November 20, 2003
Dear Member of Congress:
We are writing as members of the Consortium for Citizens
with Disabilities (CCD), a Washington-based coalition of national disability
organizations that advocates on behalf of the 54 million people with
disabilities and chronic conditions in the United States. After careful
deliberation of the publicly available information on the Medicare conference
report, we are very disappointed that the conference committee has produced a
bill that we simply cannot support.
This Congress, in our view, has missed an historic
opportunity to finally provide prescription drug coverage to millions of senior
citizens and people with disabilities who receive their health care through
either the Medicare program alone or in coordination with the Medicaid program.
We strongly support the creation of a prescription drug benefit that meets the
needs of Medicare beneficiaries and “dual eligibles.” Regrettably, Congress has
chosen to couple a marginal drug benefit with a series of fundamental structural
changes to the program that will undoubtedly have a severe negative impact on
people with disabilities.
Over 13 million Medicare beneficiaries have a disability or
chronic health condition. The poorest and most vulnerable are dual eligibles,
who (more than other Medicare beneficiaries) rely extensively on prescription
drug coverage in addition to services and devices to meet their basic health
care needs. Our inability to support this bill stems from our overall concern
that over the next decade, it shifts resources from a successful government
program to the private, for-profit sector. This bill will also shift resources
away from people requiring complex or frequent care, such as people with
disabilities and chronic conditions, to a relatively healthy Medicare
population.
Many provisions in the bill segment the Medicare risk pool
in a manner that will result in higher costs and compromised care for people
with disabilities and chronic conditions. Taken together, a number of
provisions in this bill serve to undermine the entitlement to Medicare that has
served this country so well for the past four decades.
Specifically, the CCD has the following concerns that
impact people with disabilities and chronic conditions:
- The Medicare Drug Benefit does not
provide adequate coverage for people with disabilities. The benefit, as a
whole, is substantially less generous than all other Medicare benefits
and the vast majority of private and
government-sponsored plans that cover prescription drugs.
Additionally, the bill has a considerable “gap” in coverage starting at
$2,200 in annual drug costs until an individual has spent $3,600 in
out-of-pocket drug expenses.
- Drug Formularies: Too few consumer
protections are provided to ensure that people will have access to all
medically necessary medications. Retreating from the standards established in
the Medicaid statute for formularies will be harmful for people with serious
and chronic health conditions and disabilities.
- Medicaid “Wrap”: Millions of “dual
eligibles” with disabilities and chronic health conditions, who now depend on
Medicaid to pay for the prescription drugs they need to maintain their basic
health, will lose access to medications. By permitting the development
of Medicare formularies that will restrict access to needed drugs and
prohibiting Medicaid from serving as a secondary payer for medications not on
the formulary, the agreement could force people with disabilities (e.g.
epilepsy or mental illness) to forego medications they need leading to less
effective or no treatment. This could result in injury or debilitating side
effects which require hospitalization or other costly medical interventions.
- Health Savings Accounts, also known as
Medical Savings Accounts (MSAs), would undermine the health care system and be
especially harmful to people with disabilities and others who rely on
insurance to finance a high level of services. Health Savings Accounts
provide the incentive to healthier and higher income people to leave the
traditional insurance market. This could de-pool the current insurance system
that seeks to spread the unpredictable risks for financing care for a
relatively small number of people with disabilities and chronic conditions
across society. Both people with disabilities and non-disabled people lose by
weakening the insurance system.
- Medicare Competitive Bidding for Durable Medical
Equipment will cause a long-term reduction in quality and access to
high quality assistive devices
and services for people with disabilities. In addition, competitive
bidding limits beneficiary choice of provider.
- Premium Support Demonstration: The
prospect of Medicare fee-for-service competing directly with managed care
health plans poses too many risks for private plans to “cherry pick” healthier
beneficiaries and increase costs for people with disabilities who remain in
Medicare fee-for-service.
- Means Testing the Part B Premium undermines
the basic premise of Medicare as an insurance program, causing a
disproportionate share of wealthier (and healthier) beneficiaries to leave the
program over time, thereby diluting the risk pool further and raising costs
for people with disabilities.
- Cost Containment:
Requiring Congressional intervention if
general revenue contributions exceed 45% of program spending is an
unprecedented tactic designed to strengthen the hand of those in the future
who seek to dilute the entitlement nature of the program and favor a premium
support model.
- The Asset Test
in the conference report could block almost four million Medicare
beneficiaries with incomes of less than 135% of poverty from getting help with
their prescription drug premiums, deductibles, and co-payments. This test is
unnecessary and comes at a cost of imposing significant administrative burdens
on states to implement such a test. It would also require state officials to
ask intrusive questions about the possessions of Medicare beneficiaries and
make complex decisions about the value of an individual's possessions. It is
unlikely that this test would be implemented evenly or fairly across states.
As you consider how you will vote on this important
conference report, thank you for consideration of our views and concerns.
Sincerely,
Advancing Independence
American Network of Community Options and Resources
American Association of People
with Disabilities
American Association on Mental Retardation
American Association on Health and Disability
Association of Academic Physiatrists
Association of Tech Act Projects
Association of University Centers on Disabilities
Bazelon Center for Mental Health Law
Brain Injury Association of America
Council of Parent Attorney and
Advocates
Disability Service Providers
of America
Easter Seals
Eastern Paralyzed Veterans
Association
Epilepsy Foundation
Family Voices
Federation of Families for
Children's Mental Health
National Association of
Councils on Developmental Disabilities
National Association of
Protection and Advocacy Systems
National Association of
Rehabilitation Research and Training Centers
National Mental Health
Association
National Organization of
Social Security Claimants’ Representatives
National Association of Social
Workers
National Respite Coalition
NISH
Paralyzed Veterans of America
The Arc of the United States
United Cerebral Palsy