Tag Archives for AARP

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.

Fix the Nursing Facility Problem Once and For All

Published in Pawtucket Times on April 28, 2003

Forty-years ago, the Senate Aging Committee hearings put the spotlight on the poor care provided in the nation’s nursing facilities.

This month, the April 2003 special issue of “the Gerontologist” sends the troubling message that nationwide improvement in nursing facility care is not likely.

Despite substantial regulatory oversight, Joshua Wiener, of the Urban Institute said “quality of care in nursing homes remains problematic. Quality of care in nursing facilities remains a problem for which there are not simple solutions.”

Before this national crisis can e directly confronted, increased staffing and raising the wages of nursing facility workers appear to be necessary preconditions for improving care quality and should receive high priority, said Weiner. (Rhode Island nursing facility providers hold similar beliefs and have called on Gov. Don Carcieri and state lawmakers to provide the necessary funding to raise facility worker’s wages.

The article’s written by 14 prominent policy experts in this special issue – “The Challenges in Nursing Home Care” – address central concerns in nursing facility care and help provide answers to questions, such as how these facilities can be financed and how care can be delivered.

The articles in this issue are the result of a conference held at Florida State University that was sponsored in part by the National Institute on Aging.

Dr. Quadagno and Dr. Stahl, guest editors of this special issue, believe a major challenge at both the national and state levels concerns the effective recruitment, training and retention of certified nursing aides.  Nursing aides, they pointed out provide about 60 percent of total nursing hours to residents (Again, this observation has been delivered to lawmakers at numerous legislative hearings on Smith Hill).

Many experts who wrote articles in this special issue contend the overall quality of nursing facility care in America still remains poor.  There are serious ongoing quality problems.

And like the rest of the nation, Rhode Island’s facilities are having problems recruiting and retaining certified nursing aids and providing higher wages to them as they receive inadequate Medicaid reimbursement.

What can be done about it?

Simply put, improving the quality of care in Rhode Island nursing facilities is directly linked to getting adequate Medicaid funding. The state must pay a fair rate when facilities are required  to provide quality care to 10,000-plus vulnerable Ocean State seniors who require intensive 24-hour-a-day care.

“The Principes of Reimbursement for nursing facilities are grossly underfunded,” charged Hugh Hall, president of the Rhode Island Health Care Association (RIHCA), a state-wide trade group representing nursing facility providers.

Hall, who is the administrator of the Cherry Hill Manor Nursing & rehabilitation Center in Johnston, estimated only two percent of the state’s nursing facilities are receiving adequate Medicaid reimbursement to cover their true costs of care.

Hall said that unless reimbursement is addressed swiftly, the quality of care delivered by facilities will begin to suffer the effects of the continued lack of attention of state policy makers.

“There is always another need for state tax dollars to be spent elsewhere,” Hall said, recognizing the growing number of special interest groups, who approach the General Assembly each year.

“Hopefully, it will be spent on where it is needed most, on the state’s frailest citizens,” he said, noting that “if the state does not spend it on them, who will?”

According to Alfred Santos, RIHCA’s executive director, the General Assembly is considering legislation (H 5803/S 0901) that would revise the state’s Principles of Reimbursement. Passage would begin to address the inadequate funding of the state’s nursing facilities, he said.

The legislative proposals, referred to the House and Senate Finance Committees, reflect the findings of an 18-month study of B.D.O Seidman, a consulting firm hired by the Department of Human Services to review and recommend fixest to the state’s flawed reimbursement system. Santos said one of the findings of this study was the state was underpaying facilities in excess of $ 30 million annually.

It’s time to fix the state’s flawed Medicaid reimbursement system once and for all. A Band-aid solution is not the appropriate approach considering the growing number of Ocean State seniors who will require higher levels of intensive care.

At an AARP  debate in gubernatorial candidates last September, this writer asked Carcieri if he would budget $ 15 million to overhaul the existing Medicaid payment system. The additional funding would greatly improve the quality of care and services provided to 10,000-plus nursing facility residents.

With this additional $ 15 million in state funding, the federal government would pick up another $ 15 million for a total of $ 30 million. This funding would allow Rhode Island facilities to provide quality care.

Candidate Carcieri acknowledged it would be difficult to find $ 15 million to fix the system because of the state’s looming budget deficit.

But there may be a light at the end of the tunnel. When the dust settles on the governor’s “Big Audit,” state funds may be identified and targeted toward ratcheting up the state’s inadequate reimbursement rate.

Combine these newly discovered funds with new tx revenues generated from the Lincoln greyhound track and you might just have the $15 million in state funds required to bring in millions of federal dollars.

For those Rhode Island seniors who are currently in nursing facilities, and for their children and grandchildren who may unfortunately require that intensive level of care, lawmakers must fix the payment problem once and for all.

Hopefully, Carcieri, along with the General Assembly, will not allow the B.D.O. Seidman report’s recommendations on fixing the state’s Medicaid payment system to sit on the dusty shelf in the Department of Human Services.

If that happens, what a waste of taxpayer money.

