Article: 'Reality Sets In' from Suddenly Senior

December 29, 2005 Medicare Consumer Advocacy Update

Last week, the Bush administration gathered reporters for an Alice in Wonderland experience. Health and Human Services Secretary Michael Leavitt heralded the new Medicare drug program enrollment data as evidence of a resounding success.

But the enrollment numbers are hardly cause for celebration. Only one million people, less than 5 percent of people with Medicare eligible to enroll voluntarily, had signed up for one of the new Medicare drug plans.

Secretary Leavitt tried to avoid talk of the enrollment data. Instead, he spoke of the more than 21 million people with Medicare who would have some drug coverage in 2006. In took some sharp pencils and some sharp reporters to figure out that 20 million of those 21 million people already had drug coverage before Secretary Leavitt and his team at the Centers for Medicare and Medicaid Services (CMS) got started on the new drug program.

Facing reality, not disguising it, would better serve a Secretary wanting to serve the American people. Once drug coverage starts January 1, expect more hype, more self-congratulations and more scripted applause both from the administration and its allies in the insurance and drug industries. How will we find out what's really happening?

That's where you come in. The reality of this new program will be felt by people, not tabulated as statistics. If people enjoy great benefit from the program, we should celebrate what works. But if they suffer in silence from breakdowns in the program, there's no chance for the truth to come out.

Many older and disabled Americans, desperate for decent drug coverage, have been waiting to find out from the Social Security Administration if they are eligible for the Extra Help program or will face unaffordable copayments for their drugs. Will they receive the coverage they were promised? The poorest Americans who now rely on Medicaid for drug coverage are being randomly placed in drug plans. Did they actually get into a plan and does the plan cover the drugs they need? Companies are threatening to cut off health benefits to their former employees who enroll in a Part D plan, making no distinction for people with Medicaid who were automatically enrolled by the CMS. Will these people and their spouses lose the health coverage they earned through a lifetime of employment? People with Medicare face many problems that stem from the drug benefit's fundamental flaw--it is delivered by profit-seeking insurance companies and not by the Medicare program. Plans have financial incentives to restrict access to certain drugs, and people with Medicare will be denied the medicines they need.

Plans may deny coverage for certain drugs because they are expensive, or the people who use them have other, high-cost medical needs.

Plans may fail to inform enrollees about how to appeal for coverage or how to get a temporary supply if a drug they need is uncovered.

Plans may make it hard to get prior approval for a drug instead of using these procedures to ensure that the drug is only prescribed to patients who need it.

The Medicare Rights Center (MRC) needs to hear about all these problems, whether they happen to you or someone in your community. With that information, we will be armed with the needed evidence to push for a decent Medicare drug benefit. And we will intervene to help people with Medicare get the medicines they need under the existing benefit structure.