Mr. Speaker, I am pleased to join my colleague, Representative Pete Stark, in introducing the Medicare Informed Choice Act, an immediate and essential first-step in protecting Medicare beneficiaries. I believe that fundamental changes are…
Mr. Speaker, I am pleased to join my colleague, Representative Pete Stark, in introducing the Medicare Informed Choice Act, an immediate and essential first-step in protecting Medicare beneficiaries.
I believe that fundamental changes are needed to make the new Medicare drug benefit more affordable and less complicated. Along with my colleagues Representative Marion Berry and Bob Andrews, I have introduced H.R. 752, the Medicare Prescription Drug Savings and Choice Act, which would establish a meaningful drug benefit in Medicare and require Medicare to negotiate for price discounts, as the VA and large employers do today. In the meantime, however, it is clear that Medicare's 42 million beneficiaries need immediate relief from the confusion and complexity of this fall's enrollment process. The Medicare Informed Choice Act would provide that relief by providing three simple changes in 2006: elimination of the late enrollment fee, a one-time opportunity for every beneficiary to switch plans, and protection against the loss of retiree health benefits.
I recently received a letter from a constituent, Phyllis Arist from Evanston, Illinois. She wrote:
I urge you to suspend the late-enrollment penalty for
Medicare Part D.
Enrollment in Part D will be a challenge for anybody and
everybody, whether that person is health care savvy or not.
There will be dozens of complex plans that consumers will
have to confront. How would you choose among a slew of
different drug plans, each covering different drugs, using
their own cost-sharing scheme, working with different
pharmacy networks, and no guarantee that the plan will be
around next year?
If Medicare Part D were a straight-forward benefit like
Medicare Part B, the penalty might be justified. But given
the circumstances, it is unfair. People with Medicare need
more time to understand the new Medicare drug benefit.
More time, combined with reliable and comprehensive
information, will ensure more people are making the right
choices and not taking a leap of faith into the unknown.
I agree with Ms. Arist. It is abundantly clear that the enrollment process for the new Medicare drug benefit is complicated, confusing and can result in bad decisions by beneficiaries. Any of us who have tried to explain the basic benefit to our constituents knows how difficult it is to do so, let alone explain the variations in the multiple private plans that will be available to senior citizens and persons with disabilities. Private plans will vary in terms of premiums, cost- sharing requirements, covered drugs, and pharmacy sources. Beneficiaries taking multiple medications will find it difficult to sort out their options, especially in areas like Chicago where about 50 plans are expected to be available.
No one who is on the ground believes that the support and outreach services will be available to provide the one-on-one counseling
that beneficiaries and their families will want and will require to make informed choices. As the former executive director of the Illinois Council of Senior Citizens, I know that it will take hours with each beneficiary, many of them taking multiple medications, to fully explain private plan options and how each choice will affect their access to the drugs they need. A majority of beneficiaries lack regular access to a computer or have the ability to navigate websites. A recent HHS Inspector General's report found that 44 percent of callers to the Medicare hotline had difficulty accessing information. Many beneficiaries are frail, some suffer from dementia, and others are not English-proficient. We have to reach beneficiaries living in Centers for Independent Living, nursing homes and isolated areas. And, of course, we have to address the needs of the evacuees from Hurricane Katrina.
Tina Kitchin, director of the Oregon Department of Human Services, is not alone in saying ``I don't know how Oregon will successfully do this within this timeframe.'' The State Health Insurance Program coordinator for McLean County, Illinois, is asking beneficiaries to call early because, ``There are too many people for us to handle all of them on or after November 15,'' the first day that enrollment can begin. Already, the constituent advocates in my own district office have had difficulty getting answers to questions about how the new federal drug benefit will coordinate with our state's pharmaceutical assistance program. And already, we are seeing constituents who are confused, scared and angry about the inability to get answers to their questions while being pressured to make a fast decision.
It is time to recognize that the late enrollment penalty imposed in the Medicare Modernization Act is unfair to the 42 million beneficiaries who want to make informed choices, will not have access to unbiased assistance in making those decisions, but who will face substantial and permanent late enrollment fees if they don't act by May 15th. The Medicare Informed Choice Act will give beneficiaries the time they need to make the decision that is right for them.
Senior citizens and persons with disabilities will face obstacles in getting access to independent information, but they will be inundated with materials from private plans seeking customers. Beginning next month, Medicare beneficiaries and their families will be subjected to multi-million advertising campaigns by insurers. As reported in The Wall Street Journal (``Insurers Bet Big on New Drug Benefit,'' September 7, 2005), ``The payoff could be big. The new drug benefit is expected to boost 2006 revenue at seven of the largest health insurers by at least $4.45 billion in 2006, and lift earnings by 2 percent to 4 percent according to CIBC World Markets analyst Carl McDonald.'' Some companies expect increased profit levels of 4 percent to 6 percent.
The pressure to make a quick decision will be enormous, particularly when coupled with a sales pitch arguing that failure to choose will result in a permanent, financial penalty. Without adequate, independent and personalized counseling, many beneficiaries will make the wrong decision. Getting rid of the late enrollment fee is only part of the solution. Our bill will give all beneficiaries the opportunity to switch their plan and enroll in one that better meets their needs, whether they enrolled by mistake or because they succumbed to sales pressure.
Finally, there is massive confusion about how the new Medicare drug benefit will mesh with current retiree benefits. Unfortunately, a beneficiary's misunderstanding and enrollment in a Medicare drug plan could result in the loss of retiree benefits. Again the Medicare Informed Choice Act gives a one-year grace period to sort out confusion and correct any errors.
I urge my colleagues to support the Medicare Informed Choice Act so that we can protect our constituents from unfair penalties or the loss of retiree benefits.