“We have never seen a health insurance transition of this magnitude,” the senator was saying. “It involves some of the most vulnerable populations in our society.” The lawmaker noted that the patients are among the poorest and sickest people in society. They are often in nursing homes, physically or mentally disabled. We must get it right, he insisted, “so that no seniors or disabled individuals go without their medications.”
The predictable sound bite of a lawmaker outraged at the bungled start-up of the Medicare prescription drug plan? No. These were the words of Sen. Jay Rockefeller, D-W.Va., and they were spoken not last week, but last year.
In March 2005, Rockefeller pushed a measure that would have extended the time allowed for the poorest and sickest Medicare patients – those whose incomes are typically less than $10,000 a year. State Medicaid programs already covered their drugs, but they were to be transferred into the new Medicare prescription drug plans, run by the insurance industry. On Jan. 1, more than 6 million of these patients were to have been switched, automatically and seamlessly, from Medicaid coverage to the private Medicare plans.
Instead, the nightmare came to life.
It takes form in the images of poor, elderly people turned away from pharmacy counters because they couldn’t come up with the enormous co-payments the insurance plans were demanding – often, in error. It has been seen in mental health clinics, where people are turning up because they can’t turn off the voices in their heads, sounds that used to be stilled by their medicines. It has thrown state Medicaid officials into a frenzy – 28 states have set up emergency programs to pay temporarily for the needed drugs. There is no firm cost estimate, but in a letter to the White House, Democratic governors claimed the price tag will be “in the hundreds of millions of dollars.” Warnings delivered, warnings ignored.
We remember the most famous of these, the memo delivered to President Bush at his Texas ranch in August 2001: “Bin Ladin Determined To Strike In U.S.” And long before Hurricane Katrina, the shelves were full of official reports declaring that the Federal Emergency Management Agency had been diminished, and its efficacy compromised, after it was merged into the Homeland Security Department.
So what became of Rockefeller’s 2005 legislation, which predicted the future so accurately? It was deep-sixed by the Republican majority.
First Rockefeller was voted down in the Senate Finance Committee. Then an effort to amend the Medicare drug bill on the Senate floor was killed on a party-line vote. “Seniors who are dual eligibles will receive their Medicare drug coverage on Jan. 1, 2006,” Republican Sen. Orrin Hatch of Utah argued at the time. “It is not true they will not be covered.” Now there is a scramble to contain the political damage and to reimburse states for their emergency drug costs. The immediate controversy will abate. Few will ask why we tried to force the sickest and least capable patients to navigate this Medicare drug maze, a labyrinth that confounds even the healthiest and best-educated retirees.
Here’s why: Early in discussions about the Medicare drug benefit, Democrats and moderate Republicans argued that those Medicare beneficiaries who were getting their prescriptions through Medicaid were entitled to the same coverage – which they assumed would be more generous – as all others. They believed then that Medicare would pay for medicines directly, using cost controls it imposes on other health services. But then, assisted by their political servants on Capitol Hill, the insurance and drug industries hijacked the Medicare drug measure.
Instead of a direct government benefit, they concocted a scheme to get millions of new patients – with billions of federal dollars flowing into industry coffers. The misalliance produced the costly and confusing monstrosity we now call Medicare Part D.
The poor and the disabled were forced off Medicaid – a program in which they paid no co-payments, or only a $3 fee for medicine – and into private drug plans. The plans might not even cover the medicines a patient is taking, and in any case they aren’t required to provide them at rock-bottom co-payments.
There is now an effort to portray the chaos at the drug counters this month as a mere bureaucratic slip-up, easily fixed with the addition of telephone hotline clerks. The truth is that Congress used the poor and the sick as unwitting guinea pigs in an experiment they were warned would fail.
Marie Cocco can be reached at mariecocco@washpost.com.
