When Congress revisits health reform next year, given the fact that surveys show a need to boost confidence in both the Affordable Care Act and government as a whole, lawmakers would do well to look at a health program that was born in controversy but has become immensely popular – the Medicare Part D prescription drug program.


Although there was no small amount of political conflict surrounding the creation of the Part D program, we often forget that Democrats and Republicans worked cooperatively in the U.S. Senate to pass the Medicare Modernization Act and extend pharmaceutical coverage to the nation’s seniors and disabled citizens.  The result of this bipartisan cooperation is a program that offers low monthly premiums, reasonable out-of-pocket costs and additional help so that low-income beneficiaries can get the medicines they need at little or no cost.

As Congress seeks ways to improve the efficacy of health reform and, for that matter, the long-term sustainability of the Medicare and Medicaid programs, the Part D program serves as a bipartisan blueprint.  Affordable care?  In 2011, average premiums will be just $30, only a one dollar increase over 2010 averages.  Taxpayer costs?  According to the most recent Medicare trustees’ report, their estimate for Part D spending is down 41 percent from initial 10-year projections.  Popularity?  According to a recent survey by the Medicare Today coalition, 84 percent of seniors enrolled in Part D plans report they are satisfied with the program.

The program works because, in Part D, private plans have to compete for beneficiary loyalties on the basis of quality and value.  On the public sector side, the Centers for Medicare and Medicaid Services (CMS) has done a capable job managing the program and creating innovative tools to help seniors become well-informed consumers.

That public-private cooperation is yielding benefits once again in the improvements that are being made to the Part D program.  Ever since Part D began, there have been concerns about the so-called “donut hole.”  That’s the gap in coverage in which Part D beneficiaries have to pay the full cost of their prescriptions once they reach $2,830 in total expenses.  After their spending total hits $6,440, then coverage kicks in again and the government picks up 95 percent of their costs the rest of the year.  But, that gap can be a serious hardship for people with multiple health conditions and significant drug spending.

This past year, seniors who reached the “donut hole” received a $250 check toward their out-of-pocket expenses.  In 2011, as part of the new health reform law, biopharmaceutical research companies will provide a 50 percent discount on brand-name medicines for enrollees who reach the coverage gap. According to CMS, this will provide a cumulative $2 billion savings for enrollees in the coming year.  Over time, the government and pharmaceutical companies will continue to phase in additional subsidies in the coverage gap for brand-name and generic drugs. By 2020, beneficiaries will see no change in their copayments until they reach catastrophic coverage levels and the coverage gap will be a thing of the past.
There is a challenge, though, regarding Medicare drug coverage that should be addressed by the private and public sectors, Democrats and Republicans alike.  According to the Medicare Today survey, only 20 percent of the nation’s seniors know that the “donut hole” coverage gap is being narrowed.  We also know that there are still thousands of low-income seniors who are not availing themselves of the assistance that Medicare Part D provides.  Given the public interest in protecting seniors against acute illnesses and chronic diseases, there is a necessity to engage in aggressive public education activities to let seniors know what’s available to them.

Bickering in Washington has elicited so much attention of late that we almost forget that bipartisan cooperation and public-private joint endeavors have occurred in our not-so-distant past.  The Medicare Part D program is a success story because individuals and organizations put their partisan and ideological differences aside to aid a population that needed a helping hand.  It’s a good object lesson as we consider how to energize Americans’ faith in health reform and their government.

Mary R. Grealy is president of the Healthcare Leadership Council - www.hlc.org - and co-chairwoman of the Medicare Today coalition - www.medicaretoday.org.