AIDS MEDICARE PROJECT

URGENT ACTION ALERT

ASK CONGRESS TO VOTE NO ON THE PROPOSED MEDICARE PERSCRIPTION DRUG BILL

Tentative Agreement of Medicare Conferees includes dangerous provisions that could adversely affect some of the most vulnerable Medicare recipients.

Bill could go to House and Senate for a vote as early as this week!

Background:

Negotiators attempting to reconcile the House and Senate Medicare bills (HR 1 and S 1) on Sunday released a six-page summary of a tentative agreement that calls for a new prescription drug benefit and a scaled-back version of the House-passed competition provision. The tentative deal was reached after negotiators on Thursday said that they had been unable to agree on three major issues in the legislation and would refer discussions on those issues to Senate Majority Leader Bill Frist (R-Tenn.) and House Speaker Dennis Hastert (R-Ill.) for resolution). Republican lawmakers, with the support of conferee Senators John Breaux (D-La.) and Max Baucus (D-Mont.), on Sunday released limited details of the proposed compromise, and President Bush immediately stated his support for the plan.

Current Issues

Important Unacceptable Provision!!!!!!

•Conference Agreement eliminates current Medicaid wrap-around drug benefits for the most vulnerable Medicare recipients  

Low income elderly and people living with disabilities who are Medicare enrollees are dual eligible for Medicaid and Medicare and have been receiving drug benefits through state-administered Medicaid programs.  This vulnerable population would stand to lose current benefits because of a provision to the Medicare legislation that House negotiators insisted upon. Under existing Medicaid policies, the states pick up the co-payments for dual elgibles and make sure they receive all medically necessary drugs.   Almost 6 million vulnerable senior citizens and persons with disabilities including over 50,000 people living with AIDS and HIV would be adversely affected by this provision.  The impact on this population could be devestating.  Experts believe that the Medicare formulary will likely include only one or two drugs per therapeutic class. If Medicaid cannot wrap around with a comprehensive formulary- many life sustaining drugs will not be available to people with AIDS who have already failed on the Medicare formulary drugs.  State AIDS Drug Assistance Programs (ADAPs) do not have the capacity to take on any added burden since they are already woefully underfunded and many ADAPs have implemented cost containment measures including wait lists and scaled back formularies.

Other Areas of Concern

• Bill will not offer much relief to Medicare recipients living with HIV/AIDS.  The new Medicare drug benefit, scheduled to begin in 2006, would pay 75 percent of a Medicare patient’s drug costs up to $2,200 a year, with a $275 deductible for prescription drugs and a monthly premium that would average $35.  The program would pay nothing more until the beneficiary had spent a total of $3,600 out of pocket. Then the beneficiary would pay a sliding scale of co-payments for each new prescription, depending on his or her income level.  This would not be much relief for a person with HIV/AIDS who has an average annual drug cost of $13,000.00. 
  

• Scaled back guarantee of coverage impacting rural areas.  The agreement includes a compromise on whether the government should, as the Senate wanted, guarantee that coverage is available everywhere, even if private insurance companies decide not to take part -- a particular concern in rural places that private plans have largely avoided because the markets are less profitable. Under the Senate plan, the government would have stepped in anywhere that Medicare patients did not have a choice of at least two private drug policies. The compromise would consider patients to have adequate choice if there is one such free-standing insurance policy for drugs and one private health plan in their area.
  

• The bill would motivate Medicare patients to leave the traditional, fee-for-service version of the program.  During the Conference Committee, there was a central ideological disagreement over how far the government should go to try to motivate Medicare patients to leave the traditional, fee-for-service version of the program, to which nearly 90 percent belong, and join private health plans. The House voted to try to foster that migration by placing the traditional program into a direct price competition for patients with preferred provider organizations, known as PPOs, and other kinds of private health plans through a strategy that Democrats have warned would end up making it more expensive to remain in the original program.  In the end, the agreement pares, but does not eliminate, the House's idea. The price competition would be allowed to start in 2010 in as many as six metropolitan areas and last for as long as six years.
  

• The bill would disqualify many low income seniors and people living with disabilities from receiving vital drug subsidies.  Contrary to the Senate bill, the conferees intend to disqualify low-income seniors and people living with disabilities from receiving much-needed drug subsidies if they have a small amount of assets. The Conference Committee's assets test would disqualify approximately 2.8 million poor seniors and people living with disabilities from the subsidies they need to make medicines affordable.
  

• Complicated enrollment process may prevent many low income beneficiaries that remain eligible for drug subsidies from receiving them.  The Conference Committee agreement will force low-income seniors and people living with disabilties to enroll for drug subsidies in state welfare offices, not in Social Security offices. This will result in a more complicated process and prevent many from getting the subsidies they need.
  

Many organizations advocating on behalf of Medicare recipients are voicing concern

The Medicare Rights Center, in a statement issued on Monday stated that “The Medicare Rights Center has set a very low bar to support Medicare legislation: it must be better than no bill for people with Medicare. The legislation now being promoted by Congressional leaders cannot meet even this low bar. The bill under consideration does more harm than good.”

Families USA, said the proposal "does too much to destroy Medicare and too little to help the seniors who can least afford their medicines".

Marilyn Moon, a health policy expert with the American Institutes for Research, said, "I think there will be a very narrow band of people who can say unequivocally that this is a really good deal"

ACTION TO TAKE

Call your Senators and House Members in Washington NOW toll-free at 877-762-8762 and tell them that there this bill is a compromise that is not acceptable.

It eliminates a safety net for the most vulnerable Medicare recipients- dual eligible low income seniors and people living with disabilities who would loose current wrap around benefit currently offered by state Medicaid programs.  This would have a devastating affect on 6 million of our nation’s most vulnerable- the elderly and the disabled poor. 

THE AIDS MEDICARE PROJECT was founded as a consumer coalition in June 2002.  Our mission is to advocate for rational public policy on Medicare for people living with AIDS and to ensure that the needs of the HIV/AIDS Community are part of the national dialogue on Medicare.

To contact the AIDS Medicare Project- email randy@allgaierhawn.net