[Congressional Record (Bound Edition), Volume 152 (2006), Part 12]
[Extensions of Remarks]
[Page 15868]
[From the U.S. Government Publishing Office, www.gpo.gov]




      ``GOING TO HAVE TO SELL MY HOUSE . . . OR DIE'': DISASTROUS 
                    CONSEQUENCES OF MEDICARE PART D

                                 ______
                                 

                            HON. BOB FILNER

                             of california

                    in the house of representatives

                         Tuesday, July 25, 2006

  Mr. FILNER. Mr. Speaker, Medicare Part D continues to bring problems 
for our Nation's seniors. As more and more reach the ``doughnut hole,'' 
seniors are confronted with dramatic, no-win choices. I offer my 
colleagues a recent article in the San Diego Union-Tribune--``Going to 
Have to Sell My House . . . or Die.'' It's past time to start over with 
the prescription drug benefit!

           [From the San Diego Union-Tribune, July 16, 2006]

               Going To Have To Sell My House ... or Die

                            (By Keith Darce)

       Frank Harrison says he's facing a choice between his health 
     and his house.
       When the Spring Valley retiree hit a coverage cap in his 
     federal prescription drug plan in early June, his monthly 
     medicine costs skyrocketed from about $250 to about $1,800, 
     largely because of two expensive immune suppression drugs 
     that he has taken since a kidney transplant 6 years ago.
       The 62-year-old former computer company operations manager, 
     whose main income comes from Social Security disability 
     benefits, stopped taking one of the drugs, which cost about 
     $575 a month, so that he could keep paying his $750 mortgage 
     payment.
       ``What it boils down to pretty soon is that I'm going to 
     have to sell my house. It's either that or die,'' he said.
       Harrison is among the 3.4 million seniors and disabled 
     Americans who have begun to fall into a gap in Medicare Part 
     D coverage. They must pay the full price for drugs after 
     they've spent $2,250 in co-payments and until their out-of-
     pocket costs reach $5,100 for the year.
       Those in the so-called ``doughnut hole'' are likely to cut 
     back on medicines to save money even if doing so jeopardizes 
     their health, according to some research.
       ``Some are being caught totally unaware,'' said Jennifer 
     Duncan, who manages the San Diego Health Insurance Counseling 
     and Advocacy Program.
       HICAP, which assists Medicare beneficiaries, has fielded 
     calls in recent weeks from about 20 Part D enrollees who've 
     either hit the coverage gap or are nearing it. Medicare is 
     the government's health insurance program for those 65 and 
     older and the disabled.
       The gap is the latest headache to confront those who 
     thought that signing up for a Part D plan would lower their 
     costs for expensive medications. Early glitches blocked some 
     from getting prescriptions because their names didn't appear 
     in the computer systems of the private companies selected to 
     operate the plans. Others tried to buy drugs only to learn at 
     the pharmacy counter that the medicines weren't covered by 
     their plans.
       Still, several surveys have indicated that most 
     participants are satisfied with the Part D program and have 
     saved money during its first six months.
       Congress created the Part D gap when lawmakers created the 
     drug insurance program in 2003. The measure was added to 
     reduce the program's overall cost. Lawmakers reasoned that 
     only a tiny portion of Part D participants would reach the 
     gap and most would be without coverage only for a short 
     period.
       Many of the 22.7 million people in the program will avoid 
     the coverage gap, according to a recent report by accounting 
     and consulting firm PriceWaterhouseCoopers. They have private 
     supplemental insurance, are enrolled in a higher-priced Part 
     D plan that doesn't cap benefits, have incomes low enough to 
     qualify for exemptions or simply won't purchase enough drugs 
     to reach the cap before calculations start over on Jan. 1.
       Those falling into the gap are largely middle-class seniors 
     who aren't poor enough to qualify for MediCal--the federal 
     health insurance for the poor known as Medicaid outside 
     California--or they are wealthy enough to afford higher-
     priced Part D plans that have no coverage caps.
       People who fall into the doughnut hole don't pay the full 
     retail price for drugs, said Peter Ashkenaz, spokesman for 
     the Centers for Medicare and Medicaid Services in Washington, 
     DC. They pay the discounted price paid by their Part D plan 
     operator--about 20 percent below retail prices, he said. ``I 
     think people tend to forget that piece of it.''
       But halfway through the first year of the prescription drug 
     program, the San Diego HICAP is fielding calls from 
     frightened seniors whose benefits are about to run out, 
     Duncan said.
       ```Doughnut hole' is a lousy term. It's more like an 
     abyss,'' she said. ``It's a soft, funny way for saying you 
     may not be able to pay your rent or eat this month because 
     you're going to have to pay for all of your medicines.''
       One recent call was from a paraplegic who takes high doses 
     of the pain-killer morphine that cost $1,500 a month. Another 
     caller takes $10,000 worth of medicine each month to prevent 
     his body from rejecting a transplanted lung.
       Even beneficiaries facing less dire circumstances could 
     have trouble dealing with the gap.
       An overwhelming majority of Medicare recipients suffer from 
     chronic diseases, such as hypertension and diabetes, said 
     Kenneth Thorpe, chairman of the Health Policy and Management 
     Department at Emory University in Atlanta.
       More often than not, they also are being treated and 
     medicated for multiple conditions, he said. ``These are very 
     expensive patients.''
       When their drug coverage runs out, even temporarily, they 
     are likely to stop taking some or all of their medications, 
     Thorpe said.
       That's what Kaiser Permanente researcher John Hsu found 
     when he studied about 200,000 Medicare beneficiaries in 2003 
     who participated in a more limited government prescription 
     drug program that predated Part D. The results, published in 
     the June 1 edition of The New England Journal of Medicine, 
     found that people whose drug benefits were capped at $1,000 a 
     year had higher rates of emergency room visits, 
     hospitalization and death than those with unlimited coverage.
       Hsu attributed the increases to people ending drug 
     treatments once the insurance cap was reached. The cost for 
     additional medical care offset the lower drug cost savings 
     created by the cap, he reported.
       When Harrison's coverage ended in early June, the maker of 
     one of his immune suppression drugs put him on a program that 
     delivered the medication for free. But he wasn't offered the 
     same deal from the maker of the other medication, and his 
     $1,300 monthly income is too high for him to qualify for the 
     doughnut hole exemption available through Medi-Cal. He's 
     hoping his doctors will provide an answer--perhaps an 
     alternative drug available at a discount or for free from a 
     manufacturer--when he goes in for a check-up in a few weeks.
       Wendel Ott, 74, of San Diego, doesn't expect to hit the cap 
     until September, but already he's considering cutting back on 
     his eight medications.
       ``It's going to cost me a tremendous amount of money for 
     the last part of the year,'' said Ott, who takes medicines 
     for high blood pressure, an enlarged prostate and chronic 
     bronchitis. ``Let's face it, I'm not wealthy.''
       While many people were aware they might face a gap in 
     coverage when they signed up for a Part D plan, it's clear 
     some haven't prepared for it, said Michael Negrete, vice 
     president of clinical programs for the California Pharmacists 
     Association.
       ``Most people haven't saved money to deal with the doughnut 
     hole,'' he said.
       Once in the gap, people create a new problem for themselves 
     if they try to save money by purchasing cheaper drugs outside 
     their Part D program, Negrete said.
       ``When they get drugs outside of Part D, that doesn't go to 
     the credit they need to get out of the (gap),'' he said. ``If 
     they are getting their medicines from Canada or from a 
     discount drug service, they will never get out of the 
     doughnut hole.''

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