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Health See other Health Articles Title: Doughtnut hole in Medicare coverage Six years after Congress added prescription drug benefits to Medicare, House and Senate Democrats are poised to make a central change that they and most older Americans have wanted all along: getting rid of a quirk that forces millions of elderly patients with expecially high expenses for medicine to pay for much of it on their own. The closing of an unusual gap in Medicare drug coverage -- a gap that Republicans had, when they controlled Capitol Hill and the White House, insisted was needed for the government to afford the program -- would "forever end this indefensible injustice for American's seniors," Senate Majority Leader Harry Reid (D-Nev.) said in announcing that the Senate would join the House in supporting the change. But details of the change underscore that, for patients and the federal budget alike, the implications of the sprawling health care bills pushed through by congressional Democrats are more nuancedthan lawmakers' talking points. The Democrats and President Obama have been clear that the "doughnut hole," as the gap is known, would disappear gradually over the next 10 years. They have not mentioned that Medicare patients would, according to House figures, face a slightly larger hole in coverage during two of the next three years than they do today. Proponents say the government can afford to phase out the gap because the pharmaceutical industry would pay for it. But less than half of $80 billion that drugmakers agreed to provide, under an agreeement last summer with Senate Democrats and the White House, would be used to help fill the gap,according to Senate Democratic aides. Moreover, there are no budget forecasts that far enough into the future to show how much the expanded drug benefits would cost the government once the gap is fully closed. Despite such uncertainties, the prospect of filling the hole in drug coverage responds to a strong desire among older Americans -- a significant consituency that tends to be wary of changes to the health care system. The 2003 law that added drug benefits to Medicare was the largest expansion since the creation of the federal health insurance system for the elderly four decades ago. The new coverage became available in 2006. As of last year, about 32 million people, nearly three-fourths of everyone on Medicare, had it. Nancy LeaMond, executive vice president for social impact of AARP, the lobby for people age 50 and over, said that, though the benefits have proven popular, "you really can't have a meeting with a chapter, you can't have a townhall" without complaints surfacing about the doughnut hole. "It's a major pocketbook issue." Pat Liberti, a retired nurse in Salem, Mass. who has heart disease and diabetes, and has had five small strokes, takes 16 prescription drugs. She is 59, six years younger than the typical age to join Medicare, and is eligible because her health problems have classified her as disabled. This year, she entered the doughnut hole in May. At that point, her Blue Cross Blue Shield plan stopped paying 75 percent of her medicine's price. Since then, she has spent $2,206 on drugs. "You know, I did everything right. I worked. I saved. I own my own home. I have an IRA," Liberti said. She had hoped to save the longterm disability checks she gets from her former job for her old age. Instead, she spends them on medicine. How many people are in similar circumstances is unclear. The Kaiser Family Foundation, a health policy organization on whose figures House Democrats relied, estimated that, in 2007, one-quarter of the Medicare patients with drug coverage fell into the gap. Less publicized figures by the Centers for Medicare and Medicaid Services, the agency responsible for the program, show that about half that many fell into it. Kaiser and the agency disagree on how often people who reach the gap stop taking some of their medicine. However many people have been affected, closing the doughnut hole has been a rallying cry among the elderly. During the second week in December alone, LeaMond said, AARP members placed 240,000 calls to 29 Senate offices, asking them to follow the House in eliminating the gap. Under the health care bill the House passed in November, people who reach the hole would be $500 better off next year than they would otherwise. But the impact over the next few years would be subtler than it appears at first for two reasons: the gap--without any change--is scheduled to expand each year, and the bill would fill it gradually. As a result, patients would face a larger coverage hole in 2011 and 2012 than this year, according to Ways and Means data. After that, it would shrink more rapidly and disappear in 2019. The Senate measure would narrow the gap halfway. Even before it passed, Reid and the chairman of the two Senate committees that handle health care issues said they would, as part of negotiations to resolve differences between the two bills, accept the