> "ACTION ALERT and Statements on Medicare Bill"
>
> Leading disability organizations are joining forces urging
> advocates to contact their members of Congress and tell
> them to FIX or STOP H.R. 1, the supposed Medicare
> Prescription drug bill. While this bill would indeed
> introduce forms of prescription drug coverage into the
> Medicare system, it also threatens to unravel the public
> health program that sustains millions of American seniors
> and Americans with disabilities.
>
> This is serious. It could be the beginning of the end of
> Medicare as bona fide public health care coverage - the
> first step toward privatizing it out of reach of those who
> need it most.
>
> Below are alerts/statements from the California Work Group
> on Work Incentives on Health Care, the World Institute on
> Disability, and the National Council on Independent Living.
>
> PLEASE call your elected representatives TODAY!
>
> Jonathan Young
> JFA Moderator, AAPD
>
> =================
>
> CALIFORNIA WORK GROUP ON WORK INCENTIVES AND HEALTH CARE
>
> November 20, 2003
>
> CONGRESS VOTES ON MEDICARE DRUG BILL IN NEXT FEW DAYS
>
> The World Institute on Disability urges Congress to fix the
> HR 1 conference report Medicare drug bill - or vote NO on
> HR 1.
>
> It does harm to Medicare beneficiaries with disabilities
> now and tomorrow.
>
> Please contact your US Representatives today.
>
> www.congress.org
>
> PLEASE FORWARD THIS POST TO YOUR NETWORKS
>
> The bill language for the conference agreement on H.R. 1,
> the "Medicare Prescription Drug, Improvement, and
> Modernization Act of 2003," is posted on the Ways and
> Means Committee website
>
> http://waysandmeans.house.gov/Special.asp?section=43
>
> ======================
>
> November 20, 2003
>
> The Honorable Dianne Feinstein
> United States Senate
> 331 Senate Hart Office Building
> Washington, DC 20510
>
> Re: No on H.R. 1: Medicare is Social Insurance Worth
> Protecting
>
> If policy makers cannot fix or replace the harmful features
> present in H.R. 1, WID strongly urges that the California
> Congressional delegation and the U.S. Congress reject and
> vote no on the H.R. 1 conference report.
>
> Dear Senator Feinstein:
>
> The H.R. 1 conference report fails to modernize Medicare or
> provide a drug benefit with equity.
>
> The World Institute on Disability (WID) believes that
> social insurance legislation of the scope of H.R. 1 must
> include all needed precautions to "do no harm" to existing
> and future populations served by the legislation. WID has
> concluded that the H.R. 1 conference report has breached
> this core principle significantly for large numbers of
> Americans without showing good cause. It is imperative that
> social insurance such as Medicare include a drug benefit.
> WID believes that the U.S. has the will, technology and
> financial capacity to meet this goal without doing
> significant harm in the process.
>
> Instead, the H.R. 1 conference report contains at least
> three core features that in combination harm current and
> future beneficiaries of Medicare and Medicaid.
>
> 1. CURRENT MEDICAID AND MEDICARE "DUAL ELIGIBLES" ARE WORSE
> OFF.
>
> 2. "PREMIUM SUPPORTS" WILL DO HARM TO MEDICARE
> BENEFICIARIES OVER TIME.
>
> 3. DRUG COST CONTAINMENT AND CONTROLS ARE MISSING.
>
> As the range of analysis below shows, the combined features
> undermine and erode the national consensus needed to
> support such fundamental changes to Medicare.
>
> 1. CURRENT MEDICAID AND MEDICARE "DUAL ELIGIBLES" WORSE OFF
>
> Up to 6.4 Million Seniors Could Be Affected
>
> * The seniors who could end up worse off under the
> conference agreement are the so-called "dual eligibles," or
> Medicare beneficiaries whose incomes are low enough to
> qualify them for Medicaid. There will be 6.4 million such
> individuals when the proposed Medicare drug benefit takes
> effect in 2006.
