Prescription Drug Coverage
January 1, 2006 signaled a new year and a new beginning in the
Medicare program. For the first time since the program’s
inception in 1965, Medicare offered coverage for prescription
drugs through the new Part D program. As part of the bipartisan
team that developed the Part D legislation, I am gratified that
it helps those in need and am determined to see it successfully
implemented.
The Centers for Medicare and Medicaid Services (CMS)
reports that as of mid-January, there were more than 475,000 seniors
in Arizona with some form of drug coverage. This is good news
because whether beneficiaries have coverage as retirees through
their former employers, through Medicare Part D stand-alone plans
or through Medicare Advantage (MA) plans, what is most important
is that people get their medication.
While more than 24 million seniors are enrolled
in prescription-drug plans nationally, it was very troubling to
me that there were a number of individuals – many with lower
incomes – for whom the transition to Part D was not successful.
I raised this concern directly with the Secretary of Health and
Human Services and Administrator of CMS and got assurances that
each and every problem would be resolved. I will not be satisfied
until everyone who is supposed to receive his or her medications
does and the system is functioning properly.
Those who are eligible for Medicare and who are
concerned about the cost of their medications should examine the
prescription-drug benefit. Seniors can identify the plans that
are best for them by visiting Medicare’s website (www.medicare.gov)
and clicking on “Compare Medicare Prescription Drug Plans.”
You should have a list of your current prescriptions handy and,
if you are interested in enrolling in Medicare Advantage, a list
of your doctors as well. You can also phone Medicare for assistance
at 1-800-MEDICARE, or call one of my offices at 602-840-1891 (Phoenix),
520-575-8633 (Tucson), or 202-224-4521 (Washington, D.C.). You
should also consult with your doctor to help identify the plan
that’s best for you.
It is important for those who decide to enroll in
one of the new Medicare prescription-drug plans to do so by May
15, 2006. If you do not enroll by that date, but decide to enroll
later, you may be subject to a higher premium based on a late
enrollment penalty. You may also have to wait to enroll until
the next open season in November 2006. As it stands in current
law, the late enrollment penalty is currently set at one percent
of the base premium for each uncovered month of each year, and
it stays in effect as long as you are enrolled in a Medicare drug
plan. (The late penalty will not apply to people who have other
drug coverage, called creditable coverage, including people with
employer-sponsored coverage.)
Health Coverage Options under Medicare
Remember, for the vast majority of seniors, participation in the
new prescription-drug benefit program is voluntary. That said,
there are advantages to enrolling now. Aside from the avoiding
the late enrollment fee, seniors will be able to take advantage
of new benefits and a broader range of health-care options. Seniors
who prefer to stay in traditional Medicare may continue to do
so. Those who have belonged to local Medicare HMOs in the past
will be able to enroll in regional HMOs, which will cover no area
smaller than an entire state. In other words, all Medicare beneficiaries
will have the ability to choose Medicare HMO coverage. It will
come under the Medicare Advantage program, which will also include
PPOs for the first time in history. PPOs are a type of health
insurance that Members of Congress and federal employees have
through the Federal Employees Health Benefits Program. In fact,
the PPO option was one of the most frequent requests made by constituents
in calls and e-mails to my Arizona offices. Competition among
PPOs has created more health-care choices for federal employees,
protected the quality of health care they receive, and provided
opportunities to reduce costs. The new PPO plans will be able
to offer seniors disease-management and chronic care programs
not covered under traditional Medicare.
Innovation, Quality and Patient Care
Beginning this year, when a beneficiary becomes eligible for Medicare,
he or she is eligible for an introductory physical. This will
enable the person’s doctor to collect all relevant medical
history and perform diagnostic medical tests and screenings that
will allow doctor and patient to plan a personalized course of
treatment and then better manage the patient’s medical conditions.
All Medicare beneficiaries are encouraged to take full advantage
of this and all other new benefits.
Careful monitoring of clinical outcomes and quality,
a component of the new Medicare updates, is designed to foster
better patient outcomes and higher patient satisfaction. By empowering
beneficiaries to act as responsible health-care consumers, the
Medicare program will be strengthened and will continue for future
generations of Americans.
When our loved ones are in need of medical treatment,
we all do whatever we can to make sure they get the best possible
care as quickly as possible. And most of us want that care from
the physician or health-care facility of our choice – a
physician or facility that is not only well qualified to provide
care, but readily available in an emergency.
Yet such access to quality care can be jeopardized
when Medicare fails to pay doctors and hospitals adequately for
the care they provide to older Americans. In an effort to control
costs, Medicare limits the amount it pays for services, causing
many hospitals, physicians, and other health-care providers to
limit the number of Medicare patients they see, to stop treating
Medicare beneficiaries altogether, or to compromise the quality
of care they provide.
Consider that, in 2002, Medicare actually cut payments
to doctors, despite the increasing cost of medical equipment and
technology, medical malpractice insurance, and other expenses.
Further reductions were slated for 2003, 2004, 2005, and 2006.
