Disability Issues

Democrats who opposed many elements of the controversial prescription drug benefit from its passage in 2003 finally have the chance to overhaul it. But will they? Part D is now a huge program with hundreds of competing private plans that would be difficult to dismantle, experts say. Rather than replacing the private system with a drug benefit directly from Medicare, reformers are more likely to move bit by bit.

One proposal would let Medicare negotiate prices directly with drugmakers instead of having insurers do so separately. But it’s unclear how to do this. To negotiate effectively, an insurer must be able to refuse to cover a drug if its maker won’t accept the offered price. “I don’t see Medicare being prepared to do that,” Ginsburg says. “If an insurer excludes Lipitor, the beneficiary can choose another plan that covers it. But if Medicare excludes it, then that’s it—it’s not there” for any beneficiary.

Closing the hated doughnut hole—the coverage gap in Part D—would be popular with beneficiaries but is unlikely because it would cost $300 billion over 10 years.

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People younger than 65 with disabilities are entitled to Medicare coverage, but only after they’ve received Social Security disability payments for two years. Forcing them to wait this long “results in these people having inadequate health care, falling into poverty or, ultimately, in death,” says the Baucus blueprint, which would begin to phase out the waiting period.

Advocates for the disabled, and AARP, have long recommended eliminating the 24-month wait. “It’s causing very great hardship,” says Rother.

Many advocates would also like disabled Medicare beneficiaries under 65 to have the same federally guaranteed right to buy medigap supplemental insurance, regardless of age or health condition, that those age 65 and older already have.

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articles/refining_medicare.html