No Sugar-Coating, Please:
Medicare Part D Is Off to a Poor Start
This LA Times report is primarily about California. I have anecdotal information relating to Ohio that confirms the problems cited, and expands on them.
Medicare Part D, the prescription-drugs-for-seniors plan, is off to a glitch-ridden start for too many people. Regardless of whether you were for or against the bill, everyone should agree that much of what is happening shouldn’t be:
State Orders Help for Elderly as Medicare Glitches Spread
California joins other states in giving seniors emergency assistance. Bush’s signature program draws sharp criticism nationwide.
January 13, 2006SACRAMENTO — California officials ordered emergency action Thursday to cover drug costs for 1 million elderly citizens, many of whom have been denied life-saving medications or charged exorbitant amounts because of glitches in the new federal prescription drug program.
The action by Gov. Arnold Schwarzenegger’s administration capped a day in which the Medicare prescription drug program — one of President Bush’s signature domestic policy initiatives — came under sharp criticism from members of Congress and governors of both major political parties.
Critics said the program, which Bush has touted as the most significant advance in Medicare in 40 years, was fast becoming a public health emergency. California officials said that as many as one-fifth of the 1 million elderly, poor or disabled state residents who were switched into the federal program on Jan. 1 could be wrongly denied their medications because of flaws in the program.
….. The root of the current problems is a provision of the Medicare prescription drug law that automatically switched about 6 million (nationwide–Ed.) elderly, low-income and disabled people into the new program Jan. 1.
Those people had previously been covered by Medicaid — Medi-Cal in California — the joint state-federal healthcare program for the poor.
Moving that many people into the new program, all at one time, appears to have overwhelmed the complicated Medicare drug benefit system.
In designing the program, the Bush administration did not want the Medicare drug benefit to be administered directly by the federal government.
Instead, it devised a public program run by hundreds of competing private drug plans, each with its own prices and coverage policies.
In many cases, pharmacists and patient-advocates say, elderly people are being denied benefits because of inaccurate or outdated information in computer databases used by the government and the individual health plans to interact with pharmacies.
In some cases, there is no information on a beneficiary, or the computer says the beneficiary is ineligible for coverage. In other cases, cost-sharing information is wrong, and pharmacists are being told to charge beneficiaries hundreds of dollars when in fact they have co-payments of only $1 to $5.
….. “People are walking out without their medicine across the board — high-blood-pressure medicine, insulin, pain medication,” (a senior advocate) said, adding that the problems were putting people at risk for stroke and other health problems. “This is the most vulnerable population.”
….. Under the plan, the state will use its own money to essentially continue the coverage that patients had under Medi-Cal before Jan. 1. Providing the coverage will cost the state as much as $70 million over the next two weeks.
State officials here and elsewhere said they would ask Congress and the Bush administration for reimbursement.
….. Healthcare advocates in California praised Schwarzenegger for stepping in to provide assistance, but questioned why it took nearly two weeks for the governor to act.
“We knew this train wreck was going to happen,” said Angela Gilliard, a lobbyist for the Western Center on Law and Poverty in Sacramento. “We’ve been saying there was no way when they flipped the switch on Jan. 1, people wouldn’t be harmed. No way. We’re glad the state acted now.”
Dr. Jack Lewin, chief executive of the California Medical Assn., said Schwarzenegger had “saved thousands of lives.”
“This may be the single most important healthcare action he has taken as governor for the nearly 1 million of the neediest patients in California,” Lewin said.
….. But Sen. Max Baucus (D-Mont.) wrote Health and Human Services Secretary Michael Leavitt on Friday to express disappointment with the transition for low-income seniors.
“Switching drug benefits from 50 state-based Medicaid programs to dozens of Medicare prescription drug plans would be complicated under any circumstance,” wrote Baucus, who voted in favor of creating the benefit in 2003.
“But this task is particularly challenging since these individuals are among the sickest and most vulnerable of all Medicare beneficiaries. Yet despite the awareness of potential problems, [Medicare] has failed to adequately protect these beneficiaries.”
OK, The Times and certain politicians quoted in the complete article are taking advantage of the troubles to fantasize about repeal (dream on) and to maximize the political fallout. The larger point is that it should not have happened, and that the administration is close to handing its opponents a potent political weapon. Ideally, everyone should shut up on the bigger issues for just a few weeks and concentrate all of their heat on getting those involved to get their act together, and quickly. But in the real world this won’t happen, and the adminstration had to know that anything less than a smooth transition would bring out the worst in some people and politicians.
One thing a lot of people don’t realize is that Medicare covers all people over 65 plus many disabled individuals, regardless of age. On what appears to be a safe assumption that the vast majority of those who were in Medicare and not in Medicaid before January 1 have NOT been affected by the glitches, here’s the impact:
- Low-income Medicare seniors who had been covered by Medicaid for prescription drugs, where there was no co-pay, have been switched into Medicare Part D automatically, with co-pays of $1 - $5. Some aren’t aware of this, and of course are less than pleased to find out. While some may not want to crank up the sympathy meter for these situations, the fact is that if you’re just getting by, didn’t know it was coming, and are on, say, 3 or more drugs, those deductibles may truly represent money you don’t have, and could have had, if you had known.
- Many of the Medicaid patients put into Medicare Part D are on psychotropic medicines and are not in full control of their faculties. Patients such as these who were not able to make a managed-care choice were arbitrarily assigned to various managed-care companies in their respective states. Some of these patients are, contrary to what was promised, walking out of the pharmacy without their medicine — maybe they didn’t bring any money for the co-pay, since they never needed it before, or maybe one of the database or other problems described in the LA Times article occurred. Some of these patients must have their meds or they will lose control, i.e., become violent or suicidal. While the “saved thousands of lives” quote in the article is ridiculous hyperbole, I’m not looking forward to reading stories of even a few real violent crimes committed by people who tried to get their meds, couldn’t, and lost it.
- Some managed-care companies are second-guessing previously made doctor decisions, in some cases made years ago, concerning dosages and/or the number of pills of different dosages that can be obtained on one visit to the pharmacy, which could upset treatment routines that were put in place for specific reasons.
- Doctors and nurses are beside themselve because of having to spend untold hours on hold trying to straighten out these situations, sometimes having to give up because the wait times are just too long. I have been told by someone distantly but definitely familiar with the situation that thousands of additional phone support people have been brought in by Medicare (and perhaps, and hopefully, by the managed-care companies) to alleviate the problem.
The fact is that they had two-plus years to get ready for this. It should have been handled better.
Once the dust settles, which had best be no more than 2-3 weeks, I want an answer to this question: How much money are the states going to save on an ongoing basis by relinquishing responsibility for a significant portion of Medicaid prescription costs to Medicare? I suspect the answer is: A LOT.
Which leads to my next question: Could the nation’s still-overburdened taxpayers please get that money back?
In the meantime, if you think that anyone you know might be adversely affected by this transition snafu, check up on them and make sure they are being properly taken care of.
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UPDATE: MarketWatch.com (free registration required at 24-48 hours) — “Medicare benefit off to rocky start”
