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Congressional Corner from Representative Robert Wexler: Meet the Press, September 20, 1998 By Representative Robert Wexler (D-FL) Why is this reduction in benefits happening now, and what can be done about it? The bottom line is that Medicare does not provide one penny of coverage for outpatient prescription drugs. Many of the HMOs, which have offered a drug benefit to attract enrollees, have found the escalating costs of drugs prohibitive. The HMOs point to the nearly 15% rise this year alone in the cost of prescription drugs. The General Accounting Office (GAO) paints a different picture. A recent GAO report finds that Medicare overpaid HMOs by $1.3 billion in 1998 and they have profited for years by attracting healthy patients who require relatively little care. Now that some of their profits are in jeopardy, many HMOs are scaling back their prescription drug coverage and charging co-payments for vital services. The sad truth is, as long a profits dominate the health care industry in this nation, many HMOs and other providers will continue to make their bottom line more important than the quality of care they deliver. For now, seniors should examine all of their health care options, including changing HMOs or returning to fee-for-service Medicare. But realistically, it is profoundly difficult to change doctors and plans when you are older and dealing with complex issues of health and prescription drugs. Clearly, the need for a national prescription drug plan has never been more compelling. Three out of every four seniors in this country lack decent, reliable prescription drug coverage. Thirteen million older Americans have none at all. Rising drug costs will virtually impoverish many seniors who live every day on the edge of economic hardship. All this in the face of a strong and vibrant economy and a nation at peace. All this in the face of record surpluses and nearly full employment. It is unconscionable that the dialogue in Washington has centered on how large a tax cut to give to the wealthiest Americans while the generation who fought World War II and Korea and rebuilt this nation after the Depression are losing their very life access to medical drugs. There is only one meaningful solution to the problem of prescription drug coverage; Medicare must cover a significant portion of the prescription drug expense for seniors. President Clinton proposed, and I strongly support, a voluntary Part D benefit under Medicare that would pay for half of a beneficiary's drug costs up to $5,000 per year. The President's drug plan would cost $118 billion over ten years, of which approximately $45.5 billion would be drawn from the budget surplus-a figure representing approximately 5% of the projected non-Social Security surplus. Most Medicare beneficiaries who choose to participate would contribute a $24 premium each month in the first year, increasing to $44 per month when the plan is fully phased in. Those whose incomes are below 135% of poverty ($11,000 for an individual, $15,000 for a couple) would not pay premiums or cost-sharing for Medicare coverage. The remaining costs of the drug plan would be generated by savings derived from other provisions of the President's comprehensive Medicare reform package. The Medicare drug plan will not materialize without Congressional leadership and advocacy, and Congress will not act until the American public demands it. Like the HMO Bill of Rights passed by the House last year, even the most obvious and egregious wrongs go unheeded until this Congress has no choice but to right them. Until Congress acts to extend the reach of Medicare to life-sustaining drugs, we may was well turn back the clock on medical progress. Even the most innovative drugs have no healing effects on those who cannot afford to buy them. This article first appeared in Volume 5, Issue 3 of "The Social Security and Medicare Advisor" newsletter (February/2000). To receive future editions of "The Advisor" in its special, free e-mail version, please click here. | ||||||||
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Last year, hundreds of thousands of Medicare beneficiaries enrolled in Health Maintenance Organizations (HMO's) throughout the nation received disturbing news that their HMOs were pulling out of their region, placing caps on prescription drug coverage, or worse yet, dropping prescription drug coverage altogether. 