Medicare Part D: (“D” is for Disaster”)

1. Medicare Part D: (“D” is for Disaster”) Margie Metzler 1121 Wayland Avenue Sacramento, CA 916-921-5008 margiemetz@hotmail.com Website: www.gpcal.org February 5, 2006 This program operates under a grant from the California Wellness Foundation

2. A Little Humor…

3. Our Motto

4. History • Medicare enacted in 1965 • 1988, a prescription drug benefit was attempted but was repealed in 1989 • The Clinton Drug plan had a drug benefit: 1993 • Clinton admin. tried to provide drug coverage under new Medicare Part D. It failed in the Senate • The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) passed the House of Representatives and the Senate in November 2003

5. Ugliness in the Background • Cost estimates were withheld: Bush, Sec. of HHS Tommy Thompson, and CMS admin. Scully said cost would not be more than $400 Billion over 10 years. • Richard Foster, the Medicare actuary, predicted it would cost as much as $600 Million. His job was threatened.

6. Background 2 • Democrats were denied opportunities to offer amendments. • The vote was held open for three hours in the dead of night. HR 1 was brought before the House for final passage at 3 a.m. Sat., Nov. 22, 2003. • Thompson was allowed on the floor to persuade members.

7. Serious Ethics Violations • Tom Scully and Assistant, Jeff Flick (Where are they now?) • Rep. Billy Tauzin and Rep. James Greenwood. • Rep. Nick Smith alleged that he was offered a bribe on the House floor by Tom DeLay

8. Drug Companies in Action! • In 2003, the Drug Companies… • hired 952 lobbyists • spent $141 million on lobbying • contributed more than $30 million to campaigns. • Drug profits rose $182 billion.

9. What have we got? Can we make it better? • Does Medicare Part D reduce costs & improve access? OR • Does it simply privatize a major part of Medicare by turning over drug coverage to an unregulated army of private drug providers (while sacrificing the standard benefits fundamental to Medicare?)

10. Advice in a Nutshell • If you have good coverage in a private plan now, STAY PUT! • Save every piece of paper you get from your current plan, Medicare, Social Security, Medi-Cal etc. Store in a safe place and make backup copies. Check with HICAP.

11. List of the Most Egregious Issues… • Enrollment = Chaos + Confusion. • Medi-Cal Beneficiaries are Treated Badly. • Late Enrollment Penalty • Retirees with Current Drug Coverage – Beware! • The Donut Hole.

12. More Egregious… • No negotiating for best prices! • People are supposed to have choices… but they can’t be informed consumers • The plans get to change prices, formularies and deductibles at any time, but you don’t have the same options.

13. The Implementation… • Medicare/Medicaid People are the first. On Jan. 1 they were all moved to one of the plans. • Medicare-only people can register at any time, but are strongly encouraged to “enroll” by May 15. There is no carrot, only a stick.

14. The Basics • Coverage began January 1, 2006 for those enrolled • Available for all people with Medicare, but impacts particular groups differently • Drug Benefits provided through Private Plans: • Prescription Drug Plans (PDP’s) • Medicare Advantage Plans (HMO’s) • Some Employer and Union Retiree Plans receive government subsidies to help prevent them from dropping drug coverage.

15. Part D Plans – The Basics • Plan Choice – 47 “stand alone” plans in California in addition to current HMO plans • Part D Plans can change formulary at any time • Customer service – up to each plan • Appeals - up to each plan

16. Don’t Blame the Pharmacist! • Pharmacists are on the frontlines: paying co-pays other costs. • Many of them are working hand-in- hand with the rest of us advocates.

18. Low Income Subsidy – The Basics • SSI and Medi-Cal people were automatically enrolled January 1, 2006. • Those with incomes OVER this level and UNDER 150% of poverty level are eligible for low income subsidy but must apply through Social Security for this benefit. • Single – up to $1197 monthly • Couple – up to $1,604 monthly • Excess assets may prevent you from getting this benefit. • First, you must apply for the subsidy, then you must enroll in a Part D Plan.

19. What did the Governor just do? • Authorized the State to pay for medications for those Medi-Medi’s who are unable to get their drugs paid for by Medicare until Jan. 27. • Was recently extended till May, and we’re hopeful for more extensions. This coverage was originally only for the period starting January 12 through January 27, 2006.

20. Low-income Medicare Beneficiaries Not on Medi-Cal • A two–step process • Apply for a “low-income subsidy” if income and assets are low • Single – up to $1,197 monthly • Couple – up to $1,604 monthly • Assets limits vary • Choose a prescription drug plan before May 15, 2006 and enroll – your subsidy should be automatically applied.

21. Your CaliforniaState Representative may be: Assembly (Dist. 25 - Rep)Assemblyman Dave CogdillCapitol AddressState CapitolRoom 4117Sacramento, CA 94249-0001(916) 319-2025 District Address1912 Standiford Avenue Suite 4Modesto, CA 95350(209) 576-6425 Senate (Dist. 14 - Rep)Senator Charles PoochigianCapitol AddressState CapitolRoom 5087Sacramento, CA 94249-0001(916) 651-4014 District Address4974 E. Clinton Way Suite 100Fresno, CA 93727(559) 253-7122 Or… you can go here, http://www.assembly.ca.gov/committee_hearings/ or look it up in the phonebook Who’s your State Legislator?

