Monthly Archives for June 2003

Congress is Close to Passing Prescription Drug Legislation

Published in Pawtucket Times on June 23, 2003

Within days of the July 4th congressional recess, the House and Senate continue their debates on enacting legislation to lower the cost of pharmaceuticals for the nation’s elderly.

The AARP will kick off a media blitz to get a point across to lawmakers that while they may take a short break during recess, the nation’s elderly don’t get a break when it comes to affording the costly medications they need.

“There’s no recess [for seniors] from high prescription drug costs,”  AARP declares in a press release sent to the nation’s media outlets.

In a written statement, Lt. Gov. Charles J. Fogarty, who chairs the state’s Long-Term Care Coordinating Council, calls on Rhode Island’s congressional delegation to pass meaningful Medicare drug benefits, rather than the legislative proposals being debated in the House and Senate chambers.

“While it is nice that after many years of promises Congress has finally taken on this issue these proposals will cause nothing but heartburn and headaches for seniors if passed,” said Fogarty, noting that many seniors will pay more for the program than they will get back in benefits. He charged that others will even be left without prescription drug coverage when they need it the most.

Under the Senate proposal, seniors would pay a $ 35 monthly premium and then have to meet a $275 deductible before Medicare starts to kick in to pay for half of the drugs costs.  Once senior’s reach a cost cap of $ 4,500 for the last year, they would then have to pick up the entire cost until they reach yet another cap of $ 5,800 in total drug spending. At this point, Medicare would then pay 90 percent of the covered drug costs.

Fogarty noted the Congressional Budget Office found that one-third of seniors would pay more money to enroll in the plan than they would actually get back in benefits.

That’s because a senior with $ 1,000 in annual drug costs would actually end up

$ 1,057 annual for the benefits ($420 in premiums, a $ 275 deductible and half of the drug costs).  A senior with $ 2,000 in drug costs would pay $ 1,557 out-of-pocket for the benefits.

Fogarty also called attention to the major gap in coverage for those whose costs exceed the $ 4,500 limit until they reach that $ 5,800 mark.

Furthermore, Fogarty, who authored the state’s expanded prescription drug program, said a study by Columbia University found that only those annual drug costs about $ 1,100 would benefit through the plan.  

In the House chamber, the Republican proposal also calls for monthly premiums of $ 35 along with a lower annual deductible of $ 250 with Medicaid paying 80 percent of the cost of drugs up to $ 2,000.

There is a gaping hole in coverage (in this legislative package).” Fogarty warned “Seniors would then have to spend at least another $ 1,500 depending on their income, on medications before coverage would again begin.”

According to Fogarty, Consumer Union, the publisher of the widely-read magazine, Consumer Reports, noted the “skimpy benefits [in the House and Senate proposal] and the historically high growth of prescription drug costs means that most who lack coverage today would wind up paying more for prescription drugs in four years than they do now.”

Will seniors see a prescription drug proposal enacted this year?

Probably, said Jason Ormsby, director of policy at the Washington, D.C.-based Allilance for Health Reform.

“There is a tremendous drive that I have not seen in the last there years [to enact a prescription drug bill],” said Ormsby.

He noted the House passed a legislative proposal to assist seniors in paying for costly pharmaceuticals, but it died in the Senate.

“The somewhat similar House and Senate bills will have a good change to pass by the July 4th recess,” Ormsby predicted.  Once passed, the legislative proposal will go to conference committee to iron out the differences between the 600-page House and 350-pshr Senate bills,” he said.

The prescription drug benefits are just a small portion of these massive legislative proposals, he noted.

Robert Greenwood, vice-president of public affairs for the National Pace Association, added: “Many Democrats see the limitation of these bills.  This legislation passed presents a historic opportunity to get this law on the book so it can be amended and improved in future years.”

While not a meaningful drug prescription proposal, it’s the first step in the right direction.

Once enacted into law, the Rhode Island congressional delegation must begin their efforts to improve the law – improve access for all: make out-of-pocket costs and cost sharing affordable; lessen gaps in coverage; more important, put the breaks to the steady increase in high-cost drugs.

