Don't Let Poor Seniors Fall Through the Cracks: Senator Murray Offers Amendment to Protect America's Most Vulnerable from New Prescription Drug Program

Nov 02 2005

Murray's plan would give 6.4 million low-income seniors and the disabled an extra 6 months to transition into problematic drug program

Murray Asks Medicare Office How it "Lost" 8,800 Washington Residents

(Washington, D.C.) – Today, U.S. Senator Patty Murray (D-Wash) urged the Senate to ensure that 6.4 million low-income and disabled Americans get an extra six months to transition into the new Medicare prescription drug program.

Murray's amendment would help "dual elibigles," low-income and disabled individuals who today receive healthcare assistance from both state Medicaid programs and the federal Medicare program. The 2003 Medicare Prescription Drug law moves these vulnerable individuals into a new federal Medicare drug program that requires them to pay more money for access to fewer drugs. The law also blocks states from providing extra help to residents who will now face greater barriers in accessing prescription drugs.

Murray's amendment would give states and dual eligibles an extra 6 months to transition into the new system. The extra time would ensure no residents fall through the cracks and that each person has time to select the plan that meets their needs. Currently, individuals who do not select a plan by December 31st, 2005, will be randomly assigned to a plan that may not meet their needs.

In a Senate floor speech, Murray said the new drug law is "a time bomb that is ticking for more than six million Americans, for our communities, and for our health care providers."

"We cannot let low-income seniors and the disabled lose their drug coverage. We cannot leave doctors, hospitals and nursing homes unprepared for the biggest change in decades, and we cannot push hundreds of thousands of people who need care onto our local communities. We cannot wait. We need to fix the problem today, and that's why I'm offering this amendment," Murray said.

Five other Senators endorsed Murray's amendment - Senator Jay Rockefeller (D-WV), Senator Jeff Bingaman (D-NV), Senator Hilary Clinton (D-NY), Senator Edward Kennedy (D-MA), and Senator Frank Lautenberg (D-NJ). Murray's amendment would cost $130 million over five years. A vote is expected on Thursday, November 2nd or Friday, November 3rd.

Murray also questioned how the federal Centers for Medicare and Medicaid Services (CMS) managed to "lose" more than 8,800 Washingtonians in its most recent mailing. According to the state of Washington, there are more than 95,000 full "dual eligibiles" in Washington state. CMS however, is mailing notices to only 86,169 Washingtonians.

"Somehow 8,831 vulnerable residents are not being counted," Murray said. "They won't get a letter. They won't be signed up for a plan. They'll just be lost in the transition, and on January 1st they'll find out they have no drug coverage. That is exactly why we need more time to make this transition."

Last month, Senator Murray held roundtables in Seattle, Lakewood, Yakima, Aberdeen and Olympia where she heard from doctors, pharmacists, senior advocates, and low-income and disabled patients who are worried about how the new treats "dual eligibles."

Today's amendment is one of the steps Murray has taken to protect vulnerable seniors. On October 28, 2005, she offered a different amendment to give states $2 billion so they could continue to provide care to low-income seniors during the transition.

In addition, Murray wrote a separate bill called the Medicare HEALS Act (S.1822), which provides special help for the most vulnerable and also gives all seniors a full benefit year to select a drug plan without penalty.

Senator Murray's Remarks Follow:

Mr. President, I have serious concerns about the budget that's now before us.

To make our country strong again, I believe we need to invest here at home, but this budget will cut $35 billion from America's priorities and burden our children with massive debt. I'm especially concerned about what will happen to our most vulnerable – in this budget and in the new Medicare prescription drug law.

This budget cuts $27 billion from Medicaid – a health care program and a safety net for our country's most vulnerable and sickest. Cutting their healthcare is the wrong thing to do.

And as I look ahead to the Medicare prescription drug law, I see a time bomb that is ticking for more than six million Americans, for our communities, and for our health care providers. That fuse is set to detonate on January 1st, 2006.

We cannot let low-income seniors and the disabled lose their drug coverage. We cannot leave doctors, hospitals and nursing homes unprepared for the biggest change in decades, and we cannot push hundreds of thousands of people who need care onto our local communities. We cannot wait. We need to fix the problem today, and that's why I'm offering this amendment. I've been working with Senator Rockefeller, Senator Bingaman and Senator Nelson to address this immediate crisis, and I want to thank them for their leadership.

