WASHINGTON—The Medicare prescription drug benefit has been cursed for its failures and celebrated for its triumphs.
The program's flaws and shortcomings were exposed early and often in the first few months after its January launch. However, recent news of lower-than-expected drug costs, patient satisfaction and a seemingly successful enrollment drive have given the program a new bounce that could help Republicans fend off future Democratic attacks.
The cost of the drug benefit has declined from a projected $737 billion over 10 years to $675 billion. Beneficiary premiums are averaging $25 a month, down from $37 in last July's budget estimates. And the projected net cost to taxpayers for 2006 will be $30.5 billion, 20 percent less than an earlier estimate of $38.1 billion. In addition to increased competition, Medicare officials credit lower-than-expected drug costs and dampened enrollment for the declines.
But a split decision isn't exactly what Republicans were hoping for when the groundbreaking legislation became law in 2004. The largest expansion in Medicare's history was supposed to be a political knockout.
"There's no question the Republicans thought the passage of (the drug benefit) was their best opportunity in years to neutralize the advantage with senior voters that Democrats have traditionally had on health, and it hasn't worked out that way at all," said Drew Altman, the president of the Kaiser Family Foundation.
So how did a program with such strong initial public support turn into a possible election-year albatross?
The answers are as complex the drug benefit itself. And if the first five months are a sign of what's to come, special-interest groups, lawmakers and concerned seniors will continue to seek changes that GOP lawmakers will likely oppose.
The activity reflects the increasing view that the program is a work in progress, rather than a finished product. If Democrats regain control of the House of Representatives or Senate, expect a push for legislation that allows the government to negotiate drug prices for the program, Altman said.
The AARP, whose backing of the program ensured its passage, now supports legislation by a bipartisan group of senators to remove, during the program's first year, the lifetime penalty for people who didn't enroll by the May 15 deadline. Currently, only Hurricane Katrina victims and people with low incomes can sign up now with no penalty.
The bill, sponsored by Sens. Chuck Grassley, R-Iowa, Bill Nelson, D-Fla., and others, also would provide more funding to encourage enrollments. In the House, Rep. Nancy Johnson. R-Conn., is offering companion legislation.
The Bush administration is urging Congress to delay action on the measure until Medicare analyzes final enrollment data to help determine if the changes are necessary. House Ways and Means Committee Chair Bill Thomas, R-Calif., said he'd conduct hearings on the matter. But Johnson and others are pushing for quick action.
Another proposal with bipartisan support requires Medicare drug plans to reimburse pharmacists promptly for prescription claims filed electronically. A similar Senate proposal also requires paper claims be processed within 30 days.
Pharmacists claim the plans sometimes take more than 45 days to fill claims. It's one of many complaints about the drug benefit.
Another is that with more than 1,200 coverage plans offered nationwide and about 40 offerings per state, selecting a drug plan has been tough for many seniors.
The program's operational problems began almost immediately when Medicare officials ignored the warnings of lawmakers, government watchdogs and patient advocates who said that coverage for 6 million sick, low-income beneficiaries could lapse when their drug coverage switched from Medicaid to Medicare in January.
Computer glitches, inaccurate and incomplete data, and jammed phone lines caused hundreds of thousands of poor seniors to go without their medications when the new benefit began.
About 30 states stepped in to pay for the drugs while the problems were worked out. Medicare agreed to reimburse states for their costs. Drug plans were required to increase from 30 days to 90 days the supply of emergency prescription refills for these and other patients with problems.
Concerns that plans would lure members and then drop coverage of the drugs they used also prompted complaints because members can change plans only once a year. In April, the Bush administration imposed a rule that said plans that stop covering drugs or impose new coverage restrictions must exempt from the changes those people already taking the medications.
A surge of more than 1 million enrollments from May 9 to the enrollment deadline of May 15 helped push the number of people getting some form of Medicare drug coverage to more than 27 million. That includes 8.9 million in stand-alone drug plans, 5.9 million in Medicare managed-care plans, another 5.9 million low-income people who receive full Medicare and Medicaid benefits and 6.9 million people with employer-sponsored retiree coverage that is subsidized by Medicare.
The Bush administration reports a total enrollment of 31.1 billion, but that figure includes 3.5 billion people with drug coverage through other federal government programs.
The drug benefit hasn't packed the political wallop that Republicans expected, but that doesn't mean that Democrats will be able to use it to their advantage in the upcoming elections.
"It isn't emerging as a top voting issue for seniors in this election. Other issues are crowding out health and (the drug benefit) for voters, like Iraq, gas prices and immigration," Altman said.
That could all change, however, if elections draw near and seniors such as Anthony Sakelarios begin to hit the coverage gap, or "doughnut hole." That's when their Medicare drug plans stop paying for prescriptions and require members to pay their prescription-drug costs from $2,250 to $5,100 before their coverage resumes.
Sakelarios, a 55-year-old retired dentist in North Las Vegas, Nev., was disabled 17 years ago by degenerative disc problems that required two operations. He had to dip into his savings to pay and fears he won't be able to do so in the future.
"I'm going to end up depleting my savings. Being on a fixed income, that's a killer," he said.
(c) 2006, Knight Ridder/Tribune Information Services.
GRAPHIC (from KRT Graphics, 202-383-6064): 20060525 MEDICARE
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