Testimony
Testimony of Robert M. Hayes
President of the Medicare Rights Center
Before the Senate Democratic Policy Committee
February 27, 2006Good afternoon, Mr. Chairman and members of the Senate Democratic Policy Committee.
We appreciate your concern over the public health emergency that is being caused by the bungled, if inevitable, mismanagement of the new prescription drug program. We are grateful to bring before the Committee—and to anyone else in the government who will listen—our day-to-day experiences assisting people with Medicare.
The Medicare Rights Center is a not-for-profit consumer service organization, with offices in New York, Washington, Chicago and Baltimore. We provide counseling and education services directly to tens of thousands of individuals and organizations and we promote policy recommendations rooted in the real needs of people with Medicare.
We are neither supported by nor controlled by the pharmaceutical or insurance industries. Our sole and non-partisan mission is to serve people with Medicare.
Two months into the Part D program, we ask whether it furthers Medicare’s fundamental goal: providing health security for the American people. By act of Congress and remarkably submissive regulation by the Administration, Part D plans have broad leeway to decide which drugs they cover, what they will charge, and what impediments they will place between patient and needed medicine.
What does this mean to far too many people with Medicare? Fear, anxiety, and uncertainty: exactly the opposite of what Medicare has offered for 40 years, and exactly the opposite of what the American taxpayer should be purchasing with their hundreds of billions of dollars.
The fear and anxiety is not unwarranted.
Consider Ms. S, a 76-year old widow. Until January she used New York’s Medicaid program to fill her prescriptions. Like over 6 million others with Medicare and Medicaid, Ms. S was switched from Medicaid to Medicare drug coverage. Armed with both her Medicaid card and her new Medicare drug card, she went to her local pharmacy to get her blood pressure medicine -- only to learn that her medicine was not covered. Ms. S left the pharmacy empty handed. A week later, she was taken by ambulance to the hospital— her heart was beating too slowly for her to stand up.
The litany of start-up problems is familiar:
- the poorest people with Medicare were wrongly charged unaffordable co-payments and deductibles because they were not entered into plan computer systems,
- drug plans did not provide temporary fills for drugs not on their formularies, as they promised,
- neither plan nor government hotlines were functioning reasonably.
Responsibly, most states stepped in to provide stop-gap coverage through their Medicaid programs to people who receive both Medicare and Medicaid benefits – a step vehemently and irresponsibly fought by the Bush Administration throughout 2005 and the early days of 2006.This temporary coverage has saved lives. But once these safety-nets are pulled, we expect not just more bungling, but systemic and widespread deprivations of needed medicines caused by the design of the drug plans.
One design feature in particular, will keep needed drugs from people with Medicare—so-called utilization management practices. To many people with Medicare, these are classic “hide the ball” plays.
Neither plan nor CMS web explain how these restrictions work. Curiously, that is acceptable to CMS. But people need that information to decide if their drug regimens are compatible with plan restrictions.
In addition, the process to appeal a denial of coverage is not working. Patients and doctors routinely cannot get through to plans to obtain the forms and documentation requirements necessary. Every plan uses different forms, requiring different documentation. Some plans are just out to undermine legitimate need, for example, requiring doctors to forward articles from medical journals to back up their case for a particular drug. Physician, pharmacist and patient groups are developing a model form for plans, but use of this form will be voluntary—CMS, curiously, will not require plans to accept it.
Needless to say, many people with Medicare—those with cognitive disabilities or mental illness, those who are isolated in their communities—would never, even with an efficient process, be able to appeal for coverage. But this system turns an appeal for coverage into an insurmountable hurdle even for the savviest Medicare consumer.
Consumer dissatisfaction—a combination of unaffordability and confusion—causing the low-take up in the drug benefit. At the current pace of enrollment, 13 million people with Medicare will be without meaningful drug coverage when the enrollment period ends on May 15.
No matter how low a bar the Administration sets for enrollment targets, those 13 million older and disabled Americans will demonstrate forcefully the failure of the Part D benefit design. They will contradict any false claim of mission accomplished.
Low as the overall Part D voluntary enrollment figures are, Congress promptly should address the even more abysmal enrollment rates in the low-income subsidy, the “Extra Help.” At last count, only 1.1 million of an estimated eight million eligible people are enrolled. Over half of those who have applied have been rejected due to the asset test—a test that punishes poor Americans who have scrimped to have some security. It also complicates the application process, preventing automatic enrollment on the basis of income information on file with the federal government.
People with Medicare need and deserve an affordable, secure and intelligible drug benefit through Medicare. So does the American taxpayer.