Medicare Part D criticized

Medicare Part D is failing Washington’s neediest senior citizens, and Monday’s deadline for enrolling should be extended until the “costly, confusing and corrupt” drug program can be fixed, labor and consumer advocates said Tuesday.

They cited a newly released report by the nonpartisan health care advocacy group Families USA that said 106,000 of the state’s poorest Medicare beneficiaries, the so-called “dual eligibles” once covered by Medicaid, are worse off under the new drug plan.

The report was referring to people like Becky Manly’s father, who lives in Spokane in an assisted living facility, which takes all but $58 of his $973 a month in Social Security benefits.

Manly said her father, whom she would not identify for publication, suffers from diabetes and dementia for which he takes between seven and 10 pills a day. He is a veteran, and Veterans Affairs pays for most, but not all, of his drugs. What the VA didn’t pay, Medicaid did. That is, until now.

Under Medicare Part D, Manly’s dad must pay $24 a month in co-payments.

“If he didn’t have children who were able to help, he would have to choose between his telephone and his medication,” Manly said. That’s not counting the cost of things like the occasional new pair of pants.

The state of Washington is currently paying the co-payments for the “dual eligibles,” said Jim Stevenson, public information officer for the Department of Social and Health Services. He said the state is prohibited from using Medicaid funds to pay co-payments, but the Legislature budgeted for these payments through the biennium. Many other states are not paying co-payments.

Adding to the problem is that three out of every 10 dual eligibles were automatically assigned to plans that covered less than 85 percent of the most commonly used drugs, according to the report. Beneficiaries are now finding that the Part D plans can drop the drugs from their lists, forcing their doctors to fill out new paperwork on alternative drugs.

Though they are allowed to switch plans, finding another is cumbersome, because there are so many plans, formularies, co-payments and deductibles from which to choose.

“It’s like being told you can buy any bath towel in the country. Go out and buy the best one,” said Ralph DeCristoforo, project coordinator for Community-Minded Enterprises, which helps people find health care in Spokane County. “You really can’t compare one to the other.”

He said even professionals still take at least two hours on a computer sorting through available plans. “A senior should be able to navigate the system without having to ask other people for help.”

The report also cited 7.2 million low-income seniors nationally who qualify for subsidies to help make their medicines more affordable.

As of April 28, only about 1.7 million of those people – about 24 percent – had been approved for the subsidy. In Washington, only about 21,000 of 124,000 low-income seniors had been approved.

According to the Families USA report, “low-income beneficiaries who do not receive the extra help will almost certainly not enroll in a Part D plan, as they cannot afford the premiums and substantial cost-sharing associated with the basic Part D benefit.”

The report also says that the Bush administration’s claims that Medicare drug coverage now extends to 30 million beneficiaries are misleading because two-thirds of these “covered” beneficiaries had drug coverage before the start of Part D.

The Centers for Medicare and Medicaid Services said that in Washington state, about 548,000 people have coverage out of 829,000 eligible beneficiaries as of April 28.

Washington Citizen Action and other advocates are asking that Congress extend the deadline for enrolling in Part D without being penalized for life. They also hope Congress will allow Medicare to negotiate with pharmaceutical companies for lower drug prices and restore full benefits to dual eligible beneficiaries.

A House bill to extend the deadline is awaiting 218 signatures to bring it to a vote. Washington Democrats have signed; Republican representatives have not.

Rep. Cathy McMorris believes it is important to get the program in place and move forward with it, said her spokeswoman, Jill Strait.

“Hopefully, the deadline will encourage seniors to sign up,” Strait said.

“She favors a market-based approach, and having a variety of organizations negotiate different prices will ultimately result in more choices available and a broader range of drugs that are discounted.”