Medicare Part D: D is for Disaster!

Medicare Part D: D is for Disaster! Thursday, Oct. 12, 2006 TEAMSTER’S UNION Sacramento, California Margie Metzler 916-921-5008 margiemetz@hotmail.com Website: www.gpcal.org This program operates under a grant from the California Wellness Foundation

Why do we still care? • Because the new enrollment period is coming up (Nov. 15—Dec. 31. Or more accurately, Dec. 6) • Because the average person hit the Donut Hole on September 22 • Because more and more people are losing their private coverage (endangered Middle class) • Because privatization doesn’t work in health care • Because we deserve better

Issue that Resonates: Medical Care • We pay more than other countries and get less • We are sicker on average than other countries • We are the only country where business provides coverage • US Businesses realizing they can no longer compete with countries with universal health coverage

Can this issue engage voters? • It’s a life and death issue! • Medicare Part D provides a visible example of how privatization fails! • Everyone will get Medicare at some point (if they don’t destroy it…)

Basics • The Medicare Prescription Drug Improvement and Modernization Act was passed in Dec. 2003 • It was the most sweeping change in Medicare’s 40 year history, and the most chaotic • Administered by CMS and SSA • CMS: Rx Program • SSA: Extra help for low income people • Provided by private insurers (not regulated by any state) • Private Drug Plans (PDP) • Medicare Advantage -- Prescription Drug (MA-PD)

How Does it Work? • You go to the CMS Website or call them to register. You research all the CA 48 plans (and their tiers). Or contact HICAP. • You choose a plan based on the drugs they cover, so you need to know what illnesses you will have during the year. • Administered by CMS and SSA: • CMS: RX program • SSA: Extra help for low income • You pay a monthly premium. • If you didn’t sign up by May 15 you pay a penalty for life. • You pay a co-pay for each drug. • You pay 100% while in the annual doughnut hole.

What’s wrong with the MMA? • No negotiating for best prices! • States can’t regulate • Late Enrollment Penalty: 1% penalty per month and the penalty lasts forever • Some retirees lost their creditable coverage for good • You are supposed to have choices, but get few tools to help you be informed • Originally, insurance co’s could change prices, formularies, co-pays, deductibles at will, but you couldn’t change until Nov. enrollment period. Your complaints caused the CMS to change this.

How are we now? • Five months past the May 15 deadline • Nov. 15 to Dec. 31 is new enrollment period (Really, Dec. 6) • 90% of Medicare recipients now have some sort of coverage. Most always had creditable coverage. • The 2 most popular plans are United Health Pacificare, AARP’s plan, and Humana, the cheapest. • 4-5 million seniors still don’t have coverage; of those, 3 million could qualify for low income coverage

Don’t Blame the Pharmacist! • Pharmacists are on the frontlines: paying co-pays and other costs. • Many of them are working hand-in- hand with the rest of us advocates. • They are going out of business (esp. independents)

We want legislation that… • Allows seniors to receive prescription drugs directly from Medicare • Requires Medicare to negotiate with drug companies: reduce confusion, and money saved could eliminate subsidies to insurance companies and close the donut hole. • Waive premiums when there is no coverage. • Donut hole: count all drug costs incurred, not just expenses for those on the insurance plan’s formulary. • Or… eliminate the donut hole

Give us legislation (2) • Eliminates the lifetime penalty for seniors until the whole plan is overhauled. They currently face up to a 7% penalty • Liberalizes the assets test so more are eligible for extra help. (60% of those who applied were ineligible due to the stringent test.) • Increases funding to provide counseling and education to beneficiaries and caregivers. • Revisits the income-based premium structure that “means tests” Medicare for the first time • Easier enrollment

Give us legislation (3) • If Dr. prescribes it, you can have it • Eliminates co-pays for duals • Provides a system for resolving issues “at the counter” • Provides open enrollment any time the plan makes changes to formulary • Provides a single standardized appeals process, widely publicized • Monitors plans and sanctions them if they do not comply • Makes prices public

Where is such legislation?? • 55+ bills have proposed which provide parts of the previous changes • Not one of these bills has been allowed by committee heads to be discussed, let alone voted on • Read about all of them at www.gpcal.org/documents/fedleg.pdf • Talk to every Senator, Representative, and candidate and press for change

Where You Can Go For Help • National Committee to Preserve Social Security and Medicare: http://www.ncpssm.org/medicare/ (a national, nonprofit organization) • Health Insurance Counseling and Advocacy Program (HICAP): Call 1-800-434-0222 to reach your local HICAP or go to www.calmedicare.org • Social Security: 1-800-772-1213 or go to www.ssa.gov • Center for Medicare and Medicaid Services (CMS): Call 1-800-MEDICARE or go to www.medicare.gov • CMS Region IX, San Francisco: Part D plans, (415) 744-3628; Advantage Prescription Drug Plans, (415) 744-3617 • Low income subsidy: go towww.ssa.gov/prescriptionhelpor call 1-800-772-1213 • Medi-Cal Emergency Drug Benefit: http://www.medi-cal.ca.gov • Medicare Advantage—Medicare Managed Care Manual, Ch. 2: http://www.cms.hhs.gov/manuals/downloads.mc86c02.pdf • The Health Consumer Alliance: http://healthconsumer.org

Senators http://www.senate.gov/ Boxer, Barbara- (D - CA) 112 Hart Senate Office Building, Washington, 20510 (202) 224-3553 Web form: www.boxer.senate.gov/email.html Feinstein, Dianne- (D - CA) 331 Hart Senate Office Building, Washington DC 20510; (202) 224-3841 Web Form: www.feinstein.senate.gov/email.html Representative http://www.house.gov/ Dan Lungren http://www.lungren.house.gov/feedback.shtml http://www.lungren.house.gov/index.shtml Or… Doris Matsui Sacramento, CARobert T. Matsui United States Courthouse501 I Street, Suite 12-600Sacramento, CA 95814Phone: (916) 498-5600http://matsui.house.gov/email.asp Federal Congresspersons

CIRCULATE & ADVOCATE • Contact your Senator and Representative in Washington • Contact the Media! “Only media attention gets change.” • Talk to others about the problems with Part D and urge them to join the fight • Legislation: Over 55 bills have been put forward to fix problems; go to http://www.gpcal.org/documents/fedlegpartd.pdf for a complete list. Some of the best include HR 3861, the Medicare Informed Choice Act (Stark, Schakowsky) to extend the deadline; HR 752 (S 873 in Senate) (Stark, Berry) the Medicare Prescription Drug Savings and Choice Act, to create a uniform drug benefit in Medicare and require that Medicare negotiate for the best possible prices; S. 1335, the Justice for Medicare Beneficiaries Act of 2005 (S. 1335), (Christopher Dodd, John Kerry, Edward Kennedy and Jeff Bingaman) ensures that Medicare beneficiaries who are denied health care benefits can appeal these denials in a meaningful way. • To track legislation: http://www.govtrack.us/ • Library of Congress site for Legislation http://thomas.loc.gov/ • Don’t vote for anyone unless they support this fight!

Let’s Change our Language (Lakoff-ian Stuff) • Don’t blame Medicare, blame privatization! • Don’t talk of “enrolling” in a program, talk about buying insurance. • HSA’s: they’re not savings accounts; they’re High Deductible private insurance plans • Remember, health care is a value. Talk it up!

Medicare Part D: D is for Disaster!