[Congressional Record Volume 151, Number 128 (Wednesday, October 5, 2005)]
[Senate]
[Pages S11139-S11140]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. MURRAY (for herself and Ms. Cantwell):
  S. 1822. A bill to amend titles XVIII and XIX of the Security Act to 
make improvements to the implementation of the medicare prescription 
drug benefit; to the Committee on Finance.
  Mrs. MURRAY. Mr. President, today I am introducing legislation to 
protect low-income Medicare beneficiaries from being penalized under 
the new Medicare Modernization Act. My legislation also gives all 
seniors and the disabled more time to make the right choice in 
selecting a drug plan.
  My bill is called the Medicare HEALS Act, which stands for Help for 
Every beneficiary and Low Income Seniors. I am pleased to be joined 
today by Senator Cantwell in introducing this new bill.
  My goal is to protect very low-income seniors who today are covered 
by both Medicare and Medicaid. The new drug law will impose new co-
payments and premiums on these vulnerable patients, while--at the same 
time--covering fewer prescription drugs.
  Worst of all, the law prohibits States from providing additional 
coverage, known as wrap-around coverage, to seniors, the disabled and 
low-income beneficiaries. I believe seniors deserve better. I believe 
low income working families deserve better, and that's why I've written 
this bill.
  The new drug law will force painful changes on low income patients, 
and my bill will help protect our most vulnerable from the negative 
impacts of the drug law.
  Let's start by looking at how low-income beneficiaries are covered 
today versus how they will be covered under the new law. Today, very 
low income seniors are eligible for coverage under both state Medicaid 
programs and the Federal Medicare program, so they are often referred 
to as ``dual eligibles.''
  Today, their prescription drugs are covered by State Medicaid 
programs, and they are a good deal. For many seniors and the disabled, 
State Medicaid drug coverage involves limited co-payments, no premiums, 
and coverage for a broad range of medically-necessary drugs.
  Once the new Medicare drug program is implemented, these vulnerable 
patients will lose their State Medicaid coverage. They will be shifted 
into the Federal Medicare program, which will impose higher co-
payments, new premiums and fewer covered drugs. It's a bad deal for 
low-income seniors and to make matters worse, it's incredibly 
complicated to figure out which private drug plan meets their needs.
  1 am concerned that these individuals will be unable to afford co-
payments or tiered co-payments that will be part of many MMA plans.
  I am concerned that these individuals will also be denied the most 
medically-appropriate treatments due to restrictions imposed by the 
plans or additional financial burdens that plans will use to drive down 
drug utilization costs.
  In addition, I am not convinced that we have done enough to fully 
educate and prepare beneficiaries to the choices and implications of 
these choices that they face today.
  Another problem with the Medicare drug law is that it will penalize 
anyone on Medicare who needs extra time to make a decision about which 
plan to choose or whether or not to join the program. For a new system 
that is as complex as this new drug law, it's unfair to force people to 
make a decision quickly and to penalize those who need extra time to 
make the right choice.
  To solve these problems and to protect our most vulnerable, my 
legislation would repeal the prohibition included in MMA on the use of 
Medicaid funds to provide wrap around coverage for dually eligible.
  While I still believe that additional delay is warranted in switching 
this population to private plans under Medicare, I do believe we need 
to ensure that States facing a huge backlash from this population can 
respond accordingly.
  I have joined in support of legislation aimed at providing a 6-month 
transition period for dual eligibles to give these patients time to 
phase into these new plans, but I also think we must ensure that States 
have the ability to respond to lapses in coverage or financial barriers 
that will deny access to necessary and life saving drugs.
  States would have the option of providing wrap-around coverage using 
both Federal and State Medicaid funds, as they do today.
  My legislation would also deduct any State funds used to provide 
wrap-around coverage from the so-called clawback amount. As we know, 
the MMA legislation takes back much of the savings States will see by 
transferring these patients to Medicare. I do

[[Page S11140]]