Congress recently passed the Deficit Reduction
Act (S. 1932), which freezes payments to physicians and avoids
the scheduled 4.4 percent cuts. If the cuts had taken effect,
Arizonans would have been harmed, their access to quality physicians
compromised. While physicians won’t see drastic payment
reductions in 2006, the issue still looms large for 2007. I am
taking an assertive role in shaping the discussion of physician
and hospital payment. My colleagues in the House and the Senate
together with the administration and physicians groups must work
to find a permanent solution to this problem.
An area that is of great concern is the affordability
of health insurance. Small businesses and self-employed individuals
often speak to me about the high cost of insurance and seek remedies
to this problem. Considering the large number of small businesses
and entrepreneurs in the state and across the country, it makes
sense to provide viable health-insurance options to smaller purchasers.
Health insurance means little if patients cannot
find doctors or hospitals to treat them. Misuse of our nation’s
medical liability laws is producing just this result. The dramatically
rising costs of medical liability insurance for physicians and
other health-care providers is, in some cases, making it too expensive
for them to continue to offer care, thus compromising patients’
access to quality, affordable health care.
Since 2000, direct medical liability costs have
escalated 54 percent at Arizona’s primary medical liability
insurance carrier. There are only a few ways doctors and hospitals
can bear those costs. They can pass a portion of them on to patients
or they can alter their practice patterns. Some physicians have
cut the salaries of their professionally trained medical staff
or reduced the size of their practices. Those who are still employed
after the cutbacks are overworked and stretched thin with added
responsibilities. Other doctors have reduced or completely eliminated
some gynecological, surgical, or high-risk obstetric procedures.
Perhaps most disturbing are the ever increasing instances of physicians
retiring early, relocating their practices to states with friendlier
laws, or dropping certain specialties altogether.
The average wait for a consultation with a gastroenterologist
in the Phoenix area is now two to three months. Administrators
at Mesa hospitals report that, at their facilities, there is an
acute shortage of both orthopedic surgeons and neurologists that
causes both emergency room and inpatient consults to be delayed,
almost on a daily basis. The last practicing Ob-Gyn working outside
of the reservation in Apache County has stopped delivering babies.
Patients who suffer a serious trauma or injury have only one option
for treatment in southern Arizona because other facilities have
closed their units. This is in part due to exorbitant premiums
and the lack of physicians willing to practice under the threat
of lawsuits.
And consider this: According to the Hudson Institute,
while medical malpractice insurance hikes and frivolous suits
are limiting our access to health care, the trial lawyers are
cashing in. A study by the Institute found that 57 cents of every
dollar awarded in malpractice cases goes not to the patient who
was harmed, but to trial lawyers.
Left unchecked, the problem will make more physicians
flee our state to others that have laws limiting abuse and exorbitant
awards, while other physicians will elect to go without liability
coverage and take the chance that they will not be sued. All too
many doctors will retire early from the practice of medicine.
None of these options is desirable.
In an effort to address the problem, I’ve
cosponsored the Help Efficient, Accessible, Low Cost, Timely Health
Care (HEALTH) Act, which would limit non-economic damages for
pain and suffering awarded in malpractice suits. The bill would
impose no limit on the economic damages that could be awarded.
Our neighbor to the west, California, has implemented a $250,000
cap on non-economic damages since 1975. As a result, California’s
malpractice insurance premiums rose less than those in the rest
of the country (167 percent versus 505 percent).
Health savings accounts were created in the 2003
Medicare law and allow all Americans the opportunity to have more
affordable, quality healthcare. HSAs bring together a high-deductible
health plan with a tax-free personal savings account for medical
expenses. HSAs allow health-care consumers to shop for care that
best meets their needs and restrain unnecessary spending. More
importantly, it allows individuals to continue their health-care
coverage even if they are between jobs. This new feature has been
embraced by more than three million people, many of whom were
previously uninsured.
The HSAs’ tax advantage is this: An employer’s
contributions to an individual’s HSA are excluded from the
employee’s taxable income. The employee’s contributions
are also left untaxed, as is the interest generated within the
account. Total yearly contributions could be as large as the individual’s
health-insurance plan deductible, between $1,000 and $5,000 for
self-coverage ($2,000 and $10,000 for family coverage). And consider
this: Distributions from the account would remain tax-free
as long as the money is used for qualified medical expenses. This
includes but is not limited to prescription and over-the-counter
drugs, long-term care services, and health-coverage purchases
continued under COBRA policies.
In his State of the Union Address, President Bush
outlined his plans to make HSAs more affordable and portable.
I support these efforts and am interested in working on sound
tax and health policy legislation. As one of the Members who developed
the HSA option, I am glad they have been received well and look
forward to making sure they work as intended. This may mean tailoring
HSAs to allow for higher contributions (the current maximum amount
is $2,700 for individuals and $5,450 for families) and supporting
a refundable tax credit.
Thousands of women across the country have become
engaged in the issue of hormone-replacement therapy, and whether
it is advisable to undergo it. The Food and Drug Administration
recently had a public comment period examining whether restrictions
should be placed on compounding pharmacists who dispense hormones
synthesized from plants. The agency received more than 40,000
comments on this topic from all across the country. It is currently
reviewing its policies on hormone-replacement therapy and hopefully
will have a decision in the near future. In the meantime, I encourage
women to research this issue, and if you have questions or comments,
please contact my office.
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