Medicare Part D: (“D” is for Disaster”)

1. Medicare Part D: (“D” is for Disaster”) A Presentation of the Gray Panthers California May 13, 2006 Margie Metzler 916-921-5008 margiemetz@hotmail.com Website: www.gpcal.org This program operates under a grant from the California Wellness Foundation

2. Gray Panthers Motto

3. Overview • What is the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)? • How does it work? • What’s wrong with it? • What do we want, need and deserve? • What should you do right this minute? • What can you do in the long run?

4. What is the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)? • Designed to Support Pharmaceutical and Insurance Companies • Forbids Medicare from negotiating drug prices with the pharmaceutical industry • Gives drug companies power to charge high prices under Part D • Forces you to pay high costs for your drugs • Gives billions of dollars to the HMOs and other Medicare private health plans

5. History of Medicare Part D Jan. 12006 Nov.2003 1988-89 1993 1965 What a mess! Medicare enacted (drug benefit dropped from orig.) Limited drug benefit enacted; dropped Clinton plan had Drug benefit The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) http://www.medicalnewstoday.com/medicalnews.php?newsid=9859

6. System Problems • How come a plan designed for Seniors, 25% Internet users, is completely designed for the internet? • How come we used the most vulnerable (and non-computer literate) people in our country as a Beta test group? • How come no one thought of hiring more people to answer phone etc? • How come nobody thought abut the blind, homebound, non-English speakers, TTY users, people who are functionally or cognitively impaired?

7. Anti-Medicare • Jeopardizes the long-term financing of Medicare • Forbids government from negotiating prices with the drug industry, allows drug industry to keep drug prices high, drives up Medicare costs • Authorizes Medicare spending cap when costs increase • Shifts costs to you; moves Medicare from defined benefit to defined contribution program • Forces Americans with Medicare into private drug plans for drug coverage • Does not let you use your Medicare card to get drugs • Limits coverage of drugs you need • Makes you pay each time you fill a prescription; no supplemental coverage available • Enables Congress to limit health care payments, requiring plans to shift more costs to you

8. Five key reasons why Medicare works • Automatic and reliable coverage; health security • Good choice of doctors and hospitals • Negotiated and reasonable prices • Affordable protection from the financial risk of needing costly health care services • The same cost and coverage regardless of where you live or your health status

9. Part D offers poor coverage for middle income Americans • 20 million people with Medicare have incomes under $25,000 a year and do not qualify for low-income assistance • Part D likely not to meet your needs if you need costly medications • Pays only about half the cost of your medications • Requires hefty co-pays in addition to premiums and big coverage gap—”donut hole”—once drug costs reach $2250.

10. The Dreaded Doughnut Hole

11. Chaos!

12. What’s wrong with it? • Medicaid/Medicare people were auto-enrolled Jan. 1. Chaos! • Late Enrollment Penalty: 1% penalty per month and the penalty lasts forever. • Retirees with Current Drug Coverage – Beware! You can lose all your coverage if you’re not careful. • The Donut Hole. After you’ve paid $2250, you get no coverage at all till you reach $5100. But you’re still paying premiums!

13. More Wrongs… • No negotiating for best prices! • People are supposed to have choices… but they can’t be informed consumers • The plans got to change prices, formularies and deductibles at any time, but CMS recently changed this policy.

14. Can we trust the PHRMA-ceutical Industry??

15. 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)

16. What should you do right now? • If you have “Creditable Coverage” in a private plan now, STAY PUT! • Save every piece of paper you get from your current plan, Medicare, Social Security, Medi-Cal etc. Store in a safe place and make backup copies. • Be careful who you trust. People contacting you are: • Insurance companies (Profit motivated) • Pharmaceutical companies (Profit motivated) • Government agencies (CMS) • Advocacy Groups • Check with HICAP (1-800-434-0222 or www.calmedicare.org) if you have questions. • Remember, most sources are trying to sell you something!

17. Where You Can Go For Help • 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 (and say “AGENT” to talk to a person) or go to www.medicare.gov.

18. 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/ Bill Thomas:Rayburn Bldg. #2208, Washington, DC 20515 or 4100 Empire Dr. #150, Bakersfield, CA 93309; http://www.congress.org/congressorg/mail/?id=591&type=CO&state=CA Or Jim Costa: 1004 LHOB, Washington, D.C. 20515-0520. (202) 225-3341; or 855 M St., Ste 940, Fresno, CA 93721, 559-495-1620; or 2700 M St. Suite 225, Bakersfield, CA 93301, 661-869-1027; http://www.congress.org/congressorg/mail/?id=1991&type=CO&state=CA Federal Congress People

19. What do we need? A Real Drug Benefit: • You can use your Medicare card to get the drugs and doctor and hospital services you need at a reasonable and affordable price • A simple, fair and cost-effective way to ensure that every American with Medicare who needs medications gets them • A way to insure Americans with Medicare automatically from the financial risk of needing costly medications

20. At the national level… CIRCULATE & ADVOCATE • Tell people about the problems with Part D and urge them to join the fight for a Real Drug Plan. • Organize to hold your representative accountable for real relief from high drug costs • Support HR 3861, the Medicare Informed Choice Act (Stark, Schakowsky) to extend the deadline • Support 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.  • Don’t vote for anyone unless they support this fight!

21. 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!