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“Wither on the Vine” Medicare Strategy


Newt Gingrich vowed in the mid 90s to see to it that Medicare would “wither on the vine”. What he attempted to do then was to divert Medicare’s public purpose, to euthanize it by funding starvation.

The Medicare rollback plan raised the hackles of disability groups then. Now congress is game for a replay. This time, however, the bait is more deceptive – GOP plans at long last to offer an over due prescription drug benefit to lure the unaware. The plan is to make fundamental structural changes to Medicare that will have a definite negative impact on disabled beneficiaries.

Over 13 million people on Medicare have a disability or chronic health condition. The poorest and most vulnerable are designated as “dual eligibles” -qualifying both for Medicare and Medicaid. Since they have no other secondary insurance such as a MediGap plan, dual eligibles rely heavily on Medicaid for prescription drug coverage as well as services and equipment to meet their basic health care needs.

The clincher is that under the prescription drug plan dual eligibles will lose access to medications.

The proposed plan permits the development of Medicare formularies that will restrict access to needed drugs and prohibit Medicaid from serving as a secondary payer for medications not on the formulary. This portends to force disabled people of all sorts to do without medications they need.

Over the next decade, the Medicare plan shifts resources from a successful government program to the private, for-profit sector.

All the special interests going for the bucks after conversion are not likely to stop the profit-fest to notice if this results in unnecessary and callous injury or debilitating side effects that require hospitalization or other costly medical interventions for the current Medicaid population. It takes a long time for health care advocacy groups to document devastation and present such evidence to be taken seriously in DC.

This awful bill will also shift resources away from people requiring complex or frequent care, such as disabled people and those with chronic conditions, to a relatively healthy Medicare population.

Many provisions in the bill segment the Medicare risk pool in a manner that will result in higher costs and compromised care for disabled people and chronic conditions. Taken together, a number of provisions in this bill serve to undermine the entitlement to Medicare that has served this country so well for the past four decades.

The Consortium for Citizens with Disabilities (CCD), a Washington-based coalition of national disability organizations that advocates on behalf of the 54 million disabled people and chronic conditions (along with about 40 major disability organizations) have come out strongly against this bill.

CCD offers the following excellent analysis as to how the prescription drug plan will undermine public health care:

* Health Savings Accounts, also known as Medical Savings Accounts(MSAs), would undermine the health care system and be especially harmful to people with disabilities and others who rely on insurance to finance a high level of services. Health Savings Accounts provide the incentive to healthier and higher income people to leave the traditional insurance market. This could de-pool the current insurance system that seeks to spread the unpredictable risks for financing care for a relatively small number of people with disabilities and chronic conditions across society.

* Medicare Competitive Bidding for Durable Medical Equipment will cause a long-term reduction in quality and access to high quality assistive devices and services for people with disabilities. In addition, competitive bidding limits beneficiary choice of provider.

* Premium Support Demonstration: The prospect of Medicare fee-for-service competing directly with managed care health plans poses too many risks for private plans to cherry pick healthier beneficiaries and increase costs for people with disabilities who remain in Medicare fee-for-service. * Means Testing the Part B Premium undermines the basic premise of Medicare as an insurance program, causing a disproportionate share of wealthier (and healthier) beneficiaries to leave the program over time, thereby diluting the risk pool further and raising costs for people with disabilities.

* Cost Containment: Requiring Congressional intervention if general revenue contributions exceed 45% of program spending is an unprecedented tactic designed to strengthen the hand of those in the future who seek to dilute the entitlement nature of the program and favor a premium support model.

* The Asset Test in the conference report could block almost four million Medicare beneficiaries with incomes of less than 135% of poverty from getting help with their prescription drug premiums, deductibles, and co-payments. This test is unnecessary and comes at a cost of imposing significant administrative burdens on states to implement such a test. It would also require state officials to ask intrusive questions about the possessions of Medicare beneficiaries and make complex decisions about the value of an individual’s possessions. It is unlikely that this test would be implemented evenly or fairly across states.

Both disabled people and nondisabled people lose by weakening the public insurance system. This congress may be more dangerous to disabled persons well-being than the Gingrinch congress. This is the kind of bill George W. Bush will sign. It bears the mark of the Texan – run up the deficit then reduce government support systems to the lowest common denominator in order to eliminate those pesky poor people.

Marta Russell can be reached at [email protected] http://martarussell.com

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