Quickest
boost of Medicare drug card enrolment said to hurt competition |
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The Bush administration is
resisting calls from across the political spectrum to broaden the automatic enrolment
of poor people in the Medicare discount drug card program. |
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One reason cited by
administration officials: They don't want to limit people's choice of cards, a
key element in the competition among drug cards that is supposed to help reduce
prescription drug prices. |
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"We expect that by making
the prices of most commonly prescribed drugs used by Medicare beneficiaries
available to the public, the prices will actually drop due to
competition," Mark McClellan, administrator of the federal Centres for
Medicare and Medicaid Services, told Congress in June. |
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McClellan said in a recent
interview that the administration is halfway to its goal of 7.4 million people
in the discount card program, a temporary measure before drug insurance under
Medicare begins in 2006. |
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Yet two-thirds of the nearly
3.7 million people who now have cards had no choice. Either they belong to an
HMO that requires members to use its card or they are in a state prescription
drug assistance plan for the poor that won approval to sign up participants
automatically. |
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There are roughly six dozen
national and regional discount cards for which Medicare beneficiaries pay up to
$30. The administration says prices have declined 10 percent to 25 percent
since companies that offer drug cards began revealing their prices in late April;
critics say the discounts have been undercut by price increases that preceded
the start of the program. |
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For poor older and disabled
Americans who have no drug insurance, the cards are free and the government
provides $600 a year to defray the costs of prescription medications. |
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Health care analysts estimate
the government easily could enrol 700,000 or so low-income people by simply
expanding automatic enrolment. |
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"I know CMS is hung up
about giving those people a choice," said Joseph Antos, a health policy
expert at the conservative American Enterprise Institute. "We should do as
much as we can not to leave people out." |
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Democrats in both houses of the
Republican-led Congress have introduced legislation to require automatic enrolment
of more low-income Medicare beneficiaries, but those bills have not advanced. |
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"The point is that for
these low-income individuals, it's just crazy ... for them to miss the
opportunity of $600 a year," said Sen. Blanche Lincoln, D-Ark., an author
of the Senate bill. |
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Rep. Sherrod Brown, D-Ohio, a
sponsor of the House bill, said the administration is following an ideological
path. |
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"It makes so much more
sense just to give it to people, but that doesn't fit the conservative,
free-market ideology, which they insist on even when it's clear it's not
working," Brown said. |
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Those eligible for the aid are
traditionally hard to reach for reasons that include educational and language
barriers. |
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McClellan has not ruled out
broader automatic signups, but for now the administration is spending nearly $5
million to work with a coalition of civic organizations to get the poor to enrol
on their own. |
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He said he expects the pace of enrolment
to quicken in coming weeks as more people become familiar with the discounts,
and technical problems that plagued the start of the program recede. |
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Hundreds of thousands of
applications await approval, Medicare spokesman Peter Ashkenaz said. Medicare
is approving 8,000 to 12,000 applications a day, he said. |
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Some critics say the large
number of cards available is contributing to confusion and holding down enrolment.
"You've got so many choices that no one can make a reasoned choice,"
said Sen. Kent Conrad, D-N.D., who voted for the law. Conrad has proposed a
limit of three cards for each region of the country. |
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Financial analysts who
specialize in health care investments agree the number of cards is daunting
even though there is little difference among them. |
"I told my mother-in-law
to just pick a major card and take it to the drug store. She'll save 20 percent
on brand-name drugs and 40 percent on generics," Norm Fidel, an analyst
with Alliance Capital, told a health care conference recently.
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