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Effective January 1, 2006, Medicaid, which provided affordable, reliable prescription coverage for those who  were low income ceased to exist.  It was replaced by Part D.  Due to numerous problems, dual-eligiblity (people who formerly had their prescriptions paid for by Medicaid are often referred to as dual-eligibles or "dualies"), computer errors, non-compliance, payment difficulties, denial and/or the overcharging for prescriptions, and a dishonest legislative process Part D is NOT the success that the Republican party had hoped it to be.


The reason?  According to Robert Hayes, of the Medicare Rights Center,, Medicare coverage was identical and universal, regardless of income, and administered by Medicare. And it remains today an efficient single-payer health care system providing hospitalization (Part A) and outpatient physician services (Part B) to 43 million older and disabled Americans. More than 95 percent of patients and doctors participate in the voluntary Part B.

Hayes continued,

"Medicare has become the most popular and successful program of the last 40 years because the president [Lyndon Johnson] believed in the efficacy of government."

Author Nancy Altman ("The Battle for Social Security") wrote

Johnson and the Congress relied on professionals in government to design Medicare, President George W. Bush and the Republican leadership disdained government and Part D was written in secret by drug and insurance industry lobbyists, then narrowly passed under cover of darkness.

Interestingly, Medicare was implented in an effective manner before widespread computer use was popular.    Part D was enacted in late 2003, which left ample time to prepare for a smooth implementation and operation of it.  The main reason for that is the administration's insistence on choice.  That resulted in too many choices and made a simple prescription benefit that could have been added to Medicare coverage more difficult to implement and interpret.

As a result, Part D is now percieved by its supporters as work  in progress.

Drew Altman, President of the Kaiser Foundation,

"There's no question the Republicans thought the passage of (the drug benefit) was their best opportunity in years to neutralize the advantage with senior voters that Democrats have traditionally had on health, and it hasn't worked out that way at all."

Now, legislation that is being sponsored by Sens. Chuck Grassley, R-Iowa, Bill Nelson, D-Fla., and others,  would provide increase funding to encourage enrollments. In the House, Rep. Nancy Johnson. R-Conn., introduced similar legislation.  

A second proposal would decrease the length of time that pharmacists have to wait for reimbursements.  And, in April, there an earlier victory:  a rule was changed and plans that stop covering drugs or impose new coverage restrictions must exempt from the changes those people already taking the medications.

Altman also cautioned,

"It isn't emerging as a top voting issue for seniors in this election. Other issues are crowding out health and (the drug benefit) for voters, like Iraq, gas prices and immigration>"

But, it is very possible that will change, as many on a fixed income will begin to hit the coverage gap, or "doughnut hole" and people have to pay their prescription-drug costs from $2,250 to $5,100 before coverage begins again.

In addition, there are the Fix Part D hearings that are scheduled throughout the country.

             Fix Part D Hearings Schedule

AZ  6/1  5:00 PM Speakers: Nick Nyhart - Executive Director of Public Campaign

Hope Hall, Grace Lutheran Church, 1124 N 3rd St, Phoenix

CT New Briton

FL 6/1 2:30pm, Palm Harbor Community Center, 1500 16th St., Palm Harbor

IA 6/20 1:00 PM, Waterloo Public Library,Waterloo

IN  6/5 10:00am
Town Hall
North United Methodist Church, 38th and Meridian Streets, Indianapolis

6/8 10:00 am
Town Hall
The League for the Blind and Disabled
5821 S. Anthony Blvd.
Fort Wayne

MD Longbranch Senior Center, Silver Spring

ME 5/31, 10:00 am, Hammond Street Senior Center, Bangor

MN 5/31, 10:00 am, Senate Hearing Room 112, MN State Capitol, St. Paul

MO 5/31, 1:00 pm, Palestin Senior Activity Center
3325 Prospect, Kansas City

6/1, 7:30 PM, Daniel Boone Library - Friends Room,
100 W. Broadway, Columbia

6/1, 11:00 am, Ferguson Municipal Public Library
35 North Florissant Road, St. Louis

NY, 7/10 Saratoga Springs

PA 6/1, 1:30pm, Pennwood Library, 301 S Pine Street, Langhorne

6/2, 1:30pm, Chester County Library - Struble Room
450 Exton Square Parkway, Exton

WA  6/10, 12:00 PM, Part of White House Conference on Aging
Seattle Labor Temple - Main Hall, 2800 First Ave.

WI  6/2, Paper Valley Hotel, 333 W College Ave, Appleton

WV  5/31,  3:00 PM  Panel:
State Rep Don Perdue - Chair of House Heath & Human Resources
Larry Matheney - WV AFL-CIO Sec/Treasurer
Gary Zuckett - WVCAG

Cross Lanes Unity Apts, 101 Unity Lane, Cross Lanes

In addition, Americans United is advocating for the following changes to Part D:  allowing for the negotiation for the best price of presciption drugs,  the closing of the "donut hole"/coverage gap, allowing to give people who have Part D the option of receiving their prescriptions through Medicare, as opposed to a private insurer,  prohibiting insurers from dropping a drug from the formulary (list of covered drugs) if people are prohibited from changing plans, and re-opening the enrollment period.

In addition, almost every Medicare advocate requests that it is necessary to stop trying to make a silk purse out of sow's ear and add a uniform drug benefit to Medicare that would be administered by Medicare. (That would be the most logical and easiest thing to do.)

