San Antonio Express-News
November 25, 2003

Medicare Prescription Bill

copyright 2003, Paul Premack

Medicare covers medical supplies for diabetes (with some limits) for any person who is 65 or older. At age 60, your mother does not qualify for Medicare just because her husband is 67. But she can qualify, even at age 60, if she is disabled (that is, she cannot do any type of work and is expected to remain disabled for at least a year or to die), or if she has End Stage Renal Disease (kidney impairment that appears irreversible and permanent, requiring dialysis or a kidney transplant).

Since you asked about Medicare, what about the bill Congress is debating? The House Ways and Means Committee released a six-page summary on November 17. The bill (HB1) was released on November 20. On Saturday, November 22 (at 5:51 a.m.), with less than 2 days to consider the contents of the 678 page bill, the House voted in an unusual three-hour roll-call to approve the bill by a 5 member margin. The Senate is also being pushed to move rapidly.

AARP endorses the bill, stating that while it is "far from perfect" it will "provide prescription drug coverage at little cost to those who need it most: people with low incomes, including those who depend on Social Security for all or most of their income." Critics of AARP feel its role as insurance company is displacing its role as advocate for its retired members.

Families USA opposes the bill, stating it will "disqualify low-income seniors from receiving much-needed drug subsidies if they have a small amount of assets. … [the bill] will force low-income seniors to enroll for drug subsidies in state welfare offices, not in Social Security offices."

The House committee summary tells us the $400 billion plan contains:

1) A discount card for Medicare beneficiaries starting April 2004 that could save 15% or more per prescription (the discount probably coming out of your pharmacy’s pocket). It may also provide low-income beneficiaries $600 of assistance in 2004 and 2005; and

2) A prescription insurance program starting in 2006. Beneficiaries would pay $35/month to a participating insurance plan, and would pay the first $275 for prescriptions. The plan would then pay 75% of prescription costs up to $2,200. There is zero coverage for costs between $2,200 and $3,600, but for drug expenses beyond $3,600 Medicare would pay 100% for the poor, and others would pay about $5 per prescription.

Many analysts criticize the proposal as very generous to the drug manufacturers since it does not impose any cost controls. It specifically forbids Medicare from negotiating lower prices, and fails to authorize lower-price purchases from Canadian suppliers. Considering the federal deficit has never been higher (according to the Congressional Budget Office, the government spent over $480 billion more than it received from taxes in fiscal 2003) many believe Congress should slow down to allow the people to understand and weigh-in on this mammoth health bill.