I've also introduced my own bill to protect our most vulnerable. It's called the Medicare HEALS Act. It is S. 1822.

Mr. President, I've been traveling around my home state of Washington meeting with people in Seattle, Lakewood, Yakima, Aberdeen and Olympia. They are angry, confused and worried – and with good reason. Mr. President, here are some of the concerns I heard.

One senior told me: "Everyone I have talked to is totally confused - my doctor, my pharmacist, even the Medicare number you are supposed to call."

Another said, "If we can't understand this, the whole plan is going to fail."

Everywhere I went people were confused. There were questions I couldn't answer, and when I turned to the doctors sitting next to me, they didn't know the answer. And neither did the pharmacists or the patient advocates.

If Senators and doctors and experts don't understand this – how can we expect an 80 year-old person with serious medical problems to understand this complicated program? We can't – so we need more time and more resources to make this work.

One person I met with said, "Please give us more time, give us the chance to understand this so we don't make a mistake when we sign up."

Finally, one panelist said, "Taking something away from those that need it the most . . . is not the American way."

I couldn't agree more and that's why I'm here on the Senate floor offering a solution.

Mr. President, I have many concerns with the Medicare Prescription Drug Law. I voted against it in 2003 because I believe seniors deserve better, and America can do better. I'm concerned about the complexity, the coverage gap, and whether needed drugs will be covered. I'm concerned about retirees losing the good coverage they have today, and I'm concerned about the late-enrollment penalty that will punish seniors who need more time to pick the right plan. I'm working with many other Senators to address all of those concerns.

But today the most urgent problem is the way the new law treats our most vulnerable – people with low incomes, the disabled and those facing serious medical challenges like AIDS. This law takes away the critical drug coverage these people have today and puts them into a new program that could charge them more money in exchange for less drug coverage. If they don’t sign up for a plan, they're randomly assigned one.

Either way, the prescriptions they need may not be covered. And because these Americans are living on the financial brink, an interruption of their drug coverage – or a new co-payment – could keep them from getting the drugs they need to live.

The people who are being affected don't know what's going to happen. Their doctors and pharmacists don't understand it either – and this entire mess is going to burst into the open on January 1st. We need to take action now to prevent this catastrophe which is just a few months away. To understand the problem, let's look at how our most vulnerable get prescription drugs today – and how that will change.

Today, about 6.4 million Americans with low incomes get help from two programs – Medicare at the federal level and Medicaid at the state level. These individuals are sometimes called "dual eligibles" because they are eligible for assistance from both Medicare and Medicaid. What Medicare doesn’t cover, states usually cover.

For example, since the federal program did not cover prescription drugs, the state programs filled in the gap. This state coverage – often called "wrap around coverage" – is critical for vulnerable families.

As a result, these individuals get the drugs they need – often without co-payments or deductibles. But there's a big problem coming on January 1st. The new drug program prohibits states from providing the extra help they provide today. Instead, it moves these individuals into the Medicare program alone – which requires higher out-of-pocket payments and which may cover fewer drugs.

To me, it doesn't make sense to – take away the good coverage vulnerable families have today, force them into a program that might not meet their needs, charge them more money in the process, and then prohibit states from helping out their most vulnerable residents.

It doesn’t make sense – but that's exactly what the new drug program will do unless we fix it before January 1st. In fact, the new Medicare prescription drug program changes the coverage for our most vulnerable in five ways:

  • It imposes higher costs (premiums, co-pays and deductibles).

  • It covers fewer drugs.

  • It blocks states from providing extra help – as they do today.

  • It provides no transition period to ensure low-income residents don't face gaps in coverage.

  • And it penalizes people who more need time to pick the right plan.

Mr. President, these are real people we're talking about. Let me introduce you to two of them.

Earlier this month in Seattle I met Kathryn Cole. Kathryn is 36 years old, disabled and living on Social Security disability. She fills about 15 prescriptions each month, and her monthly income is $757.

She told me, "Even if the co-pay were only $5, that adds up to $75 a month. I don't have the kind of extra money to squeeze out of my budget." Kathryn asked me, "Which week am I not supposed to eat?"

People like Kathryn are living on the financial edge – they can't afford to pay more for their medication. They need our help.

