more insurance options through plans offered on state-based health exchanges and expanded Medicaid. This means that people in the two-year waiting period, one of the populations most in need of affordable, high-quality care, will now be able to access coverage.

Mr. J, a client in Texas, has leukemia and is in the two-year waiting period for Medicare. He needs a bone marrow transplant, but does not have insurance and is unable to afford private insurance on his income of around $1300 a month. Mr. J is eligible for the Pre-Existing Condition Insurance Plan created by health reform. Repealing the ACA would take this option away from Mr. J.
Beginning in 2014, people in Mr. J’s situation will be able to access insurance through an exchange plan, which will be made affordable through government subsidies that help those with limited incomes pay premiums. Some in the waiting period may also become eligible for expanded Medicaid. The ACA ensures that people like Mr. J won’t have to forgo medically necessary cancer treatments because they can’t access insurance.

Finally, the ACA works strategically to keep the Medicare trust fund solvent while preserving the core benefits of the program. Health reform will extend the Medicare trust fund by 12 years (from 2017 to 2029), and reduce the federal deficit by more than $100 billion over ten years.

“Preserving the ACA is preserving Medicare. We must set politics aside and put the well-being of people with Medicare first,” said Baker. “By repealing health reform, H.R. 2 not only takes away benefits that people with Medicare desperately need and have already started to use, but it also weakens the fiscal strength of Medicare and adds to the federal deficit. That is not a good prescription for people with Medicare or for any American.”

 

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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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