The horror show of technical glitches that has been the rollout of the Medicare prescription-drug program may well smooth out over time. The bigger story is that the real problems are still to come.
There is rich irony here. This mess has been effectively turned over to the healthcare industry, which backed the new program to the hilt in exchange for a huge payday in the form of extra hospital reimbursements and a slush fund to entice managed care into Parts C and D. Now providers will have to pay for their exuberance, as confused and angry seniors try to navigate the rest of the program and Congress inevitably rethinks the program's escalating costs.
It's true that the CMS, the managed-care industry and pharmacies botched the technical aspects of the rollout, leaving many of the aged and infirm without life-saving prescription drugs. Many poor people who had been receiving drug coverage under Medicaid found they had been switched to Medicare, but discovered they failed to show up on computers as being low-income and so were charged the full $250 deductible and 25% copayment. Some seniors were being steered to hospital emergency rooms after being turned away at their pharmacies for lack of a drug card or inaccurate information on their registration.
The CMS on Jan. 4 sent out a letter to insurance companies telling them they need to hire more customer service employees and be able to provide correct information, which may say something about the quality of the information that went out before.
Customer service representatives at the CMS were no more likely than private-sector counterparts to know what they were talking about. For example, under Medicare rules, each drug plan is supposed to provide a temporary supply of any prescription that a person was previously taking. But people answering calls at Medicare's toll-free telephone number said they knew nothing of this requirement.
CMS Administrator Mark McClellan, surveying the chaos, said that he was working hard to solve the problems, but that overall, things were A-OK. "Many, many people are getting the prescriptions they need," he said. McClellan is like the general who, after sustaining mass casualties in a losing battle says, "Many, many soldiers are still alive."
Just wait until more people wind up realizing they signed up for the wrong plan. Seniors are locked into a Part D plan for a year, but drug formularies can be changed during that year, potentially leaving seniors without a needed medication. If they waded into the wrong plan during the online signup or were sold on a plan by an insurance salesman, there may be many surprises in store.
More importantly, many beneficiaries will encounter the infamous "doughnut hole" in coverage later this year. Under the standard Medicare drug benefit, the patient pays the $250 deductible and 25% of the next $2,000 in annual drug costs. Then, the beneficiary is on the hook for all of the next $2,850 in drug bills until Medicare resumes paying. The doughnut hole is when the real outcry will come.
For all its many faults, there will be benefits for many beneficiaries, especially the elderly poor and others who may not have had any coverage before. That leads us to the final point. Part D is estimated to cost $850 billion over the next 10 years, at a time when the national debt is predicted to be exploding. At some point Congress may take a hard look at what it has wrought and try to fix this program.
On the other hand, given its track record, Congress may simply cut benefits or provider payments.
What a mess.
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