In Olympia, I met William Havens. He's 50 years old and living with HIV/AIDS. He takes 43 pills a day. William told me, "For the first time I realize I'm going to have to make a choice between pills and food." It's outrageous that this new law is going to make life so much harder for people like Kathryn and William.

In addition to hurting people, the new drug program will hurt our health care system. It will have a costly impact on nursing homes, doctors, pharmacists and hospitals. Many dual eligible individuals live in nursing homes. Now nursing homes are going have to have to navigate all these new plans.

In my home state of Washington, there will be at least 14 new plans – all with different costs and different formularies. Nursing home managers are going to have see which plan a resident has and if the needed drugs are covered.

In Olympia, I met with Dr. David Fairbrook. He's in private practice and is also the medical director at two skilled nursing facilities, which care for 150 people. He's very concerned about patients being randomly assigned to plans that don't meet their medical needs. He said patients may be denied needed drugs, they may be forced to change their medications, and they could face a time consuming, stressful appeals process. Dr. Fairbrook predicts there will be "chaos for nursing staff regarding coordination of multiple suppliers. It further duplicates paper work and documentation requirements."

Mr. President, that is a tremendous new administrative burden for understaffed and under-funded nursing homes and care providers.

Unless we act, the new program will make the work of pharmacists so much harder. Pharmacists will literally be on the front lines. They will be forced to deny coverage to seniors. CMS is telling us that pharmacists will be able to look up and see what plan someone was assigned to.

Frankly, Mr. President given the errors and mistakes CMS has made so far, I don't have a lot of confidence this will be a flawless transition. And remember, the people that will be hurt have no financial cushion. They're living on fixed incomes and don't have an extra twenty or thirty dollars for co-payments or premiums. If they're turned away at the pharmacy counter, they don't have the money to pay for drugs now and get reimbursed later when the paperwork is sorted out.

Doctors will also be on the front line. Doctors will have to know which drugs are on the formulary, they may need to help patients appeal any denials, and they'll have to treat patients who have gone with out their medicine.

One doctor I met with told me that "Doctors don't have the information they need on this yet. If patients pick the wrong plan and their medicine is not covered, it can have serious medical harm"

Hospitals will also be affected. They're going to have to navigate all these new plans. They're also going to have to deal with patients who haven't been able to get their prescriptions. In fact, for many poor families, the only place to get needed medicine will be the emergency room. That's going to increase the cost of healthcare for all of us.

In summary, this new drug law will impose an expensive and confusing administrative burden on doctors, pharmacists, hospitals and nursing homes. We can do better. My amendment says, Let's fix this problem before people realize they can't get the prescriptions they need.

The Murray/Rockefeller/Bingaman amendment provides a 6-month transition for low income dual eligible beneficiaries. It does not delay implementation of the Medicare Part D benefit. It simply gives States, CMS and the Social Security Administration 6 more months to ensure that all those who currently have access to prescription drugs through Medicaid -- or who are eligible for Medicaid assistance -- are not lost in the transition.

According to CBO, this amendment could cost $130 million over 5 years. That is a small price to pay when we're talking about the lives of 6.4 million Americans. In this budget, we're being asked to cut $27 billion from healthcare for the poor. I think it's worth spending less than one percent of that amount to make sure our most vulnerable don’t lose their drug coverage.

Today we got another example of how easily our most vulnerable could fall through the cracks. Today, CMS announced it will send a mailing to 86,169 dual eligibles in Washington state.

But according to the figures I got from officials in my home state, there are actually 95,000 dual eligibles. So somehow 8,831 vulnerable residents are not being counted. They won't get a letter. They won't be signed up for a plan. They'll just be lost in the transition, and on January 1st they'll find out they have no drug coverage. That is exactly why we need more time to make this transition.

I urge my colleagues to support this amendment and give our most vulnerable a few extra months to make sure they don't get lost in the transition. This is really a life or death issue for so many. Please do not rip away the last remaining safety net for these seniors. We owe them at the very least this one small fix.

Mr. President, time is running out. On January 1st, millions of vulnerable Americans will be forced into a new system they don't understand and that does not meet their needs. We can avoid this train wreck. People's lives are hanging in the balance.

I urge my colleagues to vote for the Murray/Rockefeller/Bingaman Amendment.