2003-06-25 / Seniors

Senior Spotlight

Private Insurers Seen Running Medicare Rx
By John Toscano
Senior Spotlight By John Toscano

Private Insurers Seen Running Medicare Rx

Two key votes last week strengthened the impression that when Congress casts the final votes for a drug prescription benefit for 40 million Medicare members, possibly this week, the system will call for them to get their drugs through a private insurance company, not the Medicare program itself.

This was the choice of President George W. Bush from the start and now Republicans, who control both the House of Representatives and the United States Senate, are holding the line against Democrat attempts to keep Medicare involved in the new benefit.

Just how this will affect individual Medicare members remains to be seen. It may work just fine, but some lawmakers and senior citizen advocates are concerned because in the past, private HMOs administering Medicare benefits have had a spotty record.

The way these latest developments occurred began last Tuesday, when the important House Ways and Means Committee, with no debate, approved the Republican-sponsored bill to add prescription drug benefits for Medicare members.

Democrats offered an amendment that would authorize Medicare to offer its own plan for members, in addition to any plans that might be offered by private insurers. Members’ premium for either program would be the same, $35 a month. The Democrats said there should be a government plan in case private insurers don’t want to get involved in the new benefit.

The Democrats’ proposal was defeated 23 to 15 because, Republicans held government involvement could lead to government control of drug prices. That has always been the drug industry’s main fear about a prescription drug program for seniors.

The following day, Democrats in the Senate offered an amendment to the Republican-sponsored drug benefits bill, which has already been approved by the Finance Committee. The amendment would guarantee that seniors would have the option of taking a plan offered by Medicare rather than plans only offered and run by private insurers.

The amendment failed 37 to 58, led by Republican opposition. Democrats had pointed out that Medicare is run more cheaply than private plans, but again Republicans raised the specter of price controls and the amendment was defeated.

During last week, the president met with both sides to urge them to keep working at getting bills passed in both houses. He would like to get a bill by July 4 which he could sign. Such a bill would provide the first major change in Medicare in its 38-year history.

SCHUMER’S GENERIC BILL PASSES: U.S. Senator Charles Schumer (D–New York) was successful in amending the prescription drug coverage legislation in a way to save seniors money. Approved by the full Senate last Thursday, his bill would make generic drugs more readily available to consumers. Generics are identical copies of brand-name prescription drugs, but are much cheaper.

Schumer said the bill could save consumers $60 billion to $70 billion over the next 10 years and reduce Medicare costs by $18 billion to $20 billion.

CLINTON’S POSITION: Last week, before the Senate Finance Committee passed its drug benefits bill, U.S. Senator Hillary Rodham Clinton (D–New York) issued a statement saying she would continue to work to make sure low-income seniors—those on Medicaid, those who receive group retiree drug benefits, and seniors in rural areas where there are no private plans—are protected under the historic new drug coverage plan.

Clinton said, "For seniors who are trying to get by on a modest Social Security check and maybe a small pension, much of this proposal just doesn’t make sense."

There will be times, she said, when many low-income seniors will be paying for drugs under the program and will be getting nothing back from it.

Clinton fears New York state will drop members from Medicaid in order to bring them under the new program. This would mean some people would then have to give up the long-term care benefits that are only available through Medicaid, Clinton warned.

Group retiree benefits should be protected by making sure retirees can stay in their own plans.

Clinton said she had offered an amendment to the Senate plan that allows states to provide assistance to seniors, as New York state does with the EPIC program, while being reimbursed by the federal government. The amendment passed and Clinton said she would continue to monitor the bill’s progress to make sure it remains in the legislation when the final vote comes.

KNOW YOUR BENEFITS: Sunnyside Community Services (SCS) at 43-31 39th St., Sunnyside, says that more than half of older New Yorkers don’t receive the benefits to which they are entitled because they don’t know these benefits exist or don’t know how to apply for them.

SCS has a solution. That agency, working with GreenPoint Bank, 40-20 Queens Blvd., Sunnyside, and the Council of Senior Centers and Services (CSCS) can help seniors find out in one sitting whether they’re eligible for 40 benefits.

The service is free, done through CSCS "Access To Benefits", a screening program that determines eligibility for 40 federal, state, city and private benefits.

Seniors can meet with a trained volunteer at the GreenPoint Bank any Saturday, 9 a.m. to Noon and in about 15 minutes receive a list of benefits for which they are eligible. Information and assistance in applying for benefits is also provided. About 90 percent of seniors are eligible for most such benefits.

There could be some savings in store. for example SCRIE protects elderly seniors from future rent increases. HEAP assists eligible seniors with the cost of utilities. Verizon Lifeline provides a discount of almost $10 per month on telephone service. The Medicare Savings Program pays a senior’s Medicare premium, a savings of $58 a month.

In these hard times, seniors shouldn’t have to struggle to make ends meet. A visit to the GreenPoint Bank at 40-20 Queens Blvd. might ease the crunch. Call Phyllis Ruiz at 212-398-6565, ext. 227 and ask for information about CSCS Access To Benefits.

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