House's goal of closing the hole completely. Congressional budget analysts have not said how much that would cost. Instead, they predicted a savings of $43 billion over the next decade--based on the combined effect of filling the hole and two steps the pharmaceutical industry has said it would take. As one of those steps, drug manufacturers would repay the government the difference between the prices the companies charge for medicine for low-income patients in Medicare and the prices they used to charge in Medicaid, before the drug benefit existed. As the other step, the House bill requires the manufacturers to give a 50 percent discount for brand name drugs that patients buy once they enter the doughnut hole--and to give the government the equivalent of that money after the hole closes. Budget analysts say the discounts for brand name drugs would end up costing the government money; fewer people would switch to cheaper generic medicine--in turn, causing more people to reach the gap's far side, beyond which almost all remaining drug expenses are covered. Without a Congressional Budget Office prediction, the only estimate of the cost of filling the gap comes from the Medicare program's chief actuary, Richard S. Foster, who told House Republicans it would be $31 billion over the next decade. No one has analyzed how expensive the expanded drug benefits would become after that, although health care options prepared a year ago by the CBO provided a clue: It said that, if the gap were eliminated right away, it would cost $134 billion over 10 years. Democrats predict that, in the end, pharmaceutical companies will provide enough money to cover the expense. Republicans are skeptical. "They are shielding the true cost by phasing it in," said Sage Eastman, spokesman for Rep. Dave Camp (Mich.), ranking Republican on House Ways and Means. Meanwhile, no one knows how much the pharmaceutical industry could end up benefiting by an expansion in coverage that could drive up spending on brand name drugs. Said one health policy expert who favors closing the gap: "It's not very transparent."
Poster Comment: Some cut and paste of key issues: ...Proponents say the government can afford to phase out the gap because the pharmaceutical industry would pay for it. But less than half of $80 billion that drugmakers agreed to provide, under an agreeement last summer with Senate Democrats and the White House, would be used to help fill the gap,according to Senate Democratic aides. Moreover, there are no budget forecasts that far enough into the future to show how much the expanded drug benefits would cost the government once the gap is fully closed...Democrats predict that, in the end, pharmaceutical companies will provide enough money to cover the expense... ...Pat Liberti, a retired nurse in Salem, Mass. who has heart disease and diabetes, and has had five small strokes, takes 16 prescription drugs...This year, she entered the doughnut hole in May. At that point, her Blue Cross Blue Shield plan stopped paying 75 percent of her medicine's price. Since then, she has spent $2,206 on drugs. "You know, I did everything right. I worked. I saved. I own my own home. I have an IRA," Liberti said. She had hoped to save the longterm disability checks she gets from her former job for her old age. Instead, she spends them on medicine... Seniors are being thrown under the bus by the Dems. There is no way the Dems will close the donuthole. After all, in order to extend Obamacare to 20 Million illegals and other Usual Suspect Dimwit voters as well as expanding Medicaid to facsimile Dem voters hinges on the necessity of gutting Medicare benefits to senior citizens.
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#1. To: scrapper2 (#0)
Privet companies made a deal with the government to help old folks --- then the government reneged on the deal and stole the money away from the folks. The government types are assholes!
One way to get rid of the doughnut hole is is to get rid of the doughnut. My mother could afford medication from her retirement savings, but complained bitterly when she reached the hole last year (this year her primary Rx went generic so she didn't reach the hole). But why should taxpayers pick up the tab for her meds? Part of the problem is that she notices that while she has saved her whole life, especially when she worked, the old people who have not saved get "everything for free". As I have told her many times, the only result from the current health care giveaways is that our country will go bankrupt sooner. At 46 I expect nothing whatsoever from the federal government when I get older and I am planning accordingly. The socialists who believe that health care is a human right will send my country into default or hyperinflation. I have planned for those to some extent as well, but I hope that some sort of common sense prevails in the mean time.
Money problems do not come from a lack of money, but from living an excessive, unrealistic lifestyle
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