>
> * Under current law, when a benefit or service is covered
> by both Medicare and Medicaid, people who are eligible for
> both programs receive it through Medicare. Medicaid,
> meanwhile, fills in any gaps in coverage and picks up most
> or all of the co-payments that Medicare charges. The
> conference agreement would largely eliminate this
> supplemental (or "wrap around") Medicaid coverage for the
> new Medicare drug benefit. This marks an unprecedented
> change in the way the two programs interact. For low-income
> seniors, it means generally higher co-payments and possibly
> the loss of coverage for certain drugs.
>
> * The elements of the legislation that will adversely
> affect low-income and disabled seniors were added during
> conference negotiations, apparently as a way to free up
> more funds for larger subsidies for more powerful groups.
> "It's interesting to note that this was done at the same
> time that a $12 billion "slush fund" was added to the bill
> for private insurers," noted Edwin Park, lead author of the
> analysis noted from Center on Budget and Policy Priorities.
> And Robert Greenstein, Executive Director of the Center on
> Budget and Policy Priorities said, "This conference
> agreement manages to worsen drug coverage for many of the
> nation's poorest elderly and disabled people despite a
> price tag of $400 billion. This problem could have been
> averted by providing less extensive subsidies to for-profit
> HMOs, PPOs and other provider groups and taking better care
> of those most in need."
>
> 2. "PREMIUM SUPPORT" WILL DO HARM TO MEDICARE BENEFICIARIES
> OVER TIME.
>
> A six-year "premium-support" demonstration project would be
> established in six metropolitan areas. Medicare recipients
> in areas covered by the project would choose between
> traditional Medicare and private health plans. If the cost
> of the selected form of coverage exceeded a benchmark level
> set for the area -- and the cost of traditional Medicare is
> likely to exceed the benchmark for reasons explained below
> -- the individual would pay added premiums to cover the
> difference.
>
> * The proposal is much larger than what is needed for a
> demonstration project. Data from the Department of Health
> and Human Services show that it could cover several million
> Medicare beneficiaries, which substantially surpasses what
> is needed to conduct a valid demonstration.
>
> * The proposal is likely to increase "cherry-picking"
> healthier beneficiaries and cause a substantial increase
> over time in premiums for traditional Medicare coverage. As
> the two analysts who developed the premium support concept
> in the mid-1990s -- Henry Aaron of Brookings and Bob
> Reischauer of the Urban Institute -- have noted, premium
> support poses serious dangers unless it is accompanied by
> regulatory and other measures to assure that the private
> plans do not "cherry-pick" the healthier beneficiaries,
> leaving traditional Medicare with the sicker ones.
>
> The emerging conference agreement lacks these other
> provisions. It thus poses dangers to sicker beneficiaries.
> Traditional Medicare would likely cost more than the
> private plans, both because it would be serving a sicker
> population and because the emerging agreement includes
> billions in subsidies for the private plans. Because of the
> resulting differential, premiums charged to the sicker
> retirees left in traditional Medicare could rise
> substantially over time.
>
> "The virtue of Medicare is that it creates a large risk
> pool. The wealthy and the healthy are in the same boat as
> the poorer and the sicker. Busting up Medicare's risk pool
> would almost certainly raise costs to poorer and sicker
> seniors, as insurance companies make more money insuring
> healthy people than sick ones. It would take an enormous
> amount of regulation to prevent this sort of "cherry-
> picking.'" E. J. Dionne Jr, Washington Post, November 18,
> 2003
>
> * The proposal is biased in favor of private plans.
> "They've created a huge bias in favor of private plans,"
> says Jeanne Lambrew, Senior Fellow at the Center for
> American Progress and a professor at George Washington
> University. "How can you call it choice or competition when
> private plans have such a large financial advantage?"
> Lambrew noted that the H.R. 1 bill that is supposed to
> expand drug coverage may cause at least 2 million seniors
> to lose their coverage from their former employers
>
> 3. DRUG COST CONTAINMENT AND CONTROLS ARE MISSING.
>
> Of particular concern on the fiscal front is the
> legislation's failure to include true cost-containment
> provisions that would moderate the escalating cost of drugs
> to both the federal Treasury and American consumers. The
> legislation could have used Medicare's enormous purchasing
> power to negotiate significantly lower prices for drugs
> (as, for example, the Department of Veterans Affairs and
> the Medicaid program do). Instead, at the apparent behest
> of the pharmaceutical industry, the legislation is
> structured so that Medicare will not play this role.
