[US] DeFazio calls drug plan prescription for poverty

from The Register Guard

By Matt Cooper

U.S. Rep. Peter DeFazio on Monday attacked the federal government's new Medicare plan to help pay for prescription drugs, calling it a confusing, unfair program that will force most users to pay an additional $2,000-plus a year for medicine.

With the start of Medicare prescription-drug coverage Jan. 1, users must now pay up to $2,850 annually after satisfying the initial payment requirements, DeFazio said during a news conference at his Eugene office.

"I opposed this plan because I knew it would be extraordinarily complicated," added DeFazio, a Democrat who represents the 4th District.

Congress in 2003 added prescription-drug coverage - called Part D - to Medicare. The Medicare program uses a portion of income tax receipts to pay some health care expenses for those 65 or older, and for people with disabilities.

Under the program, Medicare recipients pay the first $250 for medicine - called the deductible - and then 25 percent of the total cost until that cost reaches $2,250.

By then, the person will have spent $750, said Leslie Roy of Cascade Health Solutions, a Eugene organization that provides home health care, hospice and other services.

The catch? Roy said users pay the entire cost after the $2,250 has been spent, and until $5,100 is spent total. At that point, the federal government pays 95 percent of the cost.

The amount in between the $2,250 and the $5,100 is $2,850 - lawmakers call it the "donut hole," a gap in coverage - and many Medicare users don't realize that they will pay all of it, Roy said.

"I'm really worried, when they get into `the donut hole' they're not going to have a lot of money to pay for these medications," Roy said. "What are they going to do?"

Patricia Garcia, a Spring- field woman with a rare disease that leaves her vulnerable to a stroke or heart attack, isn't sure.

Garcia, who spoke at DeFazio's meeting, exhausted the insurer's portion of her coverage in three weeks last month. Her five to 10 medications had cost $24 to $40 monthly; now, one alone costs her $1,400 to $2,000 monthly - no small expense for someone who lives on $1,200 a month through Social Security, she said.

"I am truly one of those people who has to choose between food and medicine," she said.

Garcia said the hole in coverage should be eliminated, perhaps by creating a sliding scale that ties the cost for medicine to one's income.

More than half of Medicare's 24 million users could be affected, said Penny Dodge, DeFazio's chief of staff.

President Bush has acknowledged the need to iron out problems with Part D, but said that the competition to provide coverage is lowering costs for users and taxpayers. Most Medicare users will pay about half of what they paid before, Bush said.

Users must choose an insurance plan by May 15.

DeFazio warned that insurance companies may change which medications they cover at any time, while users can change plans only once annually. He wants to extend the enrollment period until the end of the year and allow recipients to change plans at any time during the year.

The "donut hole" does not apply to people who use Medicaid, the federal program that helps low-income people with health care costs. Nor does it affect people who receive the low-income subsidy determined by Social Security.