Advocacy Groups Support Bills Making Pharmaceutical Drugs More Affordable

Published in the Pawtucket Times on April 21, 2003

The Gray Panthers have been around the Ocean State since 1975.

Richard Bidwell, state coordinator of the Rhode Island Gray Panthers, which represents 400 members state-wide, said his group has fought on behalf of seniors and disable persons on many aging and consumer-related issues.

He recalled one legislative victory that enabled seniors and disabled persons to use a special RIPTA bus pass and ride free during off-peak hours. Later the Gray Panthers would successfully expand this use to all times.

As state coordinator, Bidwell has been involved in lobbying the Rhode Island General Assembly on behalf of the state’s growing senior population for more than 14 years. Last year, the Gray Panthers coordinated their efforts with senior advocacy groups to organize the Senior Agenda Consortium.

This year, the Consortium turns its attention to four legislative proposals that will assist seniors in paying for costly pharmaceuticals.

“We’re trying to get them out of committee with favorable votes,” Bidwell told All About Seniors.

The group has locked horns wit Blue Chip in an attempt to lower prescription drug prices for older beneficiaries who have signed up for that health plan.

S 566, introduced by Sen. James Sheehan (D-North Kingston) would require health plans, such as Blue Chip, to pass on their drug discounts to their members. Blule Chip’s highest premium (costing $148 a month) allows senior beneficiaries to purchase up to $ 1,000 worth of brand-name drugs a year, being charged only a $ 25 co-pay for reach prescription.

This premium also allows a person to purchase up to $ 5,000 in generic drugs, with an $ 8 co-pay charged for each prescription.

Bidwell said that with each purchase of a prescription, Blue Chip subtracts the retail price rather than the actual contracted lower price allowed by the insurance company for the purchase.

As a result,” People are being charged too much,” Bidwell said. “The $ 1,000 coverage is disappearing too quickly with the purchase of each prescription drug.

“Our legislation allows Blue Chip to subtract only the contracted actual price of the prescription rather than the much higher retail price.”

“At press time, the Gray Panthers are attempting to find a House sponsor for this legislation.

A related bill, H 5237, sponsored by Rep. Peter Ginaitt (D-Warwick) and S 374, sponsored by Sen. Elizabeth Roberts (D-Cranston), would allow a person eligible to participate in the Rhode Island Pharmaceutical Assistance to the Elderly Program (RIPAE), who also has prescription drug coverage through a health plan, to use RIPAE to pay for an individual prescription drug once they reach a maximum level of coverage for that drug.  Currently access to RIPAE until he or she uses all of the brand and generic allowance by Blue Chip.

Meanwhile, Bidwell noted that the Gray Panthers are also pushing H 5239, sponsored by Sen. Mary Ellen Goodwin (D-Providence), for expanding RIPAE to allow persons ages 55 to  61 on Social Security Disability Insurance to receive RIPAE co-payments at the same level as Ocean State seniors.

Finally, another legislative proposal, H 5478, sponsored by Rep. Fausto Anguilla (D-Bristol-Warren) and S 299, sponsored by Sen. Rhode Perry (D-Providence), would allow Rhode Island residents to buy prescription drug from Canadian pharmacies, where they are routinely cheaper.

Susan Sweet, an elder rights advocate consultant to non-profit groups and a member of the Senior Agenda Consortium, has called for the passage of these bills, which are key to creating a “responsive and less costly” long-term care system.

“Pharmaceutical drugs may be expensive, but they are certainly less expensive than hospitalization, nursing home care, and other medical services required as a result o a senior not having or taking the prescribed medication,” said Sweet.

“It is primarily the advances in pharmaceutical therapy that have enabled seniors to live longer and healthier lives. By permitting more access for seniors and persons with disabilities to afford their prescriptions, state policy makers can save people’s lives and ultimately save taxpayer money by preventing more costly interventions,” added Sweet.

At the AARP gubernatorial debate, seniors called for state government intervention in putting the brakes of rising pharmaceutical costs.

The calls for action continue to grow. During this legislative session, the Gray Panthers, AARP, the RI Commission on Aging, along with the Forum on Aging and the Senior Agenda Consortium, have made this legislative issue a high priority.

It is time for Gov. Don Carcieri and the leadership of the General Assembly to tackle this senior issue head-on and allocate the necessary state funds to help make prescription drugs more affordable for Rhode Island seniors and persons with disabilities.

Because of the growing costs of medication, a large number of seniors cannot afford to fill their prescriptions, many do not event take their prescriptions as directed by their physicians.”  Noncompliance in taking medications or not taking them at all can result in unnecessary hospitalization, premature admission to nursing facilities, and untimely death.

Even with the state’s looming budget deficit, enabling seniors to afford the purchase of needed pharmaceutical drugs will hopefully be placed on the General Assembly’s short list of bills that must be enacted this legislative session.

Call Senate President Bill Irons at 401-222-2447 and House Speaker Bill Murphy at 401- 222-2466 to tell them of your concerns about this issue and how   the high cost of prescription drugs hits you in your pocketbook.

Urge these key lawmakers to pass legislation that makes pharmaceuticals more affordable to all seniors and persons with disabilities