But, as written earlier, the AARP sells the UnitedHealth plan and receives an undisclosed amount in royalties for doing so.  Is it a suprise that the AARP has not taken a stand re:  fixing Part D?

Considering that Americans United was the one of the major players in winning the battle against Social Security Privatization a few years ago, it will definitely be an interesting summer.

Originally posted to Street Kid on Tue May 30, 2006 at 12:19 AM PDT.

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Comment Preferences

  •  coffee mug and xposted (6+ / 0-)

    epm, The Frog Pond and at MLW

    again, if a person has a part d story that he/she wants to share please email it to partdstoriesatgmaildotcom

    "Do not go gentle into that good night." Dylan Thomas.

    by Street Kid on Tue May 30, 2006 at 12:26:01 AM PDT

  •  Will penalties be waived (1+ / 0-)
    Recommended by:

    for folks who didn't sign up by May 15?

    It's time to be a Democrat!

    by annefrank on Tue May 30, 2006 at 12:36:57 AM PDT

    •  Well... (1+ / 0-)
      Recommended by:
      Street Kid

      Not likely until it's too late for quite a few.
      The GOP still runs the show, after all.

      "Think this through with me, let me know your mind." - Hunter/Garcia

      by epcraig on Tue May 30, 2006 at 01:20:08 AM PDT

      [ Parent ]

    •  the penalties (2+ / 0-)
      Recommended by:
      epcraig, Street Kid
      i understand they are a lifetime penalty that you have to pay for the rest of your life if you want the medicare part d and didn't make the deadline?

      is this correct?

      Is that pretty much a tax levied on people who are late or were maybe putting it off to avoid the donut hole? or putting it off for any reason whatsoever?

      I'm kind of stalling for time here...They told me what to say. George W Bush, 03-21-2006 10:00 EST Press Conference

      by Tamifah on Tue May 30, 2006 at 02:52:41 AM PDT

      [ Parent ]

      •  You are correct (1+ / 0-)
        Recommended by:

        Although unlike taxes, the penalty surchages can only benefit insurance companies, not the governnment.

        "Think this through with me, let me know your mind." - Hunter/Garcia

        by epcraig on Tue May 30, 2006 at 03:00:41 AM PDT

        [ Parent ]

        •  hardcore selling point for our message (0+ / 0-)

          if you didn't sign up for medicare part d on time for any reason whatsoever, then you are being taxed and the money isn't even going to the government, it's going directly to whatever insurance comapny you pick

          very important question

          didn't the government say at one point that if people didn't sign up by a certain date, they would be automatically enrolled in some certain program? I swear i remember reading that

          I'm kind of stalling for time here...They told me what to say. George W Bush, 03-21-2006 10:00 EST Press Conference

          by Tamifah on Tue May 30, 2006 at 04:54:52 AM PDT

          [ Parent ]

        •  Have to correct that one (0+ / 0-)

          The Congressional Budget Office estimates that extending the deadline through December would bring in 1 million more enrollees. But the government would forfeit $100 million in late fees this year, which would grow to $3.4 billion over 10 years.


          "Do not go gentle into that good night." Dylan Thomas.

          by Street Kid on Tue May 30, 2006 at 02:50:36 PM PDT

          [ Parent ]

      •  Pending (0+ / 0-)

        A bipartisan bill was announced earlier today that would waive penalties for late enrolles to Part D. People would be allowed to enroll for 2007 without paying any penalty. The legislation was sponsored by Sens. Bill Nelson, D-Fla., Charles Grassley, R-Iowa, Max Baucus, D-Mont., and Mike DeWine, R-Ohio. Rep. Nancy Johnson, R-Conn. is working w/colleagues in the House to introduce similar legislation. Michael Leavitt feels that it is necessary to wait and see if the legislation is needed. Mark McClellan is concerned as to whether or not the legislation could further reduce costs to Medicare managed care plans.


        "Do not go gentle into that good night." Dylan Thomas.

        by Street Kid on Tue May 30, 2006 at 02:53:47 PM PDT

        [ Parent ]

  •  Medicaid still exists (0+ / 0-)

    For what it's worth, Part D didn't completely replace Medicaid. Part D is only available to people over the age of 65. People under 65 still are eligible for Medicaid benefits (however meager they may be)

    •  You are corect, BUT, (0+ / 0-)

      Medicaid no longer pays for prescriptions except for a few instances.  And the reimbursements in some states are so low, that more and more doctors are refusing to accept it.  In addition, there are more restrictions on what is covered under Medicaid and what isn't.

      "Do not go gentle into that good night." Dylan Thomas.

      by Street Kid on Tue May 30, 2006 at 02:47:22 PM PDT

      [ Parent ]

  •  Nightmare on Medicare Part D Street (1+ / 0-)
    Recommended by:
    Street Kid

    I am on SSDI and my mother-in-law is on SSI (low income).

    Apparently, we (me) signed her up for the wrong Medicare drug plan (one where Medicaid or the State picks up most of the tab) so in January we paid FULL, JACKED-UP prices for all her drugs (over $500).

    The next month, after I straightened everything out, her drugs were only $40 total (one of her drugs is not covered).

    What pissed me off more than anything else was that she was eligible for State Medicaid drug assistance for 10+ years and nobody, especially her Medicaid Social Worker, EVER signed her up. (She used to live in another town and we moved her down here to take care of her).

    My husband and I pay for all of her bills!!!

    -6.13 -4.4 Republicanism is an Ideology, not a Reality.

    by MarciaJ720 on Tue May 30, 2006 at 06:51:59 AM PDT

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