not think it is fair to penalize States for trying to do the right 
thing.
  Finally, my legislation would delay the late penalty enrollment from 
May 15, 2006 until January 1, 2008, for all beneficiaries. This will 
give all Medicare beneficiaries the time to fully evaluate the plans. 
The extension will provide beneficiaries with one full benefit year and 
the open enrollment period to determine if these plans offer them a 
good value or provide the kind of security we all expect from Medicare.
  This extension is of particular importance to those seniors who may 
be eligible for assistance but have not yet applied. We know that full 
dual eligibles will be automatically enrolled in a plan if they fail to 
select one. However, those with incomes from 135 percent to 150 percent 
of the Federal poverty level could also qualify for assistance but will 
not be automatically enrolled.
  Early estimates from the Social Security Administration and the 
Centers for Medicare and Medicaid Services (CMS) indicate that a number 
of seniors have failed to even apply for eligibility determination. I 
have been told from CMS that 18 to 19 million beneficiaries were mailed 
information and an application this summer to begin the eligibility 
determination. So far, only 3 million have even applied.
  A recent USA Today/Gallup Poll shows that only 37 percent of 
beneficiaries understand the program somewhat, but 61 percent do not. 
Fifty-four percent of beneficiaries do not even plan on joining the 
program. Many seniors have simply chosen not to even try and navigate 
the process. For some, there are more than 20 different plans with 
premiums nationwide, ranging from $1.87 to $100 and deductibles from $0 
to $250. This does not even get into restricted formularies or other 
restrictions that may be imposed.
  It is clear that all beneficiaries need more time. Extending the late 
penalty enrollment deadline of May 15, 2006 is the simplest step we can 
take to give seniors time to evaluate these plans and this new benefit. 
The late enrollment penalty of 1 percent each month is a huge financial 
hit that punishes those who may need the help the most.
  In Washington State, we could see thousands of frail, vulnerable 
beneficiaries paying significantly more for life saving drugs or simply 
going without. There are an estimated 86,167 full dual eligibles and an 
additional 22,869 who receive some assistance from Medicaid. The intent 
of MMA and this new benefit was to expand access to affordable drug 
coverage; however, the unintended consequence could be the disruption 
of care for millions of low income beneficiaries nationwide.

  It is my understanding that dual eligibles in Washington State will 
be automatically enrolled into 1 of 12 plans. There are 31 plans 
participating as Medicare Advantage or Prescription Drug Plans (PDPs). 
Within these plans, there are often several different benefit packages. 
Premiums range from $0 to $120; deductibles can range from $0 to $2500; 
and many will have tiered co-payment structures. None of these plans 
will cover all top 100 drugs used by seniors. Some plans provide only 
77 of the top 100 drugs.
  While these plans may offer far better benefits than many receive 
today, it will be difficult to make this determination. The range of 
choices; the restrictions; the variations in out-of-pocket and the 
belief by many that this is not a good benefit overall, will lead many 
seniors to simply walk away.
  But, even if seniors decide to sit down and do the calculation and 
evaluate each plan or option, they face challenges in the reliability 
of the information.
  CMS has partnered with a number of outstanding groups in Washington 
State who are working hard to get information and help to seniors so 
they can make informed choices. But the task is made much more 
difficult when CMS announces that materials already mailed to 
beneficiaries are incorrect.
  My office received notice this week from CMS that the area specific 
2006 version of the ``Medicare and You Handbook'' already mailed to 
beneficiaries contains a rather large error. The error occurs in the 
comparison charts listing the Medicare Prescription Drug Plans (PDPs). 
In the last column of the comparison table, entitled ``If I qualify for 
Extra Help, will my full premium be covered?''
  For each plan listed, the column should say yes if the plan's premium 
is at or below the regional benchmark, and a beneficiary who qualifies 
for the low income subsidy would pay no premium for this plan.
  The column should show no if the plan's premium is above the regional 
benchmark and a beneficiary who qualifies for the low income subsidy 
would pay the difference between the regional benchmark and the plan's 
premium.
  Due to an error, this column lists yes for every plan. Even if one 
could figure out what the regional benchmark is and the difference in 
the premium, they are still getting bad information.
  How can anyone determine the value of a plan or benefit when the 
initial information is wrong?
  There are other examples of information being provided by CMS that is 
incorrect or inconsistent. I think this has happened in part because 
this administration is in a race against time to enroll, enroll, 
enroll. This kind of pressure will only lead to more and more confusion 
and distrust.
  As we saw with the temporary discount drug card, seniors simply 
refused to participate. Even those who would have qualified for $600 
did not bother to enroll. The largest enrollment was done by States and 
private plans for those who qualified for the subsidy, but far more 
simply did not bother. The choices were too complex, there were too 
many rules or restrictions, and there was no way for beneficiaries to 
measure the value of these cards.
  My legislation does not address every problem and every coverage gap, 
but it is a small step to protect the most vulnerable. I urge my 
colleagues to join me in making these small but necessary corrections 
today before beneficiaries lose their coverage and lose access to 
affordable life saving drugs.
  I know that this administration has resisted any efforts at fixing 
this program and has said the President would veto any legislation that 
delays implementation or changes the structure of the benefit. But, I 
am convinced we will be back making changes to this program over the 
next 2 years because seniors will demand action.
  Maybe before all confidence in this program is gone and seniors are 
calling for repeal, the administration would look at small, humane 
fixes today, and that is the Medicare HEALS Act offers.
                                 ______