22. Where You Can Go For Help • Health Insurance Counseling and Advocacy Program (HICAP): Call 1-800-434-0222 to reach your local HICAP or go to www.calmedicare.org. • Social Security: 1-800-772-1213 or go to www.ssa.gov. • Center for Medicare and Medicaid Services (CMS): Call 1-800-MEDICARE or go to www.medicare.gov. • CARA Part D Toolkit at www.retiredamericans.org • Remember, most other sources of information are trying to sell you something

23. Enrollment = Chaos + Confusion • Enrollment is being pushed too quickly • Enrollment decisions are too complex • Too few resources are available to help consumers • Too little information is available in multiple languages and in formats easy for consumers to understand.

24. Late Enrollment Penalty Lasts A Lifetime! • Beneficiaries not automatically enrolled have until May 15, 2006 to chose a plan. • After May 15, 2006, if you have not chosen a plan, you will pay 1% of the average area premium PER MONTH…FOR LIFE as your penalty! • Example – say the average monthly premium in your area is $50 a month. If you wait 12 months to sign up, your premium would be $50 + $6 (12% of $50) every month or an additional $72 per year forever! If the rate goes up, your penalty goes up proportionately. If you wait longer, the penalty just keeps growing.

25. The “Donut Hole” – Not a Sweet Deal • You get no coverage for costs between $2,250 and $5,100 • You keep paying premiums but get no benefit • It is unclear what drug costs will get counted toward the $2,250 (i.e. all out of pocket costs or only those that show up in the Medicare computer) • Many factors will make it difficult for individuals to reach the other side of the hole ($5,100) and to start getting benefits again.

26. America Can Do Better After all that you’ve heard, what do YOU think… Will Medicare Part D reduce cost, improve access, and increase your ability to live a healthy life?

27. We Get By with a Little Help from Our Friends… • CARA (Alliance for Retired Americans)http://www.californiaalliance.org/default.asp • OWL (Older Women's League), Californiahttp://www.owl-national.org/ • Health Access Californiahttp://www.health-access.org/ • Congress of California Seniorshttp://www.seniors.org/ • Pharmacists Planning Services, Inc.http://www.ppsinc.org/ • California Pharmacists Association http://www.cpha.com/AM/Template.cfm?Section=CPhA_Home • This presentation made possible by a grant from The California Wellness Foundation.

28. Together We Can Get A Real Prescription Drug Benefit Here are at least 4 Ways you can help. • Circulate & advocate • Educate • Tell your stories • Organize & mobilize

29. At the national level… CIRCULATE & ADVOCATE • Tell people about the problems with Part D and urge them to join the fight for a Real Drug Plan. • Join Gray Panthers and participate in meetings in your area. Call 916 921-5008 for the network in your area or to start a new one. • Organize to hold your representative accountable for real relief from high drug costs • Support HR 3861, the Medicare Informed Choice Act (Stark, Schakowsky) to extend the deadline • Support HR 752 (Stark, Berry) the Medicare Prescription Drug Savings and Choice Act, to create a uniform drug benefit in Medicare and require that Medicare negotiate for the best possible prices. 

30. Call Your Congressional Representatives • Dial the House & Senate switchboard 1-202-224-3121 • Ask the operator for the first representative you want to reach • When connected: “Hello, I live in your district and I’m calling to ask you to: • Support HR 3861, the Medicare Informed Choice Act to extend the enrollment period and protect against bad choices. • Support HR 752, the Medicare Prescription Drug Savings and Choice Act, to create a uniform drug benefit in Medicare and require Medicare negotiate for the best prices • Reconsider & replace Medicare Part D with real reform that saves Medicare and provides relief from high drug prices.” • Repeat until you have called all 3 of your representatives! • Call today, call often, get your friends to call too!

31. Educate Be part of a team to follow-up on today’s presentation. • Take what you’ve learned today back to other groups you’re involved with • Let us know if people are interested in further presentations (call (916) 921-5008) • Write a “Letter to the Editor” about the pain and confusion Medicare Part D is causing

32. Let’s Change our Language (Lakoff-ian Stuff) • Don’t blame Medicare, blame privatization! • Don’t talk of “enrolling” in a program, talk about buying insurance. • HSA’s: they’re not savings accounts; they’re High Deductible private insurance plans • Remember, health care is a value. If you belong to a church, synagogue etc., consider mentioning it.

33. Tell Your Story (or help your friends….) Share your experiences and those of people you know • Tell your story today! • Collect stories from others tomorrow • Host a local meeting to get the press to cover the “dangerous side” of Part D.

34. Use Our Form if You’d Like… …or you can just use any old paper. We’d love to have people who are willing to testify, but we’ll protect your anonymity if you wish. We know that real stories are more effective than statistics in the advocacy process.

35. At the state level…Organize & mobilize • Participate in state hearings on Medicare Part D • Coordinate legislative visits in your area.

36. Reach Out To Potential Allies • Gray Panther member groups • Local senior and disability advocacy groups • Pharmacists and their organizations • Non-profit housing providers to seniors and persons with disabilities • Nursing Homes & Residential Care Facilities • Legal Services Programs • Paid and family care givers

37. Are we laughing yet?