Statements on Introduced Bills and Joint Resolutions
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS -- (Senate - October 05, 2005)
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Mrs. MURRAY. Mr. President, today I am introducing legislation to protect low-income Medicare beneficiaries from being penalized under the new Medicare Modernization Act. My legislation also gives all seniors and the disabled more time to make the right choice in selecting a drug plan.
My bill is called the Medicare HEALS Act, which stands for Help for Every beneficiary and Low Income Seniors. I am pleased to be joined today by Senator Cantwell in introducing this new bill.
My goal is to protect very low-income seniors who today are covered by both Medicare and Medicaid. The new drug law will impose new co-payments and premiums on these vulnerable patients, while--at the same time--covering fewer prescription drugs.
Worst of all, the law prohibits States from providing additional coverage, known as wrap-around coverage, to seniors, the disabled and low-income beneficiaries. I believe seniors deserve better. I believe low income working families deserve better, and that's why I've written this bill.
The new drug law will force painful changes on low income patients, and my bill will help protect our most vulnerable from the negative impacts of the drug law.
Let's start by looking at how low-income beneficiaries are covered today versus how they will be covered under the new law. Today, very low income seniors are eligible for coverage under both state Medicaid programs and the Federal Medicare program, so they are often referred to as ``dual eligibles.''
Today, their prescription drugs are covered by State Medicaid programs, and they are a good deal. For many seniors and the disabled, State Medicaid drug coverage involves limited co-payments, no premiums, and coverage for a broad range of medically-necessary drugs.
Once the new Medicare drug program is implemented, these vulnerable patients will lose their State Medicaid coverage. They will be shifted into the Federal Medicare program, which will impose higher co-payments, new premiums and fewer covered drugs. It's a bad deal for low-income seniors and to make matters worse, it's incredibly complicated to figure out which private drug plan meets their needs.
1 am concerned that these individuals will be unable to afford co-payments or tiered co-payments that will be part of many MMA plans.
I am concerned that these individuals will also be denied the most medically-appropriate treatments due to restrictions imposed by the plans or additional financial burdens that plans will use to drive down drug utilization costs.
In addition, I am not convinced that we have done enough to fully educate and prepare beneficiaries to the choices and implications of these choices that they face today.
Another problem with the Medicare drug law is that it will penalize anyone on Medicare who needs extra time to make a decision about which plan to choose or whether or not to join the program. For a new system that is as complex as this new drug law, it's unfair to force people to make a decision quickly and to penalize those who need extra time to make the right choice.
To solve these problems and to protect our most vulnerable, my legislation would repeal the prohibition included in MMA on the use of Medicaid funds to provide wrap around coverage for dually eligible.
While I still believe that additional delay is warranted in switching this population to private plans under Medicare, I do believe we need to ensure that States facing a huge backlash from this population can respond accordingly.
I have joined in support of legislation aimed at providing a 6-month transition period for dual eligibles to give these patients time to phase into these new plans, but I also think we must ensure that States have the ability to respond to lapses in coverage or financial barriers that will deny access to necessary and life saving drugs.
States would have the option of providing wrap-around coverage using both Federal and State Medicaid funds, as they do today.
My legislation would also deduct any State funds used to provide wrap-around coverage from the so-called clawback amount. As we know, the MMA legislation takes back much of the savings States will see by transferring these patients to Medicare. I do not think it is fair to penalize States for trying to do the right thing.
Finally, my legislation would delay the late penalty enrollment from May 15, 2006 until January 1, 2008, for all beneficiaries. This will give all Medicare beneficiaries the time to fully evaluate the plans. The extension will provide beneficiaries with one full benefit year and the open enrollment period to determine if these plans offer them a good value or provide the kind of security we all expect from Medicare.
This extension is of particular importance to those seniors who may be eligible for assistance but have not yet applied. We know that full dual eligibles will be automatically enrolled in a plan if they fail to select one. However, those with incomes from 135 percent to 150 percent of the Federal poverty level could also qualify for assistance but will not be automatically enrolled.
Early estimates from the Social Security Administration and the Centers for Medicare and Medicaid Services (CMS) indicate that a number of seniors have failed to even apply for eligibility determination. I have been told from CMS that 18 to 19 million beneficiaries were mailed information and an application this summer to begin the eligibility determination. So far, only 3 million have even applied.
