Medicare Part D helping many

WASHINGTON – With the first enrollment deadline a week away, the Medicare prescription benefit apparently is achieving its primary objective: helping millions of Americans get protection they did not have previously against one of the most draining problems of growing older.

By the May 15 deadline, federal officials expect to have well more than 20 million seniors enrolled in plans under Medicare Part D, as the benefit program is called. That would include an estimated 7 million or more who previously lacked insurance for outpatient prescriptions. Of the millions who have signed up, many are enjoying significant savings, sometimes $1,000 a year.

That’s a considerable achievement for a government that has not tried to roll out such an ambitious new entitlement program since the days of Lyndon B. Johnson. It’s especially notable for President Bush, who is no fan of big government. Even some of the program’s critics have given up trying to repeal it, while vowing to make it better.

And the performance of the drug plan, offered through private insurers, goes well beyond benefits for today’s seniors. The plan is a test of Bush’s idea that, instead of creating new federal bureaucracies, Washington, D.C., can use businesses, informed consumers and market competition to solve knotty social problems such as access to health care – potentially for all Americans.

“This is the first full test of competition in Medicare,” said Joseph Antos, a health policy expert at the business-oriented American Enterprise Institute. “It’s also a test of consumerism in health care.”

So if Medicare Part D is meeting its goals and helping millions of elderly Americans, why isn’t it being hailed as an unqualified success?

For one thing, the system remains so complex and hard for seniors to navigate that many have yet to enroll, including about 2 million who live near the poverty line and would benefit from its generous subsidies.

More important, Part D might not be working so well for a substantial minority of patients – seniors with complex illnesses and those requiring relatively expensive medicines. These patients often face high costs under the new program that threaten to put needed treatment beyond their reach. A recent poll for the Kaiser Family Foundation found that 19 percent of enrolled seniors said they expect their medications to cost them more under Part D, compared with the 55 percent who said they would save.

That’s because the private insurance companies quietly put these medicines into special coverage tiers that carry higher costs for patients. Doing this helps the companies meet the twin goals of saving taxpayers money while earning a profit.

Officials of organizations representing patients with multiple sclerosis, mental illnesses, arthritis and cancer have expressed particular concern about the coverage policies of the plans.

Another problem is that many pharmacists say they continue to experience difficulties with basics such as timely payment. Pam Grisnik of Grove City, Pa., told Congress recently that more than one-third of her fellow pharmacists around the country fear Part D will put them out of business.

Looking ahead, the program faces challenges:

“Simplifying the plans and the choices so that seniors who have remained outside the program will be induced to join.

“Finding ways to make Part D work as well for the patients with special needs as it has for the majority.

“Dealing with the issues raised by pharmacists and others whose continued cooperation is vital to the program’s success.

Farther down the road, financial problems lurk. Part D does not have its own dedicated revenue stream or tax base. It’s financed with general tax revenues and premiums paid by beneficiaries. Currently, costs are running below initial projections, but the rosy outlook is bound to change. The program’s long-term financial shortfall is estimated to be greater than that of Social Security.

But for now, both the insurance companies and the government vow to fix problems and make the Bush approach work. And, overall, they say it’s working well.