Statehouse Rally Calls for Passage of Nursing Home Payment Reforms

Published in Pawtucket Times on June 9, 2003

In the final days of this year’s legislative session, the Coalition to Ensure Funding for Quality Long-Term Care rallied its troops at the Statehouse rotunda to push for the passage of two legislative proposals that would fix an ailing Medicaid reimbursement system.

The goal of last Wednesday’s rally was to keep the Coalition’s two legislative proposals on the radar map of the Rhode Island General Assembly, which has been bogged down with a multitude of heated legislative issues – separation of powers , fire code changes, smoking bans in restaurants to name a few.

Even with an expected $ 225 million budget deficit for fiscal year 2004, the long-term care advocates, including provider groups, consumer advocates, state policy makers and legislators, urged lawmakers to pay a fair Medicaid rate for nursing facilities, required by state and federal law to provide quality of care to 9,000-plus vulnerable Rhode Island seniors who need intensive, 24-hour-a-day care.

Rally supporters gave a thumbs-up to two legislative proposals ( H 5803/ S 0899). The companion bills, if enacted would revise the state’s Principles of address the inadequate funding of the state’s nursing facilities.

The two legislative proposals, still in the House and Senate Financial Committee, reflected the findings of an 18-month study of B.D.O. Seidman, a consulting firm hired by the state Department of Human Resources to re view and recommend fixes to the state’s flawed reimbursement system.

A major finding of this state-financed study found that the state was underpaying facilities in excess of $ 29 million annually.

These bills call for an additional $ 14 million to state funding for Medicaid reimbursement to nursing facilities. With the infusion of state dollars, the federal government would then kick in $ 16 million for a total increase of $ 30 million.

Eighty percent of the state’s nursing facility residents rely on the Medicaid program to pay for their care, John Gage, administrator of the Coventry-based Riverview Health Care Community and a Coalition member, told those who intended the rally.

Many facilities are left struggling to remain open because Medicaid does not pay for the actual cost of care, he said, noting a number of Ocean State nursing facilities have already filed for bankruptcy of receivership, and some are even closing their doors.

An inadequate reimbursement rate continues to fuel Rhode Island’s critical nursing shortage, too, said Gage. Due to the current  reimbursement system, facilities are hard-pressed to come up with the necessary funds for increases in salaries and benefits to retain nursing staff.

Lt. Gov. Charles Fogarty, who chairs the state’s Long-Term Care Coordinating Council, warned the crowd that Rhode Island’s nursing home industry “is on verge of a meltdown.”

He- along with Sen. Stephen D. Alves (D-West Warwick) and Rep. Steven M. Costantino (D-Providence), sponsors of the Coalition’s nursing home payment reform bills – urged Gov. Donald Carcieri and House and Senate leaders to include funding in the fiscal year 2004 budget to begin the steps needed for Medicaid reform.

Throughout the afternoon rally, until 6:00 p.ml, the Coalition gathered hundreds of signatures to support efforts to increased Medicaid reimbursement to nursing facilities.

Meanwhile, posters strategy placed outside the House and Senate chambers illustrated the rally supporters point that the state is not paying enough for care  of family members in nursing facilities.

At one poster site, piles of dirt were placed on a 6-foot table.  A  poster said: “Did you know this mulch topsoil costs more than $ 5.63 – that’s more than the Medicaid system’s pay for an hour’s worth of nursing facility care for your loved one.  Isn’t your grandmother’s care worth more than the cost of a pile of dirt.”

In a previous All About Seniors column, this writer called for lawmakers to fix the state’s flawed Medicaid reimbursement system once and for all.

The legislative session will soon be ending, and immediate action must be taken now by lawmakers to pass the Coalition’s two legislative proposal, with Gov. Carcieri hopefully signing the bills into laws.

State policy makers must no longer use a Band-Aid approach to fix  broken Medicaid payment system, especially with the graying of the Ocean State’s population. A growing number of Rhode Islanders will soon require this level of intensive care.

It’s time for lawmakers to ratchet up the Medicaid rates to pay for actual costs of care, allowing facilities to deliver quality services.