(WASHINGTON, D.C.) – U.S. Senator Patty Murray (D-Wash) today spoke on the Senate floor on her amendment to the Labor, Health, and Human Services Appropriation bill (LHHS) to provide $2 billion in emergency funding for states to provide “stop gap” drug coverage for low income seniors and the disabled currently receiving assistance from Medicaid, State Drug Assistance Programs or AIDS drug assistance programs.
This funding is provided to ensure that no one currently receiving coverage or assistance will be left uncovered as the new law is implemented.
Senator Murray, who voted against the Prescription Drug Law in 2003, spent Columbus Day recess speaking with patients, doctors, pharmacists and health care advocates across Washington state about how implementation of the new law will affect Washington’s most vulnerable residents.
Senator Murray’s floor speech follows:
Mr. President, I call up the Murray Amendment Number 2220.
Mr. President, there is a dangerous flaw in the Medicare prescription drug program that’s about to take effect. This flaw is a ticking time bomb 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 and Senator Bingaman 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 this month 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.
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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. My amendment provides emergency funding to prevent this disaster.
First, it ensures that our most vulnerable don’t lose their current drug coverage. It provides $2 billion in emergency funding to make sure low income seniors don’t lose benefits or suffer a gap in coverage. That money will allow states to help low income residents, people who currently get help from state drug assistance programs, and people being helped by AIDS drug assistance programs.
My amendment protects our most vulnerable, including any beneficiary with income below 150% of the Federal Poverty Level, and any beneficiary currently eligible for Medicaid through “spend down” requirements. It gives states flexibility to protect their residents. States could provide coverage through Medicaid or as a separate drug assistance program. And my amendment provides accountability. States would be required to notify CMS of their plan for ensuring no lapse in benefits for low income beneficiaries.
Second, my amendment ensures that everyone knows about the changes. It requires states to notify those currently eligible for Medicare and Medicaid assistance. States would also notify pharmacists, Community Health Centers, rural health clinics, hospitals, critical access hospitals, doctors, and other Medicaid-eligible providers that this assistance is available. Providers would be allowed to seek reimbursement for any uncompensated costs associated with providing medically-necessary drugs to this population.
In summary, my amendment protects our most vulnerable and makes sure everyone involved knows what’s happening.
Mr. President, as I close let me just recap the main points. The new Medicare prescription drug program has a lot of problems. The most urgent problem is the way it will hurt our most vulnerable patients and the difficulty it will cause our health care providers like hospitals, nursing homes, doctors and pharmacists.
For our most vulnerable – people with low incomes – the new program will take away the coverage they get today and charge them more for less access. It could also leave many with a gap in coverage.
My amendment provides $2 billion in emergency funding to make sure no one falls through the cracks. The states can use that money to protect their most vulnerable with both flexibility and accountability.
In addition, my amendment addresses the confusion and lack of information by helping states notify affected patients and providers.
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.
Senators who are concerned about the health and well being of their constituents — but who also are concerned about the cost – do have other options. We can support efforts on reconciliation to provide additional time to transition this new plan. We can also make changes to the Medicare Modernization act to let states provide coverage through Medicaid during the transition.
This is a problem. Either we spend the money now to prevent a crisis, or we need to push the deadline back so we are all prepared to make the transition smoothly.
People’s lives are hanging in the balance.
I urge my colleagues to stand up for those who today don’t have a voice – and for the doctors, hospitals, pharmacists and nursing homes in your state – and give them the relief and protection my amendment provides.
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