Better health security in the long run with Plan D

We can’t imagine modern medicine without prescription drugs. Soon we won’t be able to imagine Medicare without prescription-drug coverage.

Twenty-four million beneficiaries now have prescription coverage. Every day, nearly 90,000 beneficiaries are enrolling in the program and about 1 million prescriptions are being filled.

Millions of people now have financial help to manage pain, keep diseases from progressing or save their lives. This coverage was overdue and desperately needed. For many older Americans, prescription drugs were either expensive or out of reach altogether.

After extended bipartisan debate, Washington addressed Medicare’s glaring omission. As chairman of the Senate Finance Committee, I helped steer Medicare’s first-ever prescription-drug benefit through Congress. We worked to deliver a completely voluntary, permanent benefit to make prescription drugs more affordable, especially to the neediest beneficiaries. The elderly poor and those facing catastrophic drug bills stand to save a lot of money under the new benefit.

Medicare launched the new benefit, Part D, on Jan. 1. There were some unacceptable problems, but as the problems are resolved I’m confident beneficiaries will agree the new benefit will bring them better health security in the long run.

This isn’t to minimize the real problems experienced by some of the poorest, sickest people. The beneficiaries eligible for both Medicare and Medicaid — the “dual eligibles” — have had real hardship in some cases. Those hardships have to be fixed, and fast.

I’m keeping close tabs on the federal agencies in charge of implementing the new benefit to make sure they take quick action to resolve the problems. Three weeks into the benefit, I convened a bipartisan Finance Committee meeting with the top Medicare program officials, Health and Human Services Secretary Mike Leavitt and Mark McClellan, administrator of the Centers for Medicare & Medicaid Services. Senators had a chance to ask tough questions.

Some senators who aren’t on the committee — mostly those with partisan political motives — are pushing for legislation to change the benefit in the name of fixing the problems. But the problems so far don’t lend themselves to a legislative fix. The issues with computer systems and long wait times on phone lines are better addressed administratively.

Administrative resolutions are also faster than legislation. A case in point: Three weeks into the new benefit, the administration announced that it would ensure that states are repaid for expenses they’ve incurred for beneficiaries eligible for both Medicare and Medicaid.

Another example: Prescription plans must have a “first fill” policy. The policy already required at least 30 days of coverage for the first prescriptions filled, even if the drugs are not on the plan’s formulary. Just days ago, Secretary Leavitt announced that the policy is being extended for 60 more days. That means plans will provide 90 days of “first fill” coverage.

While I was disappointed by the start-up problems, it’s good to see decisive action in responding to beneficiaries’ needs. There is still more work to be done. So far, though, it doesn’t look as if we need legislation to overcome the initial implementation challenges.

Some critics say the prescription-drug problem is too complex. I agree that beneficiaries have a lot of choices. Each person has to weigh a series of considerations to find the best option for him or her. Yet many options are better than few options. Beneficiaries have different needs and wants. Having choices ensures that they can get the best benefit for them.

Remember, beneficiaries aren’t in this alone. The Medicare call center is available 24 hours a day. It added employees to help with the higher call volume. The Medicare website is a good resource, improving all the time. And every state has counselors to assist beneficiaries under the State Health Insurance Information Program. The whole point of that program is to help beneficiaries understand their Medicare benefits.

Beneficiaries have significant rights and protections under the new program. They can change their enrollment outside of the open-enrollment period if their plans fail to meet certain standards. For example, they can change plans if they don’t get timely information about their benefits. Or if the benefits aren’t in line with quality standards. Or if the plans misrepresent themselves through marketing materials.

This isn’t to say Congress will sit back and watch the benefit unfold. We have a constitutional responsibility to conduct oversight and ensure the fix of startup problems of the policy we’ve created for 42 million Medicare beneficiaries.

I’ll continue to seek improvements from the federal officials implementing the benefit to make sure they resolve these issues quickly. This will involve conversations, committee meetings, hearings, and whatever else we need to make sure the problems are resolved. I’ll also continue to seek the advice of my constituents in Iowa and people in the field about their experiences.

I want to hear what people think about policy out of Washington that affects both their health and wealth. My goal is for Medicare beneficiaries to enjoy their prescription-drug benefit so much that they can’t imagine life without it.

Grassley is chairman of the Senate Committee on Finance, with jurisdiction over Medicare and Medicaid.

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