My pharmacist in California was alarmed when I told her that ALL people now on both Medicare and Medicaid would be forced onto the new Medicare prescription drug program (Part D). "Medicaid will pay for most all drugs people need," she said. "Medicare will be less of a benefit."
With the onslaught of the Bush administrations incompetence and minimal government policies that result in lethal negligence in our country and abroad, sometimes policy-wonk-type issues such as the prescription drug implications for one vulnerable population fall to the bottom of the ladder and don't get attention.
I'm going to spend some time on this seemingly small Medicare prescription drug program matter that will have grave consequences for about 6 million people on both Medicare and Medicaid, in bureaucrat-speak called "dual eligibles" - DEs for short.
To qualify for Medicaid one must be extremely poor with almost no assets, so this group is the poorest amongst Medicare beneficiaries. They cannot afford to pay for their drugs and get virtually free medications from the state.
Enrollment is not mandatory into the new Medicare prescription drug program for seniors to begin January 1, 2005. However the Congress and Bush have seen fit to make it mandatory that DEs enroll in the program.
So what is the problem if both public programs provide drug coverage? It is the introduction of private insurance corporations that will administer the Medicare drug program.
Now, Medicaid directly pays for prescription drugs for DEs - there is no middleman. But under the new Medicare drug plan private insurance corporations - the market - will control the "public" program. The Medicare prescription drug plan PRIVATIZES the pharmaceutical benefit.
This switchover means a vast structural change in how DE people obtain medications. With private insurers in charge the first concern will be to make profits off enrollees.
Historically significantly disabled and chronically ill people have been shifted onto public programs like Medicaid because their medical expenses are often high and private insurers like to unload them as soon as possible because they are not profitable. Upfront insurers cherry pick and don't want this population in their private plans. Upon disablement many employers are eager to switch employees from company-paid-for private plans onto Medicare as their primary provider. It follows that if the goal is to provide a plan that will accommodate DEs' needs, it is illogical for the federal government to force this group onto capitalist private plans. I must conclude that the Republican controlled government is once again -- as it did with its Medicare HMO plans -- going to provide a feeding frenzy for the insurance corporations while DEs struggle to figure out ways to survive this monumental change. For example, the Medicare drug plan involves a variety of insurers, premiums, co-payments and covered drugs. It is set up to be a confusing operation.
Premiums will be covered by the Medicare drug plan for DEs, but those who are being provided their medications directly by Medicaid will now have to rely upon private drug plans that may or may not cover all the drugs they are currently taking. For instance, the Center for Medicare and Medicaid Services (CMS) has made the regulations by which the private insurers must abide. CMS has already stated that some drugs that most states cover through their Medicaid programs--such as benzodiazepines--will not be covered by the Medicare drug plan.
CMS is allowing the private plans to opt out of covering the entire class of benzodiazepines - drugs often used to treat spasticity, anxiety, panic attacks and other serious conditions.
CMS is forcing DEs into the Medicare drug plan but it does not force the private insurance policies to continue a person's current drug regimen. Each private insurer may come up with its own formulary and it is highly likely that no one plan will cover the exact drugs a person may be taking (and must take because they work for them as an individual).
Often DEs have worked with their doctors for years to come up with a combination of drugs that work for them. Under the Medicare drug program DEs are expected to change to cheaper generic drugs and/or make other adjustments that may not work for their specific combination of conditions. Many of this group cannot do without even one of the drugs they must take yet they may be faced with this dire circumstance where they may not be able to pay out of pocket for an indispensable drug. Tens of thousands of persons across the nation will be affected, for they require specific drugs (not substitutes) for their conditions. Further, CMS allows any private insurer to DROP a drug off the formulary at any time it chooses to do so. Co-payments are part of the game. Since plans are not available yet to scrutinize no one knows how much. Any amount will create more hardship for DEs living on below or at-poverty fixed incomes. Privatization of Medicare failed in the past. For instance, when private industry got involved with enrolling seniors on Medicare into managed health plans, prices went sky high. HMOS eventually started dumping Medicare beneficiaries off their plans. Why should it succeed this time with prescriptions drugs? Private drug plans create formularies based on actuarial projections of what will make them the most money. There could be a run up of costs where private industry benefits while citizens get screwed but over the long haul DEs are not going to be viewed as profit makers for these insurance corporations. President Bush has made a disaster out of this drug "benefit" by choosing to put DEs at the nonexistent mercy of the market with his ideological impulsion to protect the insurance and pharmaceutical businesses.
That is not unexpected.
What is unexpected is that national disability organizations did not mobilize to stop the herding of DEs into this crapshoot Medicare drug plan.
The look in my pharmacist's eyes told all - it was the look of horror at the thought of what may lie ahead come January 1. Her recommendation: "Tell everyone to get a three month supply of every drug they take at the end of December while they are still on Medicaid."
That is current law. A better plan would be to make the states cover drugs that the private insurance companies will not. Maybe then some real protections will become law.
Russell is the author of "Beyond Ramps: Disability at the End of the Social Contract" (Common Courage Press).