February 2000
The Hippocratic Oath directs physicians to "guard the sick from harm and injustice." We believe Congress should follow this same principle by passing our legislation that would help the poorest and sickest Medicare beneficiaries obtain prescription drug coverage.
The most antiquated aspect of Medicare - the federal health insurance program for senior citizens and individuals with disabilities - is its lack of a prescription drug benefit. Prescription drugs are a corner stone in modern medicine. Despite this, one-third of Medicare beneficiaries are without prescription drug coverage. The two-thirds of beneficiaries who have coverage obtain it though a variety of sources, often at considerable expense.
The issue of prescription drug coverage for seniors has taken center stage in Congress and in the Presidential elections – for good reason. Today, too many beneficiaries are forced to choose between buying groceries and filling a prescription. This is a decision no American should ever have to make. We should not make them wait any longer for help.
Prescription drugs play a vital role in modern medicine. For instance, anti-rejection drugs enable Americans to benefit from life saving procedures such as heart, kidney and liver transplants. High blood pressure drugs, cholesterol lowering medicines, blood thinners, and other medicines improve life quality for hundreds of thousands of seniors. It is no wonder seniors are demanding prescription drug coverage, and it is our responsibility to deliver.
Ideally, prescription drug coverage should be a component of larger Medicare reform. However, while we work to find the best ways to strengthen and modernize Medicare for current and future generations, Congress must not forget about the most vulnerable Medicare beneficiaries.
To that end, we introduced H.R. 2925, the Medicare Beneficiary Prescription Drug Assistance and Stop-Loss Protection Act of 1999. Our bipartisan bill would help Medicare beneficiaries in greatest need - those individuals who have low incomes or high annual drug costs. H.R. 2925 is designed to provide drug access to this population, without disrupting Congress’s Medicare reform efforts.
The bill includes two key provisions to help beneficiaries in desperate need today. First, it would assist states in establishing and expanding programs — State Drug Assistance Programs (SDAP) — to help low-income beneficiaries obtain prescription drugs. Second, it would create a federal stop-loss protection for beneficiaries who have high annual prescription drug costs.
The S-DAPs would give states flexibility to design a program to meet the unique needs of its residents. Federal matching funds would assist states in developing or expanding programs to serve low-income Medicare beneficiaries. States would receive enhanced federal matching funds to cover individuals whose income is at or below 150 percent of poverty. Regular federal matching funds would be available to states serving individuals whose income is at or below 200 percent of poverty.
S-DAPs would not be operated as an expansion of the states’ Medicaid programs, and the Medicaid rebate system does not apply to these programs.
The stop-loss component would limit beneficiaries’ exposure to high annual drug costs - with no increase in their Medicare premiums. Seniors would continue to receive prescription drug benefits through a market of competing private sector plans.
The federal government would protect beneficiaries who obtain qualifying up-front coverage from paying more than $1,500 annually in out-of-pocket costs for prescription drugs.
It is important to note that our bill provides targeted assistance through funding separate from the Medicare program. It preserves private sector coverage, and would not raise beneficiaries’ Medicare premiums, increase Medicare spending or jeopardize the program’s solvency.
Over 6 million additional beneficiaries would be eligible to receive prescription drugs through the S-DAP program. Together, these two proposals have the potential to help over 31 million Medicare beneficiaries.
One person who would receive help is an elderly woman who recently called one of our offices. She explained that she pays $720 per month for prescription drugs, over $8,000 per year, not including the cost of her oxygen. Sadly, she said - hopefully sardonically - that she might have to kill herself because she "can't afford to live."
Our plan helps those people who need this benefit most now, while preserving Medicare for the future. As Hubert Humphrey used to say, a nation is judged by how it treats its most vulnerable citizens. Congress should not ignore the plight of our nation’s poorest and sickest beneficiaries any longer.