Testimony
Statement for the Record
Robert M. Hayes
President
The Medicare Rights Center
March 3, 20051030 15 th Street NW, Suite 250
Washington , DC 20005
1460 Broadway
New York , NY 10036
www.medicarerights.orgChairman Smith, Senator Kohl, and Members of the Committee,
Thank you for holding a hearing today on a critically important subject – how the Medicare Modernization Act (MMA) will affect the millions of so-called “dual eligibles,” Medicare’s most vulnerable, poorest, and sickest individuals, who are enrolled in both Medicare and Medicaid. The nearly six-and-a-half million “dual eligibles” have the unfortunate distinction of being at greatest risk of being harmed by the MMA. Under the law, they will lose Medicaid drug coverage and replace it with Medicare coverage literally overnight on January 1, 2006 . There is no margin for error, and if the transition does not go perfectly, dual eligibles will have nothing to fall back on to get the medicines they need.
In our view, it is essential that the federal government act swiftly to ensure that it does not violate the most fundamental principal of health care: do no harm. We look to Congress to ensure that their transition to Medicare drug coverage is smooth and assures that they can get the drugs they need when they need them.
In addition to trading Medicaid drug coverage for Medicare coverage, “dual eligibles” are singled out for another special distinction in the MMA scheme: they are the only group guaranteed to be enrolled in Part D plans on the very first day that Medicare drug coverage begins. The rest of Medicare’s 35 million beneficiaries will be able to wait a few months to see how the Part D plans are working before they must decide whether to enroll. If dual eligibles’ transition experience is rocky, it could bode very badly for the success of the entire Part D benefit.
But the prospects for a smooth transition are dim. Despite CMS’s best efforts to add a few weeks to the transition timetable, there is simply not adequate time to ensure that the frailest people on Medicare will be able to access needed medications when Medicaid drug coverage ends on January 1, 2006 . If there are gaps in drug treatment, there will be unnecessary hospitalizations, disease progression, drug resistance, and deaths. The stakes for this transition are very high.
There are so many ways that many of America ’s most vulnerable men and women can fall through the cracks of this transition. They could move during the transition period and not receive their Part D card on time; they could receive it and toss it, or misplace it, as we have all done; they could remember to bring it with them to the pharmacy on January 1 but not realize that their old pharmacy is not in their new network; or they could make it to the right place with the right card only to learn that their plan doesn’t cover the right drug for them. The potential for problems is endless; the time to resolve them is extremely short.
The attached analysis, MMA and Dual Eligibles: A Transition in Crisis, was developed by a small working group led by the Medicare Rights Center , a national consumer service organization. It provides greater detail on the nature of the challenge posed by the dual eligible transition under the MMA. And it proposes a way for Congress to buy more time for the critical education and outreach activities needed to ensure that “dual eligibles” have access to the drugs they need on January 1, 2006 and thereafter. In short, Medicaid should be permitted to continue for a targeted transition period as backup coverage to new Part D plans.
This way, the neediest and frailest men and women with Medicare can ease into a complex new program with a familiar safety net, Medicaid, for the first few months of the program.