> Moreover, the legislation bypasses a measure the Senate
> approved last year on an overwhelming bipartisan basis to
> substantially improve access to lower-cost generic drugs
> and instead includes a weak generic-drug provision that was
> acceptable to the major pharmaceutical companies."
>
> TRAGIC CONCLUSION
>
> "It is nothing short of tragic that legislation that was
> meant to offer relief from high prescription drug costs to
> seniors is laden down with so many dangerous provisions
> that it will harm Medicare beneficiaries and threaten the
> program's long-term viability," said Gail Shearer, senior
> health policy analyst for Consumers Union and author of
> their analysis (available at www.consumersunion.org).
>
> If policy makers cannot fix or replace the negative
> features present in H.R. 1, WID respectfully recommends and
> requests that the California Congressional delegation and
> the US Congress reject and vote no on the H.R. 1 conference
> report.
>
> Respectfully submitted:
>
> Deborah Kaplan
> Executive Director
>
> =================
>
> NCIL VOICES SERIOUS CONCERNS WITH MEDICARE PRESCRIPTION
> DRUG CONFERENCE PACKAGE; VOTE LIKELY TOMORROW!!!
>
> In a letter that will be hand-delivered to all 535 Members
> of Congress later today, in advance of an anticipated vote
> in both the House and Senate tomorrow, NCIL is stating its
> very serious concerns with the reported provisions of the
> Medicare legislation. Please find our letter detailing
> these concerns below.
>
> We believe that it is very unfortunate that the 1100 page
> bill, which may have a dramatic impact upon the shape of
> America's safety net, is being considered and voted upon in
> such a hasty manner. Our concerns are:
>
> 1) There are provisions to implement "cost containment"
> that effectively "cap" the Medicare benefit without
> providing for adequate attention to containing the rapidly
> accelerating costs of prescription medicines.
>
> 2) There are provisions subjecting the Medicare program to
> competitive bidding with private health plans that will
> weaken traditional Medicare in order to "privatize" the
> program.
>
> 3) In addressing the issue of durable medical equipment,
> provision should be made to ensure that competitive bidding
> takes into consideration the value added by certain more
> expensive equipment that is of a higher quality, greater
> durability and/or can enable people with disabilities to
> live more independently and to move into the workforce.
>
> 4) NCIL is concerned that in the effort to provide a
> catastrophic benefit, the gaps in the Medicare prescription
> drug benefit are too sizeable to meet chronic care needs.
>
> 5) It has been reported that there may be provisions in the
> Medicare bill that could restrict states from taking
> advantage of existing regulations to use less restrictive
> methodologies when calculating income and assets for
> Medicaid coverage and/or to eliminate Medicaid buy-ins.
>
> 6) Reportedly, the Medicare legislation contains changes
> that could restrict or prohibit states from providing wrap-
> around Medicaid prescription drug coverage to individuals
> who are dually eligible for both Medicare and Medicaid.
>
> 7) NCIL seriously questions the adequacy of the Medicare
> prescription drug benefit.
>
> We urge members of Congress to take these concerns into
> serious consideration as they weigh whether or not to
> approve the prescription drug legislation before them. Our
> recommendation to legislators is to follow the time-honored
> principle of medicine to "first do no harm."
>
> We urge you to share your concerns with your federal
> representatives. If you wish to go one step further and
> formally put your organization on a list of groups opposed
> to the bill, then send an e-mail to the staff of House
> Democratic Leader Pelosi at
> Charmaine.Manansala@... and call Sarah Lucas of
> the Senate Democratic Steering Committee at 202-224-9048.
>
> If you have questions about NCIL's position or the Medicare
> legislation, contact Gwen Gillenwater or Daniel Davis at
> 703-525-3406 or by e-mail at daniel@... or
> gwen@....
>
> # # #
>
> =====================
>
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>
> JUSTICE FOR ALL -- A Service of the
> American Association of People with Disabilities
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