Morning Call Editorial - Medicare Drug Benefit Should Augment PACE

Morning Call (Allentown, PA)

HEADLINE: Medicare drug benefit should augment PACE

BYLINE: By Rick Santorum Special to The Morning Call - Freelance

BODY:
Medicare has played an important role in providing health care security to millions of America's seniors and people with disabilities. Unfortunately, the program has remained largely unchanged since its creation in 1965 and has failed to keep pace with the advancements in modern medical care.

Perhaps the most glaring of Medicare's deficiencies is the lack of an outpatient prescription drug benefit. Most Pennsylvania seniors know the valuable role medicines play in preserving and enhancing quality of life from the successes of the popular PACE and PACENET low-income drug assistance programs. I am firmly committed to ensuring that a new Medicare drug benefit works effectively and efficiently with PACE, so it can partner with and complement the new Medicare benefit.

As a member of the Finance Committee, I participated in the drafting of the Medicare improvement legislation, and above and beyond the prescription drug benefit, one of my goals is to apply the best practices of the private health care market to Medicare, providing seniors more choices where drug benefits can be integrated into medical coverage.

"Medicare Advantage" as proposed by President Bush, places greater emphasis on preventive services and coordination of care. A core component of Senate Bill 1, Medicare Advantage, would allow beneficiaries to choose the coverage that makes sense for them, just as federal workers and members of Congress do through the Federal Employees Health Benefit Program. Seniors would have "one-stop shopping" for their health care needs: one simple combined deductible, drug coverage, preventive and coordinated medical care, disease management and new protections against high out-of-pocket medical costs.

The new federal prescription drug benefit—whether it is part of traditional Medicare or through the new integrated Medicare Advantage options—should serve as a universal foundation of prescription drug protection for all beneficiaries, and state programs like PACE should have the opportunity to complement, or "wrap around," the new federal benefit.

What would this mean? For example, say you take five prescriptions per month and have annual drug costs of approximately $3,000. Under PACE, seniors pay $6 per prescription, or about $360 per year under the above example. With the Senate bill's new universal Medicare drug benefit, the same senior would pay much less for prescription drugs: between $75 and $150 per year.

With states like Pennsylvania relieved of a large portion of the costs of their current low-income state-run programs, PACE could use these savings to help more people by building even more generous coverage and expanding eligibility on top of the new federal benefit.

Unfortunately, an amendment was added to the bill by Sen. Jon Corzine, D-N.J., that would have effectively "carved out" beneficiaries in certain states with existing drug-assistance programs, preventing Pennsylvania from participating in the full range of choices that the Senate bill embodies. The Corzine amendment would force Pennsylvanians to choose between a drug-only, government-run prescription drug program such as PACE and the new enhanced Medicare Advantage health-care options.

I believe that effectively "block-granting" the new Medicare prescription drug benefit to a few states in a way that limits the health care options available to seniors is a shortsighted, flawed and misguided policy.

Not only would such a proposal have PACE directly compete with Medicare Advantage, it would deny certain Pennsylvanians who choose to remain in "PACE-only" the strong beneficiary protection requirements that are guaranteed in the Senate bill, including grievance, appeal and reconsideration rights and access standards. This is an especially important point, given that many states facing budget deficits are restricting access to certain medicines and limit the number of prescriptions seniors can use in their drug and Medicaid programs.

Pennsylvanians should have access to the benefit of both PACE and the full range of health options that the new Medicare legislation envisions, and I cannot and will not support any proposal that would seek to limit the choices available to seniors.

One of Medicare's long-standing principles is that it is a program for all—not just people who are not in state assistance programs. Those seniors who are in PACE today should have access to the fullest range of health care options, as should all Medicare beneficiaries. And I will work to ensure that all Pennsylvanians have the ability to take advantage of the most that both PACE and Medicare have to offer.