A recent USA Today/Gallup Poll shows that only 37 percent of beneficiaries understand the program somewhat, but 61 percent do not. Fifty-four percent of beneficiaries do not even plan on joining the program. Many seniors have simply chosen not to even try and navigate the process. For some, there are more than 20 different plans with premiums nationwide, ranging from $1.87 to $100 and deductibles from $0 to $250. This does not even get into restricted formularies or other restrictions that may be imposed.
It is clear that all beneficiaries need more time. Extending the late penalty enrollment deadline of May 15, 2006 is the simplest step we can take to give seniors time to evaluate these plans and this new benefit. The late enrollment penalty of 1 percent each month is a huge financial hit that punishes those who may need the help the most.
In Washington State, we could see thousands of frail, vulnerable beneficiaries paying significantly more for life saving drugs or simply going without. There are an estimated 86,167 full
dual eligibles and an additional 22,869 who receive some assistance from Medicaid. The intent of MMA and this new benefit was to expand access to affordable drug coverage; however, the unintended consequence could be the disruption of care for millions of low income beneficiaries nationwide.
It is my understanding that dual eligibles in Washington State will be automatically enrolled into 1 of 12 plans. There are 31 plans participating as Medicare Advantage or Prescription Drug Plans (PDPs). Within these plans, there are often several different benefit packages. Premiums range from $0 to $120; deductibles can range from $0 to $2500; and many will have tiered co-payment structures. None of these plans will cover all top 100 drugs used by seniors. Some plans provide only 77 of the top 100 drugs.
While these plans may offer far better benefits than many receive today, it will be difficult to make this determination. The range of choices; the restrictions; the variations in out-of-pocket and the belief by many that this is not a good benefit overall, will lead many seniors to simply walk away.
But, even if seniors decide to sit down and do the calculation and evaluate each plan or option, they face challenges in the reliability of the information.
CMS has partnered with a number of outstanding groups in Washington State who are working hard to get information and help to seniors so they can make informed choices. But the task is made much more difficult when CMS announces that materials already mailed to beneficiaries are incorrect.
My office received notice this week from CMS that the area specific 2006 version of the ``Medicare and You Handbook'' already mailed to beneficiaries contains a rather large error. The error occurs in the comparison charts listing the Medicare Prescription Drug Plans (PDPs). In the last column of the comparison table, entitled ``If I qualify for Extra Help, will my full premium be covered?''
For each plan listed, the column should say yes if the plan's premium is at or below the regional benchmark, and a beneficiary who qualifies for the low income subsidy would pay no premium for this plan.
The column should show no if the plan's premium is above the regional benchmark and a beneficiary who qualifies for the low income subsidy would pay the difference between the regional benchmark and the plan's premium.
Due to an error, this column lists yes for every plan. Even if one could figure out what the regional benchmark is and the difference in the premium, they are still getting bad information.
How can anyone determine the value of a plan or benefit when the initial information is wrong?
There are other examples of information being provided by CMS that is incorrect or inconsistent. I think this has happened in part because this administration is in a race against time to enroll, enroll, enroll. This kind of pressure will only lead to more and more confusion and distrust.
As we saw with the temporary discount drug card, seniors simply refused to participate. Even those who would have qualified for $600 did not bother to enroll. The largest enrollment was done by States and private plans for those who qualified for the subsidy, but far more simply did not bother. The choices were too complex, there were too many rules or restrictions, and there was no way for beneficiaries to measure the value of these cards.
My legislation does not address every problem and every coverage gap, but it is a small step to protect the most vulnerable. I urge my colleagues to join me in making these small but necessary corrections today before beneficiaries lose their coverage and lose access to affordable life saving drugs.
I know that this administration has resisted any efforts at fixing this program and has said the President would veto any legislation that delays implementation or changes the structure of the benefit. But, I am convinced we will be back making changes to this program over the next 2 years because seniors will demand action.
Maybe before all confidence in this program is gone and seniors are calling for repeal, the administration would look at small, humane fixes today, and that is the Medicare HEALS Act offers.
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