Prescription Drugs - A Letter to Congressman Simmons

A LETTER TO CONGRESSMAN ROB SIMMONS
ENUMERATING CONSTITUENT CONCERNS ABOUT
CONGRESS' PRESCRIPTION DRUG PLANS

August 27, 2003

Congressman Rob Simmons
2 Courthouse Square
Norwich, CT 06360

Re: Medicare prescription drug coverage

Dear Representative Simmons,

It was a pleasure to meet you at the Town Meeting for Union Retirees and Members held on August the 21^st, at Asnuntuck Community College, in Enfield, and to hear such an informed and passionate discussion regarding the Senate’s proposed Prescription Drug and Medicare Improvement Act and the House of Representatives’ proposed Medicare Prescription Drug and Modernization Act.

Prior to the start of the discussion, you shared with me that it was your opinion that both bills could be improved, and in furtherance of this goal, asked me to note the concerns raised by your elderly constituents, so that you could forward them to the House conferees. To this end, I recorded the following:

1. Privatization of Medicare: "If it ain’t broke, don’t fix it."
Several participants in the discussion indicated that they were unhappy with both the Senate and the House bill because both had the intent of privatizing Medicare.

One participant cited a study indicating that Medicare’s administrative costs are only 2% of its budget while private health insurance plans spend 16% of their budgets on administrative costs.

Participants indicated that Congress’ last attempt to privatize Medicare, that is with Medicare HMOs, had been a disaster in Connecticut, as most of the HMOs quickly raised premiums and then withdrew from the program.

Participants argued that health care insurance was a basic human right that should not be trusted to those who are motivated not by the provision of care, but by the making of profit.

2. Premium Inflation:
Participants were wary of both bills as there will be no control over premium inflation. In fact this inflation is a given, as both bills explicitly index the premiums to the annual growth in average per capita spending for Medicare beneficiaries for covered outpatient drugs.

3. Cost of Drugs:
Many participants were frustrated with the rising cost of prescription medications and the government’s failure to control these costs. One participant stated that she had taken a bus load of senior citizens to Canada, and in total, for a month’s worth of medications, the group had saved over $30,000.

4. Home Health Co-payment:
One participant raised the issue of co-payment for home health services. You indicated that you understood the importance of home health care for seniors, and that you were quite dismayed to discover that the bills contained such a provision.

5. Portability:
Participants expressed grave concerns about portability of health care insurance. Some stated that many of Connecticut’s citizens travel to Florida for the winter. When Medicare initiated its Medicare+Choice campaign, many of these individuals signed up for Medicare HMOs. However, these same individuals found that when they needed care in Florida, getting coverage for that care, because they were "out of network," was a bureaucratic nightmare. The participants indicated that they felt that the proposed legislation, due to its intent to privatize (through HMOs and PPOs), would further fragment the Medicare system, and thus create even more bureaucratic nightmares for travelers.

6. Out-of-pocket Costs:
Participants complained that the proposed legislation had too many out-of-pocket costs. They pointed to the "donut hole," high premiums, high deductibles, and high co-payments. This is a legitimate concern, as the break-even point (how much each beneficiary will need to pay out-of-pocket before he or she has any real benefit) has been determined to be $1,155 under the Senate bill and $775.00 under the House bill.

In closing, thank you for addressing the proposed prescription drug legislation at the town meeting and for promising to forward the concerns of your constituents onto the conferees. As you stated in your talk, and as promised by President Lyndon Johnson thanks to Medicare:

No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings they have so carefully put away over a lifetime so they might enjoy dignity in their later years. No longer will young families see their own incomes and their own hopes, eaten away simply because they are carrying out their deep moral obligation.

Please let me know if the Center for Medicare Advocacy can be of further assistance with your efforts in fulfilling our deep moral obligation, that of ensuring a strong Medicare program for America’s elderly population.

Sincerely,

Mary T. Berthelot, M.S.W., J